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Dentine Hypersensitivity

An electric storm suggests the type of pain dentine hypersensitivity causes

Summary

Dentine hypersensitivity (dentine sensitivity) is a common cause of sensitive teeth with a prevalence of about 10-20%. When someone says they have ‘sensitive teeth’ this is usually the first condition that comes to mind. However it is important to rule out other forms of sensitivity such as reversible pulpitis or a cracked tooth symdrome and often dentine hypersensitivity becomes a diagnosis of exclusion. The pain associated with dentine hypersensitivity is generally described as sharp, it comes on rapidly, usually in response to a cold stimulus and is short lived. Here is a more formal definition:

Pain derived from exposed dentine in response to chemical, thermal, tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease

Home care advice

Dentine Hypersensitivity can be treated quite successfully at home using over the counter products. It is important however to rule out other causes of tooth sensitivity such as reversible pulpitis, irreversible pulpitis, post-operative sensitivity and cracked tooth syndrome.

Toothpastes for sensitive teeth have been around for some time now and continue to improve. They work by forming a microscopic chemical layer over the dentine to prevent the pain occurring. 

They can be used as a regular toothpaste as well as rubbed on the root surface of particularly sensitive teeth. Mouthwashes containing fluoride can also reduce the symptoms.

Other products which may help are fluoride mouthwashes

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Causes

The pain from dentine hypersensitivity comes from the fact that the dentine is exposed to the outside world. This dentine is made up of tiny microscopic tubes with the opening of the tube facing out. Stimulation of these tiny openings by cold, hot, acid, touch etc cause the nerve inside the tooth to fire and let the brain know this though a pain signal.

The causes of this exposure are due to EITHER loss of the enamel of the tooth OR shrinking back of the gums to expose the root surface.

Erosion

This where tooth surface has been dissolved by dietary acids (fizzy drinks, fruit etc) or by stomach acids (reflux, bulimia, morning sickness etc). Recent studies suggest that all tooth loss that is not caused by decay has some degree of erosion. For more information visit https://www.dentalhealth.org/dental-erosion

Abrasion

This is tooth surface loss due to an external mechanical action such as toothbrushing or adverse habits. Studies shows that the majority of the abrasion from tooth brushing comes from the toothpaste and not from the brushing itself. A medium hard bristle is recommended hard brushes abrade more and soft brushes retain more toothpaste which abrades more.

Abfraction 

Abfraction is a much debated phenomenon. Many dentists and researchers believe that when we grind our teeth tiny bits of enamel fracture at the neck of the tooth and create v-shaped intents at the gum margin. However there are equally many dentist who do not believe in this theory. The author's opinion is that it may well be a factor and the mechanisms of tooth loss are likely to be multifactorial.

 

 

Written by Andrew Bain BDS MJDF (RCS Eng)
Apr 27, 2020