Tooth hypersensitivity remains a persistent challenge in dental practice, often prompting patient concerns during routine examinations. The similarity of its symptoms to those of various dental conditions tooth decay and periodontal issues can confuse even experienced practitioners. Accurate identification is crucial for developing tailored treatment plans, emphasizing the necessity for a comprehensive understanding of this prevalent dental issue.
The anatomy of a tooth comprises two primary sections: the crown, which is visible in the oral cavity. and the root, which is anchored within the jaws. Enamel acts as a protective outer layer for the crown. The cementum is the specialized hard covering for the root. Dentin forms the core of the tooth. It lies beneath the enamel and contains microscopic tubes leading to the pulp. The pulp contains neurovascular structures.
Tooth hypersensitivity can indicate various underlying issues, such as dental caries, cracked teeth, exposed dentin due to gum recession, or pulp inflammation. Ignoring these potential causes could lead to further complications such as tooth infection, abscess or even tooth loss if left untreated.Dr. R. Shirley, MDS, Consultant Endodontist, Tirunelveli, Tamil Nadu, India.
Tooth hypersensitivity occurs when the enamel that protects the dentin wears away. Some of the causes of exposed dentin are as follows:
Gum recession occurs in some individuals with a genetic predisposition to thin gum tissue and in people with periodontal or gingival disease, exposing tooth roots.
Excessive brushing or using a toothbrush with hard bristles can gradually wear down the enamel (abfraction).
Cracked/chipped teeth can directly expose the dentin or become susceptible to bacterial infiltration, leading to pulpal inflammation.
Aged or worn fillings may allow leakage and irritate the dentin.
Habitual grinding/clenching of teeth can lead to enamel wear (attrition).
Dental erosion caused by the consumption of acidic foods or drinks, sugary foods, certain medications, dry mouth, and gastric reflux disease can manifest as tooth hypersensitivity.
Apart from these factors, teeth whitening products frequently contribute to tooth sensitivity. Acid-containing OTC mouthwashes exacerbate tooth sensitivity, particularly on exposed dentin. Recent dental procedures like scaling, periodontal surgery, cavity preparation, dental fillings, and crown preparation in vital teeth can induce temporary teeth sensitivity. This gradually resolves within a few weeks.
Tooth hypersensitivity presents as brief, sharp, intense bursts of pain and discomfort originating from the teeth in response to specific stimuli. It can be triggered by a gentle touch, hot, cold, sweet, sour, or sticky foods and drinks, cold air inhalation and brushing or flossing. It can adversely impact a person's quality of life, particularly concerning dietary choices and maintaining optimal dental hygiene.
Dentists typically perform several diagnostic tests and examinations to identify the underlying cause of tooth hypersensitivity.
We ask about your dental history, including any recent changes in oral hygiene or dietary habits. Then, clinical examination where we visually inspect your teeth and gums to look for signs of decay, gum recession, enamel erosion, or cracks in the teeth. We use dental explorer to check response to tactile stimulus or air blast to check response to cold stimulus to the teeth to determine which ones are sensitive and to what degree. We measure the depth of the pockets around the teeth to assess the health of the gums and detect any signs of gum disease using a periodontal probe. By combining these examinations, we can pinpoint the underlying cause of tooth hypersensitivity and develop an appropriate treatment plan to address the issue effectively.Dr. R. Shirley, MDS, Consultant Endodontist, Tirunelveli, Tamil Nadu, India
In cases of mild-to-moderate sensitivity, home desensitizing therapy is advised. If relief is not achieved or in instances of severe sensitivity, in-office treatment by the dentist is initiated.
Desensitizing toothpastes with repeated use can potentially alleviate discomfort related to sensitive teeth. Various over-the-counter options are available, and consulting a dentist for personalized recommendations is advisable.
Fluoride solutions, gels, and varnishes provide both immediate and lasting relief from tooth hypersensitivity. They are also used in combination with dentin fluid obstruction agents and laser technology. Dentists may administer fluoride to sensitive areas of the teeth and also recommend prescription fluoride for home use.
Dentin bonding agent (resin) are occasionally applied on exposed sensitive root surfaces by the dentists.
Root coverage surgery is done with a surgical gum graft procedure taking a small amount of gum tissue from another area of your mouth and attaching it to the affected site to shield exposed roots and reduce sensitivity.
Root canal therapy is recommended for severe sensitivity that persists despite other treatments. This involves addressing issues within the tooth's pulp and is considered an effective method for eliminating tooth sensitivity.
Good oral hygiene should be maintained by brushing with a soft-bristled toothbrush and fluoride toothpaste, and flossing daily. Vigorous brushing and the use of abrasive toothpaste should be avoided. If teeth grinding occurs, the use of a mouthguard is recommended. Consumption of acidic foods and drinks should be limited, and a straw should be used when consuming acidic drinks. Mouth rinsing with water after consuming acidic substances is advised. Dental issues such as cracked tooth, tooth decay, and gum disease should be promptly addressed by visiting a dentist to prevent tooth hypersensitivity. The use of a fluoride mouthwash or professional fluoride treatments from a dentist to strengthen enamel is also recommended.
In conclusion, tooth hypersensitivity can significantly impact daily life, but with proper oral hygiene care, it can be effectively managed. Personalized treatment and guidance tailored to individual needs is crucial. With these proactive measures, conquering tooth hypersensitivity is within reach!
References
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https://www.hopkinsmedicine.org/health/conditions-and-diseases/sensitive-teeth
https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sensitive-teeth/faq-20057854
(By Dr. Nirainila Joseph)