Every day in our dental office, we see patients that complain of tooth sensitivity. This “discomfort” (our word for “pain”) is most often brought on by cold, hot, sweet or sour foods and drinks, or even by simply breathing in through our mouth. The American Dental Association reports that at least 40 million adults in the United States suffer at some time from sensitive teeth. Tooth sensitivity is also most common in people between the ages of 25 and 30 years of age.
So why do teeth become sensitive? Before I talk about causes and solutions for this common problem, allow me to tell you a little about the anatomy of our teeth. The tooth basically contains three layers. The outer protective layer of the teeth is the enamel– which is the hardest substance in the body. But underneath this outer layer is the middle layer called dentin, which is a softer and more porous part of the tooth. In fact, the dentin has channels containing fluid, called tubules, which provide a pathway to the innermost layer – the nerve chamber. So if the dentinal tubules becomes exposed, sometimes as a result of receding gums, the extreme temperature or sugar in food and drinks that we love causes movement of the dentinal fluid and reaches and irritates the nerve inside your tooth, which results in the pain (oops- “discomfort”) – that you feel.
So what causes this to happen? Well- there are a number of possible causes. I’ll talk about a few of these-
First- Brushing too hard. While we think we are doing our teeth some good with a hard scrubbing, brushing too hard or using a hard-bristled toothbrush can erode enamel and expose the dentin! This may also cause the gum to pull away from the teeth. If the bristles of your brush are frayed or pointing every which way you may be brushing too hard! We also need to know what toothpaste we are using. Some toothpastes contain abrasive ingredients that may not be good for people who have sensitive teeth. Ingredients found in some whitening toothpastes and sodium pyrophosphate, the main ingredient in tartar-control toothpaste, may also increase tooth sensitivity.Academy of General Dentistry (AGD) spokesperson William Kuttler, DDS. has stated that after using tartar-control toothpaste, about 10 to 20 percent of patients complain of tooth sensitivity, so sometimes we suggest they stop using it.
Other causes are tooth decay near the gum line, plaque build-up, gum disease, and cracked teeth. Many of our patients report munching on ice cubes, regularly chewing hard candies, or have large fillings which can all lead to chipping or cracking of teeth. When the cracks fill with bacteria in the mouth, discomfort often occurs.
We are finding that another very prevalent cause of tooth sensitivity is teeth grinding. Grinding or clenching your teeth wears down the enamel and exposes the underlying dentin. As hard as the enamel is, it is no match for the power of clenching or grinding. A very common result of grinding and clenching are tooth abfractions, which is a chipping away of the enamel at the gumline. We see this every day in our practice and these often-unconscious habits wear away tooth enamel, leaving your teeth’s nerves very close to the tooth surface and very sensitive.
Tooth whitening products. Some patients really overdo it when it comes to trying to lighten their teeth at home. These products may be major contributors to sensitive teeth. Tooth whiteners and toothpastes with peroxide-based bleaching solutions can cause sensitive teeth. The sensitivity is often temporary, going away once you stop using the product. It is highly recommended that you have your teeth whitened professionally or while provided with custon-fit trays and overseen by the dentist or hygienist.
Another “accidental” cause of tooth sensitivity is using too much mouthwash! If you love keeping your breath minty fresh throughout the day, you may be setting yourself up for sensitive teeth. That’s because some mouthwashes contain acids that may make already-sensitive teeth worse. The solution: Ask your dentist about neutral fluoride rinses.
Some of our patients love acidic foods. Regular consumption of foods with a high acid content, such as lemons and other citrus fruits, tomatoes, pickles, and tea, can cause enamel erosion. These foods erode the protective enamel on your teeth, exposing the vulnerable dentin beneath.Bulimia and acid reflux can also result in erosion of the hard enamel and sensitivity due to acid in the mouth.
What Can I Do to Reduce Tooth Sensitivity?
Some steps you can take to prevent tooth sensitivity include:
Maintain good oral hygiene. Continue to follow proper brushing and flossing techniques to thoroughly clean all parts of your teeth and mouth.
Use a soft-bristled toothbrush. Soft bristles will reduce gum irritation and toothbrush abrasion of the tooth surface. Brush gently and carefully around the gum line so you do not remove gum tissue.
Use desensitizing toothpaste. Several brands of toothpaste are available for sensitive teeth. With regular use, you should notice a decrease in sensitivity. You may need to try several brands to find the product that works best for you. Another tip: Spread a thin layer of the toothpaste on the exposed tooth roots with your finger or a Q-tip before you go to bed. Do not use a tartar control toothpaste; rather, use a fluoridated toothpaste.Toothpaste for sensitive teeth usually contains a desensitizing agent that protects the exposed dentin by blocking the tubes in the teeth that we referred to earlier. In most cases, these products must be used on a regular basis for at least a month before any therapeutic benefits may be noticed.A major advance in treatment has been the introduction of sensitivity toothpastes containing strontium chloride. These products, like Sensodyne and others, cause the minerals in your saliva to crystallize and cover the pores in your exposed roots thus protecting them. Sensitivity toothpastes containing potassium nitrate can also help reduce tooth sensitivity.
Watch what you eat. Frequent consumption of highly acidic foods can gradually dissolve tooth enamel and lead to dentin exposure. Acidic foods may also aggravate the sensitivity and start the pain reaction. More neutral foods like milk or cheese may help to neutralize the effects of acidic foods.
Use fluoridated dental products. Daily use of a fluoridated mouth rinse can decrease sensitivity. Ask your dentist about products available for home use.You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride.
Avoid teeth grinding. If you grind or clench your teeth, a custom nightguard can be made for you in our office. Tooth grinding (bruxism) can fracture teeth as well. Many of our patients have experienced the pain-relieving effects that a nightguard can provide.
See your dentist at regular intervals. Get professional tooth cleaning, oral hygiene instructions, and fluoride treatments every 6 months (or sooner, depending on your condition). You don’t have to go it alone; talk to us to discover exactly what’s behind your sensitive teeth. To strengthen pearly whites, you may need to make a few more changes to your oral care routine, like switching to a soft-bristled tooth brush, using a desensitizing toothpaste, or a fluoridated mouth rinse.
Tooth-colored bonded fillings to cover exposed root surfaces. These easy to apply restorations are a great solution in many cases of sensitivity.
Fluoride varnishes applied to the exposed root surface
Dentin sealers applied to the exposed root surface
Desensitizing toothpaste. After several applications, desensitizing toothpaste can help block pain associated with sensitive teeth.
I hope this answers your questions about tooth sensitivity! Please don’t hesitate to call or email if you have any further questions. I look forward to seeing you at your regular recare appointment.
Yours in Health,
Dr. Gary Sherman