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A sensitive topic
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Don’t ignore those needling tooth pangs. The solution may be as simple as the cause
By Dr. Peter Hong, D.D.S.
With great trepidation and anticipation you eye that scrumptious, creamy, three scoop, cherry banana split overflowing with chocolate and butterscotch sauce. With hungry fervor you bite into that first large spoonful, and suddenly, you feel an electric jolt of pain that hits you behind the eyeballs and courses through to the tips of your toes.
That, my friend, is tooth sensitivity!
Most of us will at some point in our adult lives experience tooth sensitivity.
Sometimes it can linger and become a debilitating nuisance, and other times it will last a short period of time and just go away. Let’s have a look at some of the causes of tooth sensitivity and some remedies to this common problem.
Approximately one in four adults, and a much smaller number of children, complain of tooth sensitivity. Some of the common triggers for this are hot and cold food, (cold more often than hot), sweet or sour foods, and brushing, flossing and professional teeth cleanings (scaling and polishing.)
The nature of tooth sensitivity is that it is rapid in onset; the pain is sharp and intense and lasts only a short time. This is opposed to a toothache where the pain is usually moderate to severe, long-lasting and persistent.
Before we investigate causes and remedies, a quick lesson in tooth anatomy is necessary. Our teeth are living, vital organs consisting mainly of three layers of hard tissue, and a vital pulp in the core. The outermost layer, enamel, is a crystalline material that is essentially solid with no nerves or vital tissue. The inner layer of dentin is made up of fluid and cells in the tubules with live nerve endings. The root surface has a relatively soft outer layer of cementum that covers the inner dentin layer.
Some common causes of tooth sensitivity are tooth decay, broken or leaky fillings, erosion or hairline fractures in the teeth, and chipped teeth. Habits such as clenching and grinding can make teeth hypersensitive as well as cause mechanical erosion of teeth.
Root sensitivity occurs when the gums recede and the root surface is exposed. This can be due to gum disease, natural physiological recession with age, or mechanical erosion due to improper or vigorous tooth brushing. Other common causes of tooth sensitivity are tooth bleaching or whitening, professional cleanings, and gum surgery.
The first step in treating tooth sensitivity is a visit to the dentist to determine the actual cause. Sometimes a definitive diagnosis is difficult to make (as in the case of hairline cracks) and symptomatic treatment is all that can be offered.
Once a diagnosis is established, then a proper treatment course can be started to eliminate the cause. (For example, curbing a grinding habit, filling a cavity or replacing a broken filling.)
For cases of general or root sensitivity, dentists can apply fluoride varnishes, bonding or sealing agents, or chemicals such as oxalates to the sensitive areas.
At home, using toothpastes that are formulated for sensitive teeth is highly effective. These can be applied directly to a sensitive area or used in place of regular toothpaste when brushing.
Sensitivity toothpastes generally consist of one of two chemicals:
1) Strontium chloride — This crystallizes at the openings of exposed dentin tubules and blocks up these holes. Its effectiveness increases with continued use over time and as more and more of the holes become plugged up, the sensitivity diminishes.
2) Potassium nitrate — The free potassium ions enter the open tubules and block nerve transmission, therefore desensitizing the area.
Proper oral hygiene is paramount in the fight against tooth sensitivity. Proper brushing technique will prevent erosion of the gums and root exposure. Coupled with flossing, the removal of plaque will help prevent the onset of gum disease.
If your brushing technique is causing mechanical damage to the gums, an electric toothbrush is an effective plaque remover that also minimizes erosion. Currently, electric toothbrushes come in two basic forms: those that clean mechanically by scrubbing the plaque off teeth, and ultrasonic brushes that remove plaque by vibrating plaque off in addition to scrubbing. Both types work very well.
Although tooth sensitivity is a very common problem, a little knowledge and prevention can go a long way in allowing us to enjoy all those hot and cold treats that we so love and crave.
Dr. Peter Hong is on staff at Sunnybrook and Women’s College Health Sciences Centre and part-time instructor at the University of Toronto. He also maintains a private practice.
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