Got Sensitive Teeth?

Teeth should not be sensitive, ever.  So, what do you do when you have one that is?  Do you ignore it?  Hope it'll go away?  Wait for it to get worse?  Ignore it some more?  Does it go away on its own?  Sometimes it is transient.  However, most of the time it does not go away on its own.  Your dental professional is the best person to diagnose the cause and help you to feel better.  A sensitive tooth is a sign something is wrong- the nerve of the tooth is reacting to something.

When I hear my patient has a sensitive tooth, I put my detective hat on and investigate.  Most of these causes are due to pathologic conditions such as:

•            Sinus infection                                               

•             Tooth decay

•             Gum disease

•             Abscessed tooth

•             Broken teeth

•             Worn out fillings

•             Clenching or grinding teeth

•             Cracked tooth syndrome

•             Sprained tooth syndrome (really!)

•             Recent dental work

•             Bite

•             Dry mouth

•             Sleep apnea

•             Acid Reflux/GERD

•             Eating disorders

•             Diet

•             Tooth brush abrasion

•             Erosion (acidic food or drinks dissolve teeth)

•             Recession (exposed roots)

•             Abfraction (notching into the tooth or root)

•             Bleaching teeth

•             Whitening teeth

We need to look at the tooth, take a radiograph (x-ray) and even take a photo of the tooth.  Often we'll check your bite, and get the tooth "history".  Now, with all the information we can start diagnosing the problem.

Most of these causes are self-explanatory.  I just want to stress a few items-

Dry mouth- having dry mouth can put tooth decay into hyper-drive, especially along the gumline where the enamel is thinnest.  See my article Elixir Fixer for Your Dry Mouth for lots of good product recommendations.

Acid erosion from bulimia--
 the yellowish part is exposed dentin

Sleep apnea, GERD, acid reflux and eating disorders all can involve stomach acid. Stomach acid is very acidic- anywhere from a pH of 1.5 to 4 or 5 -and this can dissolve the tooth structure or what we call acid erosion, from the inside up.

Diet - Often, it's what we put in our mouth that causes sensitive teeth.  Coffee, diet soda pop, fruits, or sour acid candy as well as many other of our favorite foods cause the tooth to dissolve.  I'll spare you the photos of what acid can do to your teeth.  If you are truly curious, just Google it.  Now, I love wine and many things acidic.  I'm not saying to avoid it completely but everything in moderation.  If you have something acidic, rinse your mouth out with water or even better, baking soda and water.  Neutralize it, do not run right in and brush your teeth.  The enamel is softer after an acid attack and you can actually do damage to the tooth structure.  Give it at least 30 to 60 minutes for the enamel to harden and get the pH of your mouth back up to 7.

Recession and abfraction

Toothbrush abrasion and tooth recession go hand in hand. Often, this results in cold sensitivity, as well as sensitivity to touch, especially to my metal instruments.  I notice that folks who are overzealous scrubbers often have this type of sensitive teeth.  If your toothbrush looks like you sat on it, it's time to throw it away.  I recommend getting a new one with the season changes.  Every three months is a good rule of thumb.  If you have sensitive roots, use an extra sensitive brush head.  You may have to ask the pharmacist to order you some but it's worth it.  Plaque is soft.  Stop scrubbing your teeth like you're removing the stain on the shower floor!  And, find out how abrasive your tooth paste is- What's its RDA number?   (Relative Dentin Abrasivity)  Be gentle and use a gentle toothpaste.

Abfraction is slightly different from recession- same sensitive results though.  When you see notching along the gum line, that's abfraction. The theory is that's related to clenching and grinding.

Doing research on tooth bleaching last week is what brought me to reading more about tooth sensitivity.  Whitening products may be more abrasive- that's how they "whiten" your teeth- by removing the plaque or stain that is making your teeth appear yellow.  Clean teeth look whiter.  So check your toothpaste’s RDA number.  Anything over 100 is too abrasive.     Stay under 100 and you should be okay.  If you can tolerate the taste, plain old wet baking soda is still my favorite paste to use – it cleans, disinfects and is the gentlest.  

Tooth bleaching products can make teeth sensitive as well.  This is the most negative side effect of tooth bleaching.  It causes your teeth to ache, breathing to be painful (happened to me- I was bleaching during winter and then went outside for a walk- ouch!), and zingers to send electric shocks down into the tooth.

Open tooth tubules at X2,000 magnification
From this 2009 Compendium article

Recession, bleaching, acid erosion, abfraction and abrasion all cause sensitive teeth because the tooth surface along the gumline is uncovered.  Your tooth is like a box of straws with the lid on.  Whether it's over scrubbing, or acid or bleaching, the top of the box is removed and the straws (tooth tubules) are now exposed.  Cold, metal, liquid, it all hurts.  To stop the hurt we need to re-plug these tooth tubules.  Here are some suggestions for products to re-plug and stop the sensitivity:

Over the counter desensitizing tooth pastes- they all contain potassium nitrate- this numbs the nerve ending in the tooth tubules (the straw).  It does not re-plug the tubules, just numbs 'em.   It can take a week or two to start working.  The problem is when you stop the paste, the pain returns.  Why do the instructions say only use for a month?  In case the real cause is tooth decay, the companies want you to see your dentist and find out what’s going on.

Recaldent's website

MI Paste, or as it is called in Europe, Tooth Mousse can plug those tooth tubules.  It's nonprescription and is available on Amazon.  Smear it along the gumline and leave it there! Use as often as you need to reduce sensitivity.  It does contain milk casein so if you have an allergy to milk products do not use.

Fluoride prescription strength- either in a tube or applied in the dental office- plugs up the tubules.  I use fluoride varnish in my office.  I think that's the best of the fluoride applications.  It's easy, fast, and lasts the longest.                    

There are numerous "in-office" products that can be applied to the teeth to re-plug the tubules.  Each office has products that work best for them.  In my office we use ozone- water, gas and oil.  Check out my article The Other Ozone Layer  to learn more about ozone therapies!  I'm thrilled with the results we get using ozone to stop root sensitivity long term.  In addition to ozone, we apply caphasol.  Caphasol contains calcium and phosphate, which is used to re-plug those tooth tubules.  

So, the long and the short - you have to know the source of the sensitivity before you can address and resolve it.  Since there are lots of causes, sometimes it truly takes a detective's perseverance to super sleuth the root cause of the discomfort.  Who knew there was so much to say about sensitivity! 

Stay tuned for my bleaching post next week.  I have more information on sensitivity associated with bleaching and will address that in more depth next time.

Happy Day!

Keep Smiling,

Barbara