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Is a sensitive tooth a serious issue?

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Published date field Last Updated: 15 Jan 2025

Medically Reviewed By Dr. Varkha Rattu

Causes of Sensitivity

Sensitive teeth, sometimes called dentine hypersensitivity, often occurs where the exterior surface of the tooth’s crown (enamel) and/ or tooth’s root (cementum) has worn away, exposing the inner dentine. Dentine houses tubules (microchannels) which run from the outer surface to the inner dental pulp (where the nerves and blood vessels of the tooth are). For dentine hypersensitivity to be activated, the tubules not only need to be exposed but also opened. The exposed dentine tubules are usually opened after exposure to acids from the diet. Any stimuli (thermal – hot/ cold; tactile – toothbrushing; osmotic – sweet foods/ drinks) can induce fluid which travels down the tubule and activates the nerves of the dental pulp which causes the sensitivity you feel (usually a short, sharp pain).

The dentine of the tooth’s crown is commonly exposed following tooth-wear which can occur via physical or chemical wear  (Barbour & Rees, 2006). Root dentine is commonly exposed following gingival recession (shrinkage of the gums) (Seong et al., 2018). Gingival recession can result from periodontal disease (gum disease) and its management, or traumatic brushing to the gums.

Attrition

Attrition is the physical loss of tooth structure which occurs from direct tooth-to-tooth contact. This often produces wear facets on the biting surfaces of affected and opposing teeth. This is often a result of tooth clenching and/ or grinding habits.

Abrasion

Abrasion is the physical loss of tooth structure which occurs from factors other than direct tooth-to-tooth contact. The cervical neck of the tooth (area where the crown and root join) are often the most commonly affected area and the lesion formed is often called a non-carious cervical lesion (NCCL). However, abrasion can occur on any tooth surface.  

Traumatic toothbrushing using a hard-bristled brush, excessive pressure and/ or inappropriate brushing technique can result in abrasion. Additionally, overly-abrasive toothpastes can also contribute to the loss of tooth structure. Other behaviours with abrasive potential include, but are not limited to, chewing foreign objects (for example, pens, nails, pipes); gnawing on bones; and using teeth as tools (for example, opening bottles or holding items). 

Abfraction

This is the physical loss of tooth structure which often results in NCCLs and is thought to be due to repeated excessive forces of the teeth when biting which result in small cracks at the neck of the tooth crown meeting the tooth root. 

Erosion

Erosion is the chemical loss of tooth structure and can be caused by intrinsic or extrinsic acidic substances. Intrinsic acids involve gastric acid (stomach acid) regurgitating into the mouth via reflux or vomiting and so are present in the following conditions: anorexia nervosa, bulimia nervosa, gastro-oesophageal reflux disease (GORD), alcoholism-induced and pregnancy associated sickness. Extrinsic acids are those that come from the diet or the environment. Dietary acids include, but are not limited to, fruit juices, carbonated (fizzy) drinks and some alcoholic beverages. 

Gum recession (shrinkage of the gums)

Periodontitis (irreversible form of gum disease ) is the result of the body’s immune-inflammatory response to the plaque (bacteria) build-up on the teeth at the gum margin. It results in the formation of deep pockets (deep spaces between the gum and tooth) and surrounding bone loss. Eventually, if left untreated, it may result in tooth-loss. The gums tend to follow the bone loss that occurs which results in gingival recession (shrinkage of the gums). This exposes the underlying dentine and cementum. If the cementum is then worn away due to any of the above reasons, the underlying dentine will be exposed. 

The management of gum disease involves tailored oral hygiene instructions and non-surgical and surgical therapy. Any of these aspects can induce recession as a consequence of treatment because they aim to reduce the inflammation (swelling) in the gum tissues which can cause the gums to recede. However, it is important to note that this should not be a reason to not treat gum disease as the consequences of gum disease (for example, further bone loss and eventual tooth loss) are much more severe. 

Gum recession can also result from trauma to the gums or inflammation of the gum tissue in individuals who have risk factors for recession such as a thin bony profile around the affected tooth/ teeth, limited keratinised tissue (good quality thicker gum tissue), and thin gums. It can also be the result of poor margins on filling and/ or crowns which extend below the gum line.

Tooth Sensitivity Treatment

Once the cause for your sensitivity has been identified, your dental professional should work with you to correct the main causative factors that have contributed to the problem – for example, correcting any toothwear, gum disease, and/ or gum recession. 

Your dental professional may also recommend a desensitising toothpaste. A desensitising toothpaste usually works via 1 of 2 mechanisms:

  1. Plugging the open dentine tubules to prevent the stimuli inducing a fluid movement towards the nerves within the dental pulp. Such toothpastes contain active ingredients such as stannous fluoride.

  2. Potassium ion diffusion through the dentine tubule to reduce the activation of the related nerves when there is a stimulus. Such toothpastes tend to contain the active ingredient potassium nitrate.

A desensitising toothpaste should be part of the individual’s normal oral hygiene routine. It may take at least a month of regular use before you will notice results. Your dental professional may recommend a professional desensitising treatment applied by themselves if the desensitising toothpaste alone is not enough to manage it.

Colgate Sensitive Instant Relief Toothpaste has been created with Pro-Argin technology that plugs the areas of exposed dentine that lead to sensitivity. For instant relief, you can apply a small smear of the toothpaste directly to your sensitive tooth or teeth with a fingertip and massage gently for 1 minute up to twice a day. 

Here are some other things you can try to manage your hypersensitivity:

  • Correct your brushing technique to prevent gingival recession from traumatic brushing and/ or gum disease.

    • Use small, circular motions when brushing your teeth. Don’t scrub the teeth from side-to-side.

    • Daily interdental cleaning – cleaning between your teeth with interdental brushes will help to remove the plaque build-up between teeth (as your toothbrush can never reach these areas) which will help in preventing or managing any gum disease.

  • Minimise the progression of toothwear:

    • Attrition: See your dental professional to help manage any grinding/ clenching habits which may involve a professional-made hard splint.

    • Abrasion: Correct your brushing technique and avoid nail biting or opening and/ or holding foreign objects in your mouth.

    • Erosion: You can minimise the risk of intrinsic acid by visiting your medical professional for help in managing any underlying conditions. To minimise the effects of extrinsic acids from your diet, use a straw to minimise the contact with your teeth. Drinking water after can also help to improve the acidic environment of your mouth. Ideally, it would be better to reduce the consumption of acidic foods and drinks. 

  • Use a fluoride toothpaste or products specially formulated for sensitive teeth.

The sooner you get to the cause of your sensitive teeth, the sooner you can get treatment. Do not suffer in silence - make an appointment to see your dental professional as soon as possible.

 

REFERENCES:

Barbour, M. E., & Rees, G. D. (2006). The role of erosion, abrasion and attrition in tooth wear. J Clin Dent, 17(4), 88-93. 

Seong, J., Bartlett, D., Newcombe, R. G., Claydon, N. C. A., Hellin, N., & West, N. X. (2018). Prevalence of gingival recession and study of associated related factors in young UK adults. Journal of Dentistry, 76, 58-67. https://doi.org/https://doi.org/10.1016/j.jdent.2018.06.005

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This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.