Relax! Sensitive teeth is very common, and most of us have experienced it in some form or another at some point in time. It can be something that needs serious attention, and could just as easily be something that just needs to be monitored. We’re all different. The intensity of tooth sensitivity can range from barely noticeable, to unbearable. But why?! It’s my goal to to help you figure out!

sensitive-teeth popsicle 2 from dr. ahriri

I’ll get into all the more common etiologies/causes of sensitive teeth, but first I want to start with something they almost all have in common: exposed dentin. You probably remember the anatomy of a tooth from my previous article on teeth bleaching and whitening, but I’ll give you a quick refresher anyway:

The outer portion of the tooth is called enamel. It’s incredibly hard, inflexible, and it covers and helps protect the softer, inner portion of the tooth, called dentin. Dentin is much yellower in color, softer, and is basically a bunch of tiny tubes, packed together, that lead directly to the nerve. So whenever dentin is exposed, the greater chance we have of experiencing sensitivity to things like cold, and sweets!

Here’s a list, and a little blurb about some of the more common causes of teeth sensitivity, and what you can do about them. Keep in mind, none of these are mutually exclusive, and can often occur together. If you have more specific questions and need additional information, please feel free to reach out to us via your communication method of choice and we’ll be happy to give you more information. So here goes:

-Large Pulp Chambers:

The pulp chamber is the center of the tooth that houses the nerves and blood vessels. Most of the next few common causes of sensitive teeth we’re reviewing impact the nerve housed inside the pulp and that’s why we feel that uncomfortable little zing from time to time. But thanks to our moms and dads, some of us have larger chambers than others, so extremely cold things will be sensitive, even though there’s nothing wrong with your teeth!

What can be done? Well, wait it out! The good news here is the pulp shrinks as we get older. The tooth naturally lays down more dentin, insulating itself from the outside environment so your teeth will  become less sensitive over time. Sadly, they also get more yellow as the pulp shrinks. There’s always bleaching!

-Gum Recession:

Gum recession exposes the underlying root surface that does not have enamel to protect and insulate the tooth from sensitivity. Gum recession is most commonly caused by over-aggressive brushing, long standing gingivitis (gum/periodontal disease), and teeth grinding.

What can be done? Treat the underlying cause first. Use a soft-bristled toothbrush and brush softly. See your dentist to have your gingivitis/periodontal disease treated and have a nightguard made if you grind your teeth. Once that is done, the most conservative thing you can do is you can use sensitivity toothpaste, like sensodyne that has a small molecule called Potassium Nitrate that fills in the exposed holes in the exposed root to alleviate the sensitivity. Using a fluoride mouthwash regularly will also help prevent the root from eroding any further once it becomes exposed. Other treatments include gum grafting and fillings.

-Grinding, A.K.A. Bruxism:

Grinding your teeth at night can sometimes cause sensitive teeth, even if the root of your tooth isn’t exposed like previously mentioned. The forces you generate during nighttime grinding can be strong enough to fracture your teeth! The strain the tooth endures can cause it to become bruised, and in turn, the pulp chamber can become inflamed. We call this a pulpitis. Once inflamed, the tooth will become extra sensitive to temperature, and sometimes pressure.

In the early stages of bruxism, hairline fractures occur in the enamel with persistent grinding, and allow temperature to more easily reach the dentin. Sometimes these cracks propagate deeper into the tooth causing extreme sensitivity to cold and biting. If that crack works its way all the way to the pulp, you can expect to have some pretty serious pain, so don’t let it get to this point.

What can be done? Well, since you won’t magically stop grinding your teeth, the best thing to do is create a nightguard to wear to protect your teeth. If you’re a mild grinder, you can buy them over-the-counter and give them a try. If you’re moderate-severe, you want to have a professional one made by your dentist.

-Teeth Bleaching:

Sensitive teeth after bleaching is common because the peroxide molecule is so small it actually penetrates through the tooth. Additionally, the combination of lights, and stronger concentrations of peroxide cause the tooth to dehydrate, causing a transient pulpitis (inflammation of the pulp.)

What can be done? Very concentrated Potassium Nitrate gel(your dentist should have this available) can be  applied to the teeth before, after and even between bleaching procedures to minimize sensitivity. Avoid bleaching systems that use high powered lights, such as Zoom since the light gives no added benefit to the end whitening result.

-Xerostomia AKA Dry Mouth:

Xerostomia is a feeling of dryness in the mouth associated with poor saliva production. This can occur due to age, medications, radiation, chemotherapy, systemic diseases such as Diabetes and Sjogrens syndrome, and genetics. Some people just produce more saliva. Saliva helps protect and remineralize weak areas in the enamel. Without it, these weak areas where food accumulates tends to break down fairly quickly.

What can be done? Lots and lots of fluoride use! Fluoride will help protect those weak areas and prevent them from transitioning to exposed sensitive areas, or worse: cavities! Depending on the severity of your xerostomia, you may even need trays custom fitted to your teeth that contain a fluoride gel that you sleep with overnight.

-Cavities/Fillings:

This is the one we all fear and hopefully are not too familiar with. Cavities are essentially holes in the teeth caused by bacteria that breakdown sugars into acids. This acid continues to eat away tooth structure, causing a bigger and bigger hole over time. We begin to feel occasional sensitivity when that cavity gets into the dentin.

What can be done? The decay needs to be removed, and the defect needs to be restored with a filling. The type of filling or restoration changes depending on the size and location of the cavity. Fillings themselves can often cause temporary sensitivity, and if they’re metal (amalgam) can also transmit temperatures causing more sensitivity than usual.

-Food Impaction

Food impaction is food getting stuck in the same place over and over. Not only can this cause cavities in the adjacent teeth, but the gums don’t like it. Over time, the inflammatory response in the area can spread to the adjacent teeth, and they’ll have tiny nerves that surround the teeth begin to ache. The perfect recipe for sensitive teeth.

What can be done? Close the space! Getting braces can help straighten teeth and close spaces, or getting a filling redone so the space is closed can save a lot of grief and discomfort.

We hope that information helps with any sensitive teeth issues you may be having. Have a great weekend from all of us at Vision Dental!

Rogelio “Roger” Garcia, D.D.S.
William “Will” Cheng, D.D.S., M.S.
Owners of Vision Dental
VisionDental.com
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