Sensitive Teeth
(Dentine Hypersensitivity)
In this section, we will cover:
- What is dentine hypersensitivity?
- How is it caused?
- How can I prevent it?
- How is it diagnosed?
- How is it treated?
What is dentine hypersensitivity?
In a healthy mouth, dentine is covered by a layer of enamel which acts as an armour and the tooth's root should be covered by the gum.
When the dentine or root is exposed, you may feel a short sharp pain to certain triggers. This is called "dentine hypersensitivity". Sensitivity can be triggered by hot, cold, sweet, acid and touch. It can affect one or more teeth and may be temporary or long-lasting.
How is it caused?
Hypersensitivity is caused when the middle layer of the tooth (dentine) is exposed. This is most commonly due to one or more of the following:
- Gum recession
This is where the gum shrinks away (or "recedes") from the tooth. It can occur due to
- improper toothbrushing; commonly excessive force or use of a hard-bristled toothbrush, or
- gum disease - Tooth wear
- Erosion caused by frequent consumption of acidic food/drink, vomiting and acid reflux
- Attrition commonly caused by bruxism (grinding your teeth)
Temporary sensitivity can be caused by:
- Teeth whitening as the enamel becomes more porous
- Recent dental treatment such as fillings/scaling
It is thought that the symptoms of dentine hypersensitivity are due to a phenomenon known as the "hydrodynamic theory". This is where the fluid inside the dentine tubules shifts towards the nerve of the tooth, increasing pressure inside the tooth and causing pain/sensitivity.
How can I prevent it?
Avoid damaging your teeth/gums when brushing:
- Discuss proper toothbrushing technique with your dentist or hygienist
- Use a small roundhead electric toothbrush with a pressure sensor
Maintain healthy gums:
- Good oral hygiene
- Stop smoking
- Good diabetic control
Prevent tooth wear:
- Reduce the amount and frequency of acidic food/drink (citrus fruits, fizzy drinks, juice)
- Have acidic food/drink all in one go instead of spreading it out throughout the day
- Use a straw placed to the back of your mouth when having fizzy drinks or juice
- See your GP if you think you suffer from gastric reflux, bulimia or alcoholism
- Rinse your mouth with mouthwash after having acidic food/drink or vomiting but wait 30 minutes before brushing your teeth
- Wear a mouthguard or "splint" if you grind your teeth at night
This is made out of a thin soft plastic and is similar to a sports mouthguard.
How is it diagnosed?
Diagnosis is based on your symptoms.
Before making a diagnosis of dentine hypersensitivity, your dentist will exclude other conditions which can give similar symptoms, such as tooth decay or a cracked tooth.
How is it treated?
There are many ways to manage the symptoms of dentine hypersensitivity.
- Desensitising toothpaste
This is the first choice of treatment which your dentist will recommend. They can be found in most supermarkets and pharmacies. Examples include Sensodyne© and Colgate Pro-relief©.
It will take a couple of weeks before you can tell if the toothpaste is working for you. Desensitising toothpastes work in different ways so sometimes you will have to try a few different types to find the right one for you. - Fluoride varnish and toothpaste
Fluoride varnish is a sticky paste your dentist can apply on the teeth to help reduce sensitivity.
Your dentist can prescribe you a high fluoride toothpaste (Duraphat 2800ppm or 5000ppm) which can aid in managing sensitivity when used twice a day.
Both of these also reduce the risk of tooth decay. - GC tooth mousse©
This is a special combination of minerals (calcium and phosphate) which help to repair and strengthen the enamel. It is usually very effective at managing sensitivity. It is not available on prescription but can be bought over-the-counter from your local dentist or online. - Restoration
If the sensitivity is due to exposed dentine on the sides of the teeth, the filling placed here is likely to need replacing regularly.
If the sensitivity is due to exposed dentine on the biting surfaces of the tooth, a filling can be placed if there is enough space between the top and bottom teeth.
If there is no space between the top and bottom teeth, space needs to be created. This is a more complex treatment, most likely involving onlays/crowns, and may require treatment by a specialist.
If using desensitising toothpaste, high fluoride toothpastes or GC tooth mousse, you can use your finger to smear a small amount on the sensitive teeth before you go to sleep. This can improve your symptoms faster. Most products will need at least 2 weeks of regular use before determining whether they were a success or failure.
As well as managing the sensitivity, it is important to find and treat the underlying cause.