Why do I have sensitive teeth?

The media of late has created a unique awareness on teeth sensitivity or what dental doctors refer to as dentine hypersensitivity. Toothpaste brand advertisements have raised awareness on the symptoms of sensitive teeth, and what needs to be done about that. Hitherto thought of as a minor irritation, sensitivity of the teeth can be of a deeper origin and can lead to many other dental problems if left untreated.

Toothache and inflammation of the gums are among the most common dental complaints in India apart from dental caries. And like dental caries, sensitivity of teeth seems to affect almost people of all age groups and both genders. However, it is said that teeth sensitivity is prone to be misinterpreted most often.

What is sensitivity of teeth?

Sensitivity of teeth or dentine hypersensitivity is a condition in which there is a sudden sharp and shooting pain in a tooth when it is exposed to external stimuli. External stimuli involves thermal, chemical, evaporative, tactile, and osmotic.

This means tooth pain occurs when there is exposure to foods and fluids that are hot or cold, foods that have citrus content (acidic foods), sugary foods, and hot or cold vapors. When a person with teeth sensitivity consumes these foods, there can be mild to sharp pain and discomfort.

Causes of sensitive teeth

In people with healthy teeth, the inner layer of the teeth called “dentin” is not exposed. This is because “enamel” the external layer of the teeth acts as a protective cover that protects inner parts of the teeth from acidic and hot foods and bacteria that flourishes in the mouth. Though enamel is the strongest material of the human body, over a period of time and due to various conditions, it erodes and thus the inner layer dentin is exposed.

When dentin is exposed, small pores on the surface of dentin are also exposed to external influences like foods, beverages, and vapor. Since dentin is extremely sensitive to stimuli, it leads to pain and discomfort.

What causes erosion of enamel?

Overzealous brushing –

Many people are under the impression that brushing vigorously can lead to cleaner and whiter teeth. This in fact is not productive and yields negative results. Brushing too hard and in the wrong way can result in abrasion, erosion of enamel, injury to gums, inflammation of the gums, and receding gums. Overzealous brushing is one of the causes of sensitive teeth.

Bruxism –

Bruxism is grinding and jaw clenching excessively. People who have this condition are usually unaware of it. There are two types of bruxism called nocturnal bruxism (that which happens when a person is asleep), and daytime bruxism (that which happens when a person is awake). Though bruxism can occur due to various factors like psychological reasons, medical reasons, and neurological problems, it often leads to headache, jaw pain, hypersensitive teeth, erosion of enamel, and teeth mobility. This is another cause of sensitive teeth.

Receding gums –

Recession of gums happens when the gum tissue that surrounds the tooth wears off and exposes the inner part of the tooth. In this condition, the tooth appears longer and leads to damage of the tooth, surrounding gum tissue, and even the bone structures. Though gum recession is caused due to factors like poor dental hygiene, smoking or use of chewing tobacco, brushing too hard and crooked teeth, it causes hypersensitivity of the teeth and gums with redness and inflammation of the gums.

Gum disease –

Sometimes, advanced gum diseases like periodontal diseases also cause sensitive teeth. Bacterial infections and poor dental hygiene cause gum disease. In the initial stages, it presents itself as gingivitis in which there is redness and inflammation of the gums. When gingivitis progresses, it turns into periodontitis and causes symptoms like receding gums, sores in the mouth and sensitivity of teeth.

Cracked or fractured tooth –

Fractured or cracked tooth also causes sensitivity of the tooth as the crack or fracture tends to expose the inner layer of the tooth dentin. Trauma or injury to the tooth also cause tooth sensitivity as they expose dentin.

Other causes of sensitive teeth include dental procedures which cause temporary teeth sensitivity, and conditions like acute necrotizing ulcerative gingivitis.

Symptoms of sensitive teeth

• Temporary sensitivity and pain after eating cold or hot foods/fluids
• Sharp pain while biting into foods
• Tooth pain that persists after eating hot or cold foods/fluids ( generally 30 seconds to one minute)
• Discomfort and dull toothache
• Gum redness and inflammation

How are sensitive teeth diagnosed?

An accurate diagnosis is needed in the case of sensitive teeth as against temporary palliative measures as sensitive teeth can be a sign of a hidden dental problem like periodontitis, and acute necrotizing ulcerative periodontitis or acute necrotizing ulcerative gingivitis. Diagnosis of sensitive teeth begins with a thorough dental examination that looks out for cracked teeth, presence of receding gums, dental decay, and other conditions. Once the degree of teeth sensitivity is ascertained along with the causes of sensitive teeth, preventive care and treatment of sensitive teeth are prescribed.

 Sensitive teeth treatment

Sensitive teeth treatment involves desensitizing the nerves that cause pain, treating the underlying condition, and taking preventive measures that exacerbate sensitivity of teeth.

When it comes to desensitizing the nerves of teeth, materials like potassium nitrate, silver nitrate, zinc chloride and other materials are used.

Since toothache is caused by the exposure of tubules in the dentin, sealing and plugging of dentinal tubules is done. This is done by sodium fluoride, potassium oxalate, calcium carbonate, and other materials.

As for sealing the dentine tubules, adhesive sealers are used. These include, dentin bonding agents, oxalic acid and resin, fluoride varnishes, glass ionomer cement, and other sealants.

In some cases, bioglass is used in order to regenerate bone and in other cases Portland cement is used for remineralization.

When it comes to preventive care a patient has to take for sensitive teeth, the following steps are prescribed:

• Usage of nerve desensitizing toothpastes that contain strontium salt and fluorides, potassium citrate, and potassium nitrate.
• Avoiding overzealous brushing
• Use the proper technique of brushing with circular movements
• Brush within 20 minutes of finishing dinner
• Using a soft bristle brush
• Changing toothbrush every three months
• Getting treatment for jaw clenching and teeth grinding
• Avoiding acidic foods
• Usage of mouthwashes containing potassium nitrate and fluoride

Someone who is experiencing severe tooth pain might also be prescribed corticosteroids. However, one can prevent tooth sensitivity by good oral hygiene and periodical dental checkups.