SENSITIVITY OF TEETH: General facts, Causes, Symptoms and Treatment Modalities
Is there a feeling of discomfort on sipping hot tea or cold drink? Do you wince and feel a current or stinging sensation while having something sour or sweet? Then you are most likely dealing with a common problem that thousands of people face called sensitivity.
Do not worry! We have it sorted for you as you will find all relevant and comprehensive information about how to combat Tooth Sensitivity.
INTRODUCTION:
Technically known as Dentinal Hypersensitivity, this dental condition is chronic in nature i.e it may last from a few days to a few months. It can progress over time and exhibits due to multiple reasons. Previously it was described as an enigma because it was poorly understood. However, now there is enough data available that helps us identify and treat this condition efficiently.
PREVALENCE AND EPIDEMIOLOGICAL FACTS:
It generally occurs in people within 20- 50 years of age limit, however people younger or older can also face this condition. It has a peak in the age range of 30-40 and more prevalent in female individuals that would probably be related to their dental hygiene and dietary habits. It has been observed that some people with DH do not pursue treatment of the disease. Patients do report this condition in a clinical visit to the dentist but usually, don’t turn up for treatment according to a few statistical data. This is perhaps due to the fact that they do not consider it as a specific disease.
The canines and premolars which are your third and fourth teeth from the center are most commonly affected. The site where you generally feel the sensation is the visible front face of the tooth near the gums called the cervical area. However, in some situations, the back side of the tooth can also be affected. The left side of the mouth is more prone to dentin hypersensitivity according to facts.
A brief description of the anatomy of the tooth is essential for all of us to understand the occurrence of this phenomenon. The tooth is made of an outer layer which is the hard white enamel and the inner layer is made up of dentin which is soft and yellowish. It has multiple microscopic channels called dentinal tubules that pass and run through the dentin to the center of the tooth. The nerve and nerve endings are connected to the dentin channels and exit into the pulp which inhibits blood and nerves. The dentin tubules or channels contain odontoblastic processes and are surrounded by fluid. Dentin sensitivity to stimuli does not lead to any problem while it is covered with protective tissues; enamel on crown and cementum on the root.
MECHANISM OF ACTION OF SENSITIVITY :
Once the layer of dentin gets exposed to the environment and the structural integrity is imbalanced, external triggers or stimuli such as hot-cold, extremely sweet- sour food and beverages or sudden rush of air spray stimulates the nerves inside the tooth and therefore a short sharp sensation is felt immediately. When this phenomenon cannot be attributed to any other specific or evident dental pathology it is termed as dentin hypersensitivity.
Well researched scientific studies attribute to the fact that there are many theories as to why and how dentin hypersensitivity occurs. The fluid movement or hydrodynamic theory which explains that the dentinal fluid shifts in response to a stimulus and causes stimulation of nerves is widely accepted.
SYMPTOMS :
Sensitivity feels like a short lasting, transient sharp piercing kind of sensation affecting a certain area of teeth which lasts for a short duration and subsides on its own only to recur in response to a similar stimulus as earlier or without any specific reason once it has been already initiated. Either one tooth or several teeth can be affected. There can be mild discomfort or extreme severity to the level that patients reject cold or hot food items outrightly and cannot bear the sensation any further.
ETIOLOGY:
- Periodontal problems like gum recession or secondary to periodontal diseases: The downward movement of gums called recession is a byproduct of either the aging process or some dental or systemic infections. Sensitivity is highly prevalent in periodontally compromised patients (60-80%)
- Thin enamel or enamel loss: This can happen due to aggressive horizontal brushing, using a hard-bristled toothbrush, excessive flossing or brushing for more than 3 mins very frequently. It leads to abrasions and abfractions and exposes the dentin. Moreover, habits like night grinding also contribute to enamel loss through attrition of teeth.
- Gastric acid reflux which is a systemic disorder in which their regurgitation of dietary acids or intake of acidic food in large amounts or an eating disorder like bulimia can also cause erosion of enamel on the side of the tooth that faces the palate and tongue and eventually lead to sensitivity. Erosive agents include carbonated drinks, citrus fruits, alcoholic drinks, yogurt, dairy products, and occupational hazards.
- Sometimes dental procedures like scaling, polishing, bleaching can also induce sensitivity. There has to be proper check-up regarding the susceptibility and predisposition of the patients before undertaking dental procedures to keep sensitivity at bay.
- People with xerostomia or lack of adequate amounts of saliva are also vulnerable to sensitivity.
- At times habits like chewing tobacco can also worsen this condition to extreme levels.
Therefore, when one observes such habits or symptoms it is wise to go to a dentist. Do not always self diagnose and worsen the situation even though it is not an emergency. Following this, we will present to you the ways in which dentin hypersensitivity can be managed in the best way possible.
Now, let’s get to know some similar dental conditions which can be a differential diagnosis for dentin hypersensitivity. In some cases, people confuse sensitivity with tooth pain. However, with a thin line of differentiation from pain, sensitivity can be a result or symptom of many other dental problems like tooth decay which needs extensive care and professional assistance by a dentist. Pain in a tooth region is more constant, prolonged and can aggravate in the night. Therefore, many diagnostic tools are used to reach the conclusion that the case is of dentin hypersensitivity and this job can be proficiently done by a clinician. The other causes of dental pain should be excluded before a definite diagnosis of dentin hypersensitivity is made.
There are a set of diagnostic protocols and tools available to assess the condition which will be elaborated underneath:
- An appropriate medical and dental history of the patient is necessary.
- The source of the pain or sensation, its nature should be assessed.
- Dietary and oral hygiene habit history is also important as it indicates an impending or potential risk factor for developing sensitivity.
- The patient’s response to various stimuli like thermal, mechanical, electrical and chemical is also checked.
- For mechanical also known as tactile: a sharp tipped instrument or mechanical stimulator is used.
- The hypertonic solution, cold air or water stimulation is done and response is assessed for chemical also known as osmotic
- For electric methods, use electric pulp testers.
- To gauge the apparent severity some scales like verbal rating, visual analog scale, Mc gill questionnaire are quite popularly used.
- The practitioners need to rule out conditions like cracked tooth syndrome, caries, defective restorations, trauma due to occlusion of teeth, postoperative sensitivity, atypical facial pain which can be referred to teeth, hypoplastic enamel or pulpitis.
- Some of the other techniques to adjudge sensitivity and pain include assessing pain response upon the pressure of tapping teeth (to indicate pulpitis/periodontal involvement), pain on biting a stick (suggests fracture), use of transilluminating light or dyes (to diagnose fractures), and pain associated with recent restorations.
TREATMENT MEASURES FOR DENTIN HYPERSENSITIVITY:
DEPENDING ON THE MODE OF ADMINISTRATION :
AT HOME DESENSITIZING AGENTS:
- Anti Sensitivity or Desensitizing toothpaste available over the counter are the first steps in the routine management of sensitivity. It is the most effective and least invasive method. Apart from this, tooth powders, chewing gums or mouthwashes are also available and without spending much you can be well equipped to handle this condition.
- The ideal requisites of a desensitizing agent like a toothpaste should be that it should be non-toxic to living oral tissues, non-irritating, easy to apply and pleasant in taste as well. It should act without taking much time and be easily available for use.
- Use these toothpaste only for 15 days to 1 month and discontinue if sensitivity reduces. However, if there is no relief, then consult a dentist as the sensitive teeth may indicate an underlying problem that may need prompt care as mentioned above.
- When the available desensitizing kinds of toothpaste in the market are not working, then the next step indeed is clinical care of the problem in a focused way.
IN-OFFICE CLINICAL MANAGEMENT:
When the etiologic agent is identified and causes are categorized treatment is planned accordingly. The patient presenting with the sensitivity issue should be made totally aware of the treatment options available. Based on the mechanism of action of the chemical agents applied by the dentists in a clinical set-up, the following measures are undertaken:
- Nerve desensitization: Potassium nitrate is one agent that renders the nerve endings of the toothless sensitive or less responsive.
- Precipitation of protein: Glutaraldehyde, Silver nitrate, Zinc chloride, Strontium chloride. These chemicals can form a precipitate of protein over the exposed areas of dentin and eventually defer the process of sensitivity.
- Dentin adhesive sealers: Fluoride varnishes, Resins, Glass ionomer cement, Composites. They just create an external barrier layer over the exposed areas.
- These chemical agents are applied to the tip of the sensitive site using a brush or a rubber tip quite gently and may require a few definite appointments.
- Lasers: Nd-Yag, He-Ne lasers. A laser is an acronym for light amplification by stimulated emission of radiations. It has been shown in various studies that lasers can be used in the effective management of this condition. This treatment modality should be used in severe cases. It is an advanced technique, newer in the market but used less frequently due to the cost involved.
- Use Anti-inflammatory corticosteroids and bioactive glass. Bioactive glass often sold under the brand name of NovaMin is a newer material and takes about 4 weeks for relief and ongoing use will help reduce the problem. It forms a protective layer on the exposed surfaces of the dentin of the tooth region experiencing the sensation.
- Fluoride iontophoresis: A fixed percentage of sodium fluoride is also an advanced method of treatment in which ionic drugs are induced into the teeth for therapeutic purposes.
- Nanodentistry: In this procedure, nanorobots are delivered to the site of sensitivity and the chemical agents are delivered locally and effectively. It demands extreme skill and high cost, therefore, it will take a long time to come into the market.
- Homeopathy: Propolis and Plantago can be used. These are rich in flavonoids, hence are anti-inflammatory and help in healing.
- Recent trends are looking into potential avenues to remineralize the tooth structure exposed or lost by increasing the calcium and phosphate levels and elevating the ph levels.
- Researches are on continuously as to how to tackle and bring the best relief to the patient for this common and widespread condition.
- Identifying and managing etiological and predisposing factors well should be the end all aim in treatment to be successful.
SOME FOOTER NOTES:
Dentin hypersensitivity is a diagnosis of exclusion where confirmation is possible when all other dental conditions have been eliminated.
As we all know prevention is better than cure, implementing preventive measures is the best way to curb this dental condition. Here are some useful tips which can help you maintain good oral hygiene and stay away from this menace of dentin hypersensitivity.
- Avoid over brushing with excessive pressure in the horizontal direction and for a long duration. The maximum recommended time is 2-3 mins.
- Use a soft bristled brush and change it every 3-4 months. Avoid medium to hard ones.
- Floss regularly following the correct technique but do not over floss and use interdental cleaning devices without the need.
- Avoid brushing immediately after the intake of acidic drinks. At Least a two-hour gap is mandatory. Take something alkaline (milk) or at least neutral (water) after acidic drinks and use a straw to sip the drink and avoid swishing it around the teeth. Cover the affected areas an occlusal splin to prevent their contact with the acids.
- Learn the correct method of brushing eg. Modified Bass or Stillman’s according to the dental health of one’s oral cavity.
- Avoid picking or scratching the gum line with a sharp object like a toothpick.
- Avoid the use of abrasive kinds of toothpaste and ones which do not contain fluoride. Try using mouthwashes which also contain fluoride.
- While brushing, avoid horizontal scrubbing near the gumline areas.
- Dentinal hypersensitivity can recur and definitely can be an issue with no final solution. Therefore, consistent and continuum of care is essential.
- Be conscious of the diet you take and avoid acidic food and beverages.
- If the dentist suspects underlying systemic or general conditions and diseases while diagnosing and treating sensitivity then do follow up with a general medicine doctor.
- Do not undermine dental issues and defer them for months.
After all, it is very rightly and aptly said oral health is the mirror to the overall health of the individual. Follow up and feedback is necessary for dental treatment. Therefore, never fear or shy away from them. Thus, maintain proper oral hygiene and visit your dentist regularly for routine checkups and battle dental problems like sensitivity like a boss!
REFERENCES:
https://www.sensodyne.in/about-sensitivity/tooth-sensitivity-causes.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927677/
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce200/references
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010026/