Are you avoiding ice cream or your favorite candy because of a sudden toothache? What could this pain mean?

Let’s take a deeper look at its root cause .

What is Tooth Hypersensitivity?

It is defined as short ,sharp pain arising from exposed dentine in response to stimuli particularly thermal , evaporative, tactile ,osmotic or chemical and which cannot be ascribed to any other dental pathology.

Prevalence

15-18% general population
78-98% in periodontal patients( related to gums)
Age (20-50 yrs peak) due to gingival recession
Gender – comparatively more females are affected than males .

Sign and Symptoms

sensitivity to hot or cold temperatures, such as a cold breeze.
short, intense bursts of pain when eating or drinking hot or cold foods and drinks.
pain and sensitivity when touching or applying pressure to the tooth area.
discomfort when using certain oral products, such as abrasive toothpaste or mouthwash.
sensitivity to acidic or sweet foods and drinks.

What causes hypersensitivity?

Exposure of dentinal tubules is a major cause of dentinal hypersensitivity. It can occur as a result of-

tooth decay
tooth fracture
worn fillings or tooth enamel
gum disease
receding gums

Potential risks for dentinal exposure include –

brushing the teeth too hard, causing wear and tear to the teeth and gums.
consuming acidic foods and drinks, which can lead to the erosion (attrition )of the protective tooth enamel and cementum.
shrinking or receding gums, which can occur naturally or periodontal disease
teeth grinding, which can wear down the enamel surface.
using abrasive oral products such as whitening toothpaste or bleaching products.

How do teeth sense hot or cold?

Dentine is the second layer of our tooth which is responsible for sensing the mechanical changes in and around the tooth surface.
Dentine is composed of small dentinal tubules made up of hydroxyapatite crystals,
These tubules contain odontoblastic processes which directly end into odontoblastic body located on pulp.

Theories of dentinal sensitivity

Three theories have been proposed explaining how the dentine conducts

various mechanical stimuli to nerve fibres.

Direct innervation theory
Odontoblastic receptor theory
Hydrodynamic/fluid movement theory

Hydrodynamic theory is the most widely accepted one .

First proposed by Gysi in 1900

A fluid is present inside dentinal tubules, peritubular fluid which surrounds the odontoblastic processes.
According to this theory, rapid mechanical stimuli leads to shift in this fluid leading to conduction of impulse to nerve endings in the deeper part of dentine.

Diagnosis

It can be difficult to detect dentine hypersensitivity since its symptoms are similar to many other tooth ailments.

Clinical assessment is done by a dentist on the basis of physical examination a grading scale is set.

The dental professional may ask an individual to provide certain information, such as-

where the site of discomfort is.
how often the pain occurs.
whether the pain resolves when a person removes the stimulus that causes it.
the severity of the pain, using a pain scale.

Verbal rating scale is a simple scale based on the pain felt by the patient

0- No discomfort
1-Mild discomfort
2-Marked discomfort
3-Marked discomfort lasting for more than 10 secs

Treatment

Various treatments are available for hypersensitivity, a dentist may recommend them in accordance with the severity of damage.

Home remedies for dentinal hypersensitivity

Oil pulling – with sesame and coconut oil
Chewing guava leaves as these have flavonoids which soothe toothache and provide anti-inflammatory properties
Clove gel.
Garlic
Saltwater rinse fights bacteria
Capsacian rinse
Turmeric contains curcumin which is a pain reliever

Other treatments –

( Advice of a practitioner needed)

This may include using a desensitising toothpaste
Fluoride gel
A crown, filling, or bonding
Gum tissue graft
Root canal (severe cases)

Prevention

Though dentinal hypersensitivity is a common tooth ailment it can be prevented by general oral care .

Maintaining good oral hygiene.
Correct brushing with small soft bristles in round movements.
Changing your brush every 2-3 months
Not brushing immediately after a meal as this can soften the enamel
Avoiding abrasive chemical products that can damage gums .
Avoiding food and drinks with high acid and sugar content such as alcohol , fruit drinks as these can erode teeth

To take proper care of your teeth and prevent any dental ailment ,visit your dentist every 2-3 months for a routine dental checkup.

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– Chahhat Maini (BDS & Author, MCD)