Dentine hypersensitivity (Tooth sensitivity) is defined as ‘a short, sharp pain arising from exposed dentine in response to certain factors which cannot be ascribed to any other form of dental defect or pathology. These stimuli are typically thermal, evaporative, tactile, osmotic or chemical.
The dentine is a layer of the tooth structure that lies between the pulp (inside of the tooth containing nerves and blood vessels) and the enamel (the white part of the teeth visible to the eye). It contains a large numbers of pores or tubes that run from the enamel to the pulp.
Tooth sensitivity is due to the exposure of dentine, either through loss of the enamel layer or recession of the gums. When the dentine is exposed, these tubes can be stimulated by changes in temperature or certain foods (usually sweets) causing the characteristic sharp pain. The pain usually subsides after a short period of time.
Impact of dentine hypersensitivity
Recent research reveals that 88% of dental professionals believe dentine hypersensitivity can affect patients’ quality of life, and 79% believe the condition is on the rise. Dentine hypersensitivity causes sufferers to alter their lifestyle so as to avoid the pain.
Lifestyle changes include avoiding cold drinks and sugary foods, avoiding dental visits and eating at one side of the jaw to avoid the pain. This can ultimately lead to more dental complications.
Causes of dentine hypersensitivity
• Tooth abrasion through the usage of very hard bristles (toothbrush).
• Inappropriate tooth brushing techniques i.e. scrubbing motion of brushing instead of circular motion.
• Tooth erosion due to consumption of fizzy drinks and highly acidic foods and beverages and also through regurgitation of stomach contents back into the oral cavity.
• Gingival (gum) recession that leaves the root surface of the tooth exposed.
• Bruxism i.e. grinding of the teeth at night.
• Cavities in the tooth and broken teeth that exposes the dentine.
• Old fillings that are worn out and leaky.
• Iatrogenically after dental procedures such as bleaching.
Diagnosing dentine hypersensitivity
The best way to find out why a tooth is sensitive is to have dental professional examine you.
The dentist can look for the signs of dentine exposure, and run tests to determine what the true cause of the sensitivity is.
The diagnosis of dentine hypersensitivity is quite challenging. It is important to conduct a thorough differential diagnosis of the dental pain to exclude the other possible causes, such as leaking restorations or fractured dentition.
Treatment of dentine hypersensitivity
Treatment can be divided into two. In-office procedures that are done by the dentist or oral hygienist and home procedures undertaken by the individual.
In Office Procedures:
• Restoration of carious lesions and redoing of old and leaky fillings if that is the cause.
• Application of fluoride varnish to exposed areas, strengthening the enamel and dentin.
• Fluoride foam or gel can be placed into a mouth tray; you then sit with this in your mouth for 3-5 minutes, providing the teeth with a high concentration of fluoride to strengthen the areas.
• Application of bonding agent to seal the exposed dentinal tubules.
• Use of desensitizing toothpaste to soothe the nerve endings.
• Use soft bristle tooth brush, with low abrasive tooth paste.
• Avoid scrubbing the tooth when brushing.
• Use a high concentration fluoride toothpaste (given to you by the dental professional) to strengthen the tooth surface.
Prevention of dentine hypersensitivity
Prevention is the most cost-effective treatment option.
• Avoid using hard toothbrushes and brush with appropriate tooth brushing techniques.
• Brushing properly twice daily for two minutes with toothpaste that does not have high levels of abrasives.
• Flossing once a day can help get rid of plaque on the gum line and between the teeth, and can help reduce instances of tooth sensitivity.
• Avoiding the consumption of high acidic food and seeking medical treatment if suffering from acid regurgitation.