It’s annoying isn’t it, how you find yourself hopping out of the chair because of an ‘electric zap’ like feeling to your teeth every time you take cold, hot, sweet or sour stuff? More likely than not, you are a victim of the dreaded sensitive teeth condition that affects one in every four adult between the ages of 20 and 50 years. Sensitive teeth (a.k.a. dentinal hypersensitivity) can occur from a myriad of reasons but fret not, because with the appropriate diagnosis and intervention, sensitive teeth can be minimized or even completely eliminated.
WHAT CAUSES SENSITIVE TEETH?
The most likely cause of sensitive teeth is exposed dentine (the middle layer of the tooth) due to overzealous tooth brushing or tooth decay. Other common causes include cracked teeth, leaky old fillings or restorations (e.g. crowns or veneers) that have deficient margins.
The dentine of our teeth becomes exposed when the outermost protective layer, enamel surrounding the crown or cementum that covers root, is lost. This condition is linked to the common misconception of “the harder I brush, the shinier my pearly whites will become”. The main purpose of brushing your teeth is to get rid of plaque or lingering food debris around the gum line or stuck between your teeth and the way to do it is to do it right, and not with all your might! Plaque is relatively soft and can be easily removed by gentle, circular action and flicking movements with the toothbrush (Check out the correct way to brush here). Brushing with excessive gusto can result in toothbrush abrasion cavities at the necks of your teeth, near the gum line. The enamel or cementum covering that area is very thin and little ledges starts to form once it is worn away. This condition can be further exacerbated if you are using whitening toothpastes that often contain a much higher content of abrasive particles.
The dentine layer is porous and contains thousands of small fluid filled channels. These fluid filled channels react to external stimuli (e.g. hot, cold, sweet or sour food and beverages) and warns its owner by stimulating nearby nerve endings. This whole response manifests as the ‘electric zap’ like sensation that sends us flying out of our chairs.
Other common causes of dentinal exposure includes tooth decay which ‘eats’ away the outer protective layer of the tooth and teeth grinding habits that gradually wear away the teeth structure of an entire dentition. Leaky or deficient margins of existing restorations permit minute amounts of fluid to flow underneath the restoration and affect the fluid balance in the dentinal channels. A cracked tooth, often associated with large fillings or a recent episode of trauma, can also show up as a sensitive tooth.
Certain dental procedures such as teeth whitening may cause temporary sensitive teeth. This is caused by dentinal exposure to the bleaching agent and resolves spontaneously within one to two weeks once the procedure is discontinued.
WHAT CAN BE DONE?
Sensitive teeth can be managed and treated successfully if you give your dentist the opportunity to investigate and diagnose its cause. Conditions such as cracked teeth are not always evident nor visible on an x-ray during the initial stages
Sensitive teeth due to overzealous tooth brushing can be managed initially with the application of concentrated fluoride varnish to exposed areas of dentine, reducing its intensity. If ledges have already started to form at the necks of teeth, fillings are used to restore missing tooth structure and prevent the ledge from deepening further. Your dentist will advise you on simple modifications that you can adopt in your tooth brushing routine, helping you to brush effectively without hurting your teeth and gums at the same time. He may also prescribe toothpastes that are specifically formulated to desensitize exposed dentine so that you combat sensitive teeth from the comfort of your own home.
Treatment of dental decay and replacement of leaky fillings as well as deficient restorations often provide immediate relieve as long as the affected tooth/teeth has been correctly identified. Cracked teeth are a little trickier to manage as the prognosis is affected by the depth of the crack line. Teeth that have shallow cracks are usually crowned after root canal treatment has been performed. Teeth that have cracks that run deep are often extracted and replaced.
Root canal treatment is instituted when a particular tooth does not respond to conventional desensitization treatment. While it is very effective at getting rid of the sensitivity, it is also an irreversible procedure that weakens the tooth in the longer term. Such decisions are best made after thoughtful deliberation and in consultation with a trusted dental professional.
The most suitable treatment for sensitive teeth hinges on the identification of its cause. Your ability to work with your dentist will ensure that you receive a timely resolution to your discomfort and better long term oral health.