Tooth Sensitivity: Everything You Need to Know
Tooth sensitivity is a frequent consultation problem in dental practice. Patients go to a professional because they feel pain in the mouth when eating something cold, for example, or because they perceive discomfort when brushing.
In itself, we’re talking about a painful response in the dentin. It’s considered sensitivity when it manifests itself against stimuli that should be normal and not generate symptoms under normal conditions.
Although it may seem paradoxical, some dental treatments favor dental sensitivity. After an intervention for another reason, people can start with the symptom after days, weeks, or months. Then, it’s also classified within the complications of therapeutic approaches in the oral cavity.
According to epidemiological data, the prevalence of dental sensitivity varies according to the region considered. In the United Kingdom, the presence of the issue has been established in only 2.8% of the population, while in India, it amounts to 20.6%.
Stimuli that lead to dental sensitivity
There are three types of stimuli that can cause dental sensitivity symptoms:
- Mechanical
- Chemical
- Thermal stimuli
1. Mechanics
Among the mechanical stimuli that cause dental sensitivity, there are some that are instrumental and others that are physical. The first are called that way because they have to do with the use of some utensil or tool.
For example, it may happen that dental instrumentation in the office causes tooth sensitivity. In the same way, intense brushing at home or with poor technique could cause excessive wear of the tooth or gum retraction, favoring the symptom.
At the same time, the rubbing of the teeth against each other leads to wear that’s stimulating pain. People with bruxism suffer a loss of their enamel that exposes the dentin. Night grinding is one of the main causes of the decrease in dental tissue.
2. Chemicals
Among the chemical stimuli, we must emphasize certain food groups that wear down the enamel. The repeated chemical action of sweets and acids can be enough to lead to tooth sensitivity.
For example, among adolescents, it’s common for enamel erosion to appear due to the high consumption of acidic ultra-processed foods. Soft drinks and snacks with artificial lemon flavor have been presented as a risk food for this age group.
3. Thermal
In this point, we include hot and cold stimuli. The first are usually the most frequent. It’s common for people with the problem to notice that ingesting an ice-cold drink causes them pain.
It’s also possible that the external cold from the environment acts as a stimulant. Although it’s less frequent, it happens when we’re exposed to low temperatures in the context of worn enamel or receding gums.
Tooth sensitivity due to enamel wear
Tooth sensitivity may respond to worn tooth enamel or receding gums. Faced with the first case, there’s no single mechanism that explains it. Actually, there are four possible explanations.
Erosion
In the erosion of the tooth, there’s a progressive loss of its superficial layer, the enamel, due to the action of acids of non-bacterial origin. This loss is progressive and, at some point, we reach the point of pain due to dentin exposure.
Some professions and jobs have high contact with factors or substances that favor erosion. For example, wine tasters with the components of the drink itself. Also, swimmers who use pools with high concentrations of chlorine. In these individuals, the risk of dental sensitivity is increased.
Acidic and carbonated drinks produce chemical erosion. Of course, for the effect to be noticeable, prolonged consumption and large quantities are necessary.
Some medications also have the ability to reduce enamel. According to a 2014 publication, they’re those that have the power to lower the pH in the oral environment. Here we must include the following:
- Vitamin C supplements
- Aspirin
- Mouthwashes with EDTA
Teeth whitening deserves special mention. According to statistics, between 67% and 100% of patients who perform this technique suffer dental sensitivity as an unwanted consequence.
At present, alternatives are sought that seek to reduce this unwanted effect or, at least, prevent severe sensitivity. Therefore, it’s tested with different substances and times of use of the product. The possibility of adding desensitizing agents to bleaching formulas is also evaluated.
Finally, patients with gastroesophageal reflux are another risk group. The return of hydrochloric acid from the stomach to the mouth is a chemical stimulus that attacks dental enamel.
Attrition
Attrition is another mechanism capable of reducing the enamel layer and leading to tooth sensitivity. It refers to rubbing between teeth, so bruxism is the essential cause.
Although there’s a physiological attrition, for chewing, bruxism must be inserted in the pathological category. That is, there’s abnormal functionality that won’t only cause sensitivity, but also generate pain in the temporomandibular joint and sleep problems.
According to the analysis of the type of wear, a dentist will be able to determine if it’s a situation that deserves an intensive approach or not. When it evolves too much, the damage can be permanent in the oral cavity.
Abrasion
The third mechanism of enamel wear is abrasion. It means that the hard tissue of the tooth is progressively lost due to friction caused by contact with an external agent.
These could be a toothbrush, a prosthesis, a wind musical instrument, or even a pipe. Some harmful habits such as biting your nails or pen caps or opening bottles with your teeth can cause localized wear of tooth enamel.
Abfraction
In abfraction, wear occurs in the neck of the teeth, in the area where the enamel joins the cement. This lesion usually affects several teeth at the same time.
The causes are usually associated with occlusal trauma that generates a lateral overload in the cervical area that causes tissue loss. It’s associated with bruxism, malocclusions, and chewing habits such as always biting on one side due to pain or missing teeth.
Tooth sensitivity due to receding gums
Periodontal disease can cause receding gums that expose tooth tissue that shouldn’t be in contact with the surface. In this way, the risk of tooth sensitivity is increased.
Among people with chronic periodontal disease, 37.2% have hypersensitivity. It’s assumed that the problem is greater among those who have obvious loss of gum tissue.
The dental roots are exposed and the acid or the temperature of the food triggers the pain. In the same way, when brushing, there may be contact between the instrument and the root, also causing discomfort.
Therefore, the presence of periodontal disease is postulated as a risk factor for tooth sensitivity. Even if there’s still no gum retraction or the disease is incipient.
Possible treatments for tooth sensitivity
If there’s a clear cause of dental sensitivity, then the treatment of the same will be directed at the origin. For example, if the pulp of the tooth has been exposed by wear due to bruxism, the underlying disorder will need to be addressed. In the case of periodontal disease, implementing the protocols validated for that disease will be required.
With dental whitening, there are different approaches. If you decide to do it, then you have to take some precautions that tend to reduce discomfort and the possible side effect. Among them, the most accepted at present are the following:
- Add substances to the treatment: Potassium nitrate, fluoride, Gluma, amorphous calcium phosphate, or hydroxyapatite.
- Take anti-inflammatories: Such as ibuprofen.
- Use LED laser equipment.
For more general cases of pain, a dentist may indicate a desensitizing paste. The same is used with regular brushing. Although they can be purchased over the counter in most pharmacies, it’s better for a dentist to recommend the appropriate one for each case.
Likewise, fluoride can also be applied to affected teeth to try to reduce dental sensitivity. There are methods that are restricted to the dentist’s office, but there are also trays with this mineral that can be applied at home, although a professional’s prescription is needed first.
Finally, the existence of a root exposed to the outside that’s generating pain will require prompt treatment. A professional will define if a gum graft is needed or the placement of a resin that covers the sensitive areas.
In any case, the precise diagnosis is what will improve the chances of controlling the symptom. For that, review by a professional is unavoidable.
- Achachao Almerco, K., & Tay Chu Jon, L. Y. (2019). Terapias para disminuir la sensibilidad por blanqueamiento dental. Revista Estomatológica Herediana, 29(4), 297-305.
- Candina, H. J. R., & Batista, A. H. (2019). Abrasión dental. Presentación de un caso. Investigaciones Medicoquirúrgicas, 11(3), 1-9.
- González Emsoto, E. M., Midobuche Pozos, E. O., & Castellanos, J. L. (2015). Bruxismo y desgaste dental. Revista ADM, 72(2).
- Haneet, R. K., & Vandana, L. K. (2016). Prevalence of dentinal hypersensitivity and study of associated factors: a cross-sectional study based on the general dental population of Davangere, Karnataka, India. International Dental Journal, 66(1), 49-57.
- Hellwig, E., & Lussi, A. (2014). Oral hygiene products, medications and drugs-hidden aetiological factors for dental erosion. Erosive Tooth Wear, 25, 155-162.
- Kanzow, P., Wegehaupt, F. J., Attin, T., & Wiegand, A. (2016). Etiology and pathogenesis of dental erosion. Quintessence international, 47(4).
- Mafla, A. C., Cerón-Bastidas, X. A., Munoz-Ceballos, M. E., Vallejo-Bravo, D. C., & Fajardo-Santacruz, M. C. (2017). Prevalence and extrinsic risk factors for dental erosion in adolescents. Journal of Clinical Pediatric Dentistry, 41(2), 102-111.
- Morales, S. P. J., Villacís, P. J. S., & Aguilar, V. G. (2022). Caracterización del tipo de sensibilidad dental de pacientes con periodontitis y su respuesta a los dentífricos. Boletín de Malariología y Salud Ambiental, 62(1), 72-82.
- Paryag, A., & Rafeek, R. (2014). Dental erosion and medical conditions an overview of aetiology, diagnosis and management. The West Indian Medical Journal, 63(5), 499.
- Rees, J. S., & Addy, M. (2004). A cross‐sectional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies. International journal of dental hygiene, 2(2), 64-69.
- Rezende, M., Coppla, F. M., Chemin, K., Chibinski, A. C., Loguercio, A. D., & Reis, A. (2019). Tooth sensitivity after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel: a systematic review and meta-analysis. Operative dentistry, 44(2), E58-E74.
- Sood, S., Nagpal, M., Gupta, S., & Jain, A. (2016). Evaluation of dentine hypersensitivity in adult population with chronic periodontitis visiting dental hospital in Chandigarh. Indian Journal of Dental Research, 27(3), 249.
