Tooth sensitivity

TOOTH SENSITIVITY 

Have your ever felt a cold breeze in your tooth ? Have you ever come across the word "tooth sensitivity". Do you know what actually it is? Do you ever wonder how a bone like hard substance can ever be sensitive.? Can you tell me what causes the tooth to be sensitive.? 

Let's move ahead and talk about it. 

What is tooth sensitivity? 

It is a painful sensation of tooth in response to the stimuli such as cold, hot, sweet or acidic food or drinks. 

In general words, whenever you feel discomfort in your tooth when you eat something too hot, too cold, too acidic or a sweet food. 

      So, if you ever feel a electric current like sensation in your tooth or teeth that means you have sensitive teeth. 

 It may be temporary or a permanent, acute (short term) or chronic (long term) , affect one single tooth or multiple tooth in an individual,  and may range from mild to severe in intensity. 

What are the causes of tooth sensitivity? 

A sensitive tooth may have many causes and as per the cause the treatment varies.

• Thin enamel
• Gingival recession
• Exposed dentin
• Broken /chipped tooth
• Dislodged dental restoration
• Dental cavities
• wear off with time
• Cracked tooth or fracture lines
• Post dental procedures - restorations, bleaching, oral prophylaxis (scaling/cleaning) 
• Habits like tobacco (betel nut or gutchka) chewing or clenching at night

These are the  main outlines as the causes. 

Some people naturally have thin enamel covering over tooth. This is sometimes shared genetically within hereditary. If your parents tend to have sensitive teeth due to thin enamel, there are chances that you have sensitive tooth too. Sometimes, developmental defects results in abnormalities. Some common examples of genetically inherited abnormalities may be like enamel hypoplasia Or dentinogenesis imperfecta. 

In older people, the major cause of sensitivity is due to receeding gums. Gingival recession/ Receeding gums is the apical movement of your gingiva/gums exposing the root surface. The root surface is devoid of enamel and is more sensitive than the crown portion of tooth. 

Attrition, abrasion, abfraction and erosion are the other common causes of sensitivity. These conditions arises due to various mechanical, pathological or chemical responses. Attrition occurs in those who have habit of teeth grinding specially at night or it may even occur in people who have irregular arrangement of teeth. Abrasion or abfraction are usually seen due to improper or hard strokes while brushing tooth. Erosion occurs with excessive consumption of acidic drinks or also seen in the patients of gastro-esophageal reflux disease.

These conditions wear off the enamel layer and exposes the dentin to the outer environment which makes them sensitive. Similarly, broken/ chipped tooth,fractured cusps cause sensitivity. 

Dental cavities or caries are the sometimes the cause and they need to be treated with proper excavation followed by dental restoration. Enamel caries is asymptomatic and when it progresses towards the dentin or affects dentin it results in the sensation of tingling like, when exposed to cold fluids or food.

Other common reason is the presence of crack in a tooth. Sometimes, when you bite on a hard food or object, somehow the tooth develops cracked line within the enamel, dentin of tooth. This again exposes the dentin and results in sensitivity. Dental fractures are usually difficult to determine because they cannot be seen through naked eye and even on x-rays.

sensitivity can also be due to temporary factors.

Sensitivity induced due to post dental treatment are usually temporary. they occur for the short period, for  the course of dental treatment or lasting for few weeks. Procedures like cavity preparation ( removal of decayed tooth), tooth preparation on vital tooth for fabrication of bridges, cementation of crowns or FPD (fixed partial denture), dislodged restorations, cavity preparation done and left without any proper dental restoration done or composite restorations (rarely), bleaching are some of the examples of post dental treatment induced sensitivity.

   whatever the cause is it is always important to treat.

What is the painful response elicited?

Dentin comprises of many microscopic tubular structures known as dentinal tubules which are filled with dentinal fluid. These tubular structures originate outwards from the pulp tissue located in center of teeth. there are certain receptors present at the end of tubules located close to pulp. when any stimulus such as hot, cold food elicits trauma to the exposed dentinal tubules, the fluid within tubules move. This movement of fluid results in conduction of painful response.

What is the treatment ?

 Treatment is decided based on the condition and the extent of the pathology

Treatment depends on various causes; if you experience pain/sensitivity without any diagnostic causes, the chances are you have naturally thin enamel or an wear off due to aging process.. These can be managed by using of various desensitizing agents, like dental toothpastes , desensitizing mouthwash.if these doesn't help you, you must visit your dentist. 

Cracked tooth can be the other cause which has no clinically diagnosis but a dentist might or might not diagnose in X-ray. cracks are difficult to be diagnosed.if a crack is suspected, tooth is advised for a crown as a protective measure.

Dental cavities/caries are removed and filled with dental cements (restoration). Similarly abrasion, abfraction, are restored by filling or sometimes advised for root canal treatment depending on extend. attrition is advised for crown with or without rct.

For the prevention you must always avoid acidic foods and adopt proper and gentle brushing technique.

Your dentist will help you know the proper brushing technique.

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BY - DR. DIVYANI CHAWLA  (Dental and oral surgeon)