Dentin sensitivity is more common than you may think. This condition causes a sharp pain when one consumes certain foods and drinks.
Dentin hypersensitivity is a short, sharp pain arising from exposed dentin (the layer of tooth below the enamel) and is in response to stimuli that are typically thermal (cold or hot), evaporative (drying of teeth), tactile (the dentist running a probe over the affected area), osmotic or chemical (sugars and acidic things). This pain needs to be differentiated from other dental pathology that can cause similar pain.
The pain associated with dentin hypersensitivity is prevalent in the majority of the countries worldwide. The majority of sufferers are unaware that the condition is easily identified and treated. The dentist would normally examine the teeth and assess the degree of pain through qualitative parameters such as slight, medium, and severe pain or through using quantitative parameters such as a visual analogue scale.
Dentin hypersensitivity (DH) is typically found in patients whose dentin has become exposed by recession of the gums around teeth, gum disease and therapy. Some of the causes are:
- Enamel loss and tooth wear resulting from aggressive and abrasion.
- Ingesting acidic foods and drinks.
- Acid regurgitated from the stomach causing tooth erosion.
- Tooth erosion (also referred to as tooth wear) due to attrition in people who grind or clench their teeth excessively.
- Excessive tooth whitening.Research indicates 55-75% of patients may experience tooth sensitivity during professional whitening treatments.
- Receding gums that expose tooth roots.
Despite many theories being propounded for dentin hypersensitivity, the Hydrodynamic theory proposed by Brannstorm is the most widely accepted theory. The theory was proposed based on the movement of fluid inside the dentinal tubules. Dentinal tubules are like microscopic pipes or canal like spaces making up most of the dentin.
When enamel is worn off, exposing the dentin, it is these tubules that are opened and exposed to the environment. Stimulus causes movement of fluid in tubules which stimulates a nerve receptor at the ending of the tubules next to the nerve of the tooth deep within. This leads to neural (nerve) discharge and the sensation of pain.
Once a thorough examination is done and after a diagnosis, it is important for the dentist to explain that there is usually a multifactorial cause for tooth sensitivity.
Treatment usually focuses on prevention and management. It begins with correction of teeth brushing techniques, using soft and super soft brushes, avoiding abrasive toothpastes and brushing and flossing excessively. Oral hygiene and dietary advice are important in preventing further tooth loss. Additional advice is to use desensitising toothpastes, which after several applications, helps block pain associated with sensitive teeth.
If receding gums are the cause of your sensitive teeth, your dentist might apply a sealant to cover the exposed tooth roots, consider resin and glass ionomer-filling materials.
Gum grafting to cover the exposed areas is another option that you can enquire about.
Your dentist should re-evaluate the diagnosis and resort to in-office treatments, if dentin hypersensitivity remains a problem. This course of treatment should begin with the application of topically applied desensitizing agents, such as fluorides that work by blocking the open exposed tubules with deposits of crystals.
Today, the use of lasers show much promise in treating moderate to severe cases. The low-level power lasers or “soft lasers,” act directly on nerve transmission, while high- power provokes a melting effect with crystallization of dentine inorganic component and the coagulation of fluids contained in the dentinal tubules. Among these “high power” devices, diode lasers are the most studied and the ones that provide the best results.
If you are suffering with any of the symptoms outlined in the beginning of this article, please speak to your dentist to ascertain if you have dentin hypersensitivity. This will allow you to better understand what is happening and will lead to the correct course of treatment to correct it.
By Dr Kaizad Kermani