Dentin has microscopic fluid-filled tubules with a direct connection to nerve endings in the pulp of the tooth.
Pain occurs when cold or touch causes fluid movement in the dentinal tubules stimulating the nerve. This short, sharp pain in response to cold or touch is called dentinal hypersensitivity. Gum recession and enamel loss both contribute to this condition.
Treatment options include in-office procedures and/or home self-applied products. The treatment is aimed at either using dental products to sealing the dentinal tubules or to blocking the nerve pain response.
Gum recession and enamel loss
There are many contributing reasons for receding gums and enamel loss, which cause dentin exposure and sensitivity. Dentin is much softer than enamel and wears away 25 to 35 times faster than enamel.
As a result of enamel loss and exposure of the soft dentin, wear and/or decay can occur rapidly, followed by sensitivity. The most common reason for receding gums and enamel loss is gum disease and poor oral hygiene. Contributing reasons include:
• Gum disease.
• Poor oral hygiene with lack of brushing and flossing or improper technique.
• Grinding and/or clenching the teeth, causing enamel chipping at the gum line as well as wear on the top of teeth.
• Teeth crowded out of the jawbone.
• High frenum muscle attachment to the gum from the tongue or lip pulling the gum away from the tooth.
• Over vigorous brushing with a hard brush called toothbrush abrasion. Use a soft brush.
• Gum surgery needed for advanced gum disease.
• Gum injury from an accident or a tongue ring.
• Uncontrolled tooth whitening.
• Erosion from an acidic drinks and foods.
• Erosion from acid reflux disease or bulimia caused by regurgitating stomach acids.
Erosion
Erosion is one of the most common causes of enamel loss. It is a major contributor to sensitivity. Erosion of the enamel causes opening or exposure of the dentinal tubules, which allows food and mouth acid to wash over the dentin and remove any protective coating. Enamel is extremely hard.
It is the second hardest substance in nature next to diamonds, but acid slowly eats enamel away. Frequent consumption of acidic drinks and foods is the main cause of erosion, particular soda pop, fruit drinks and many sport drinks. It is best to avoid acidic drinks, or if used, drink with a meal and then finish with water.
Swish and drink the water to wash away the acid on the teeth. Avoid sipping acidic drinks slowly between meals.
A few years ago, I saw a 17-year-old boy who had erosion and black decay along the gum line of all his teeth, with upper and lower sensitivity to cold foods and/or drinks. His smile looked awful.
I had been seeing him since he was a young child, and he had never had a cavity before this visit. He had dental exam and cleaning only four months before without a cavity. After discussing with him what had changed in his life, I found out that he had been working at a fast food restaurant for last three months, flipping burgers. Since cooking was hot, he had been continually sipping soda while working full time. The super acidic soda had eroded away his enamel, and the high concentration of sugar in the soda had caused the rampant decay.
Luckily, he sought treatment before it got worse. After tooth colored fillings and switching to water as his drink of choice, his sensitivity is gone, he has beautiful teeth again, and he has no present decay as of his last check up.
Treatment options
First, it is important to determine the reason for the hypersensitivity and plan accordingly. Taking care of gum disease, improving oral home care, changing eating and drinking habits, preventing clenching and grinding with a mouth guard, and treating acid reflux are necessary for long term prevention. Sometimes, orthodontics to move teeth into the jawbone or gum grafting to cover exposed root surfaces is required. A comprehensive examination and discussion with your dentist is needed to determine the underlying cause.
Short-term treatment to stop dentinal hypersensitivity involves either coating the exposed dentin, sealing off the dentinal tubules, or blocking the painful nerve impulse. When tooth notching has occurred, an actual ledge formed in the enamel, the best treatment is to have tooth-colored, bonded fillings to insulate, strengthen and protect the tooth surface. If no notching is found, several paint-on, in-office dental products can be used to seal the dentinal tubules, which will give immediate relief and can last up to six months.
Special polishing paste is available for use by dental hygienists that seals and coats dentin while polishing and removing stain. Prescription fluoride toothpaste and rinses are available that will coat the dentin, reducing sensitivity and preventing decay. Over-the-counter desensitizing agents that seal the dentinal tubules are found in toothpastes, gels and mouth rinses. One of the main active ingredients found effective in sealing dentin is stannous fluoride (0.4 percent).
Most over-the-counter desensitizing toothpastes use 5 percent potassium nitrate to interfere with the nerve transmission. Products include Sensodyne, Crest Sensitivity, Colgate Sensitive Maximum Strength, and Biotene Sensitive toothpaste with dry mouth protection.
All of these products contain fluoride to protect against decay, as well as 5 percent potassium nitrate. These toothpastes have showed a significant reduction in hypersensitivity within two weeks when used twice daily. Placing a small amount of these toothpastes directly on the sensitive gum line areas and leaving for a few minutes is particularly effective. Desensitizing toothpastes can also be used in whitening trays to relieve sensitivity between home whitening treatments.
In conclusion, if you have teeth sensitivity, there is hope. Various treatments are available. Ask your dentist.
Enjoy life and keep smiling.
George Malkemus has had a family and cosmetic dental practice in Rohnert Park for more than 27 years at 2 Padre Parkway, Suite 200. Call 585-8595, or e-mail info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at www.malkemusdds.com.
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