Thursday, December 5, 2013

I was fine until...

"Oh" you say as you put your hand to your mouth.  You just drank some ice water and now your tooth hurts.  "Where did that come from?", you ask. 
One of the biggest complaints dentists receive is sensitive teeth and there are several reasons for its occurrence.  While there are many ways to prevent sensitivity, sometimes it just happens.  So where does sensitivity come from and what can be done about it?

Reason #1: Decay

Decay eats away at the tooth creating a hole.  As the hole gets bigger, the cavity gets closer to the nerve.  The closer to the nerve, the more sensitive the tooth becomes.  The nerve receives direct communication to the outside world and is not protected by enamel.  Small cavities generally are not sensitive, but when left untreated reactions to sweets and cold occur. 
Treatment:  Remove and restore decay

Reason #2:  Fillings

When a tooth has a cavity, it must be treated.  Untreated decay leads to root canals, crowns, or extractions.  However, after treatment, a tooth can remain sensitive for several days. Why?  Well, if a cavity is big and close to the nerve, then any work done on the tooth may agitate the nerve even more.  If the cavity is small, then sometimes the tooth is over-dried in the restorative procedure.  A moist tooth has an added protective barrier of the water, but when a filling is placed, the tooth needs to be dried for filling material to be placed successfully.  It takes several hours to a couple of days, depending on the dryness of the tooth, for rehydration of the tooth.  In that time, the tooth will be sensitive to cold and possibly hot. 
Treatment:  At home fluoride and Ibuprofen

Reason #3:  Bleaching

A white smile looks great and Hollywood is filled with celebrities sporting them.  But did you know that most celebrity smiles are not their natural teeth.  To obtain their pearly, toilet bowl white smile, celebrities and others have had veneers, crowns, or bridges placed over their natural teeth costing tens of thousands of dollars.  So what's the common person supposed to do? Bleach, bleach, bleach. 
Unfortunately, as mentioned above with over-dried teeth, bleached teeth have lost moisture.  Bleaching dries teeth.  Bleached teeth will be sensitive to air, cold, and hot, and they will have a chalky appearance.  The stronger the concentration of bleach, the more likely for sensitivity.  And over-doing the bleaching will make matters worse.  A natural tooth will only whiten so much, and composite bonding, crowns, and veneers will not whiten no matter what.
Treatment:  Custom bleaching trays do minimize sensitivity by keeping the material on the tooth, and dentist prescribed bleach is regulated.  Dentist-prescribed fluoride gels/toothpaste, over-the-counter fluoride.  Follow instructions on bleaching material and cut back if sensitivity occurs.

Reason #4: Recession

No, not financially.  It's the gums.  The gingiva covers a portion of the tooth root that is not planted in the bone.  Over time, minor irritations-plaque, calculus (tartar), fierce brushing, lip rings, tongue rings, partial dentures, and age-will cause the gum tissue to move away from the source of irritation, exposing the roots.  Tooth roots are not protected by enamel.  Therefore, roots communicate temperature variations more readily, leading to sensitivity.
Treatment:  Most of the time, a toothpaste for sensitive teeth works well.  If not, a de-sensitizing material can be placed on the exposed root by a dentist.  Or a gingiva transplant can be done to cover the roots.

The bottom line, most of the time sensitivity is an unfortunate normal.  Dentists would like it to not happen, but it does.  In most cases, the sensitivity will abate, but there options for when it doesn't.  Tell your dentist about your sensitive teeth and together you can solve this problem. 

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