Sensitive Teeth - Diagnosis and Treatment

For some, it's that bite of ice cream or a swig of ice tea, for others is can be a brisk inhalation on a cold winter day that causes concern. Sensitive teeth are a leading reason for urgent dental appointments. That's great, because the family dentist is the right doctor to figure out what is wrong.

Tooth decay causes teeth to be sensitive to cold and sweet. Decay may appear as a white, brown or orange spot on the tooth or as a dark spot on the x-ray image of the tooth. The dentist feels the difference between firm, healthy enamel and soft decay using a pointy probe. The treatment for decay may be as simple as removing the decay and restoring the missing part of the tooth with a filling. Deeper tooth decay will infect the pulp (the soft inside part of the tooth that includes nerves and blood vessels) of the tooth necessitating root canal treatment or extraction.

Oddly, one of the most common causes of sensitive teeth is brushing the teeth tooth hard. Using a medium, firm or hard brush, or brushing vigorously will wear away gum tissue and tooth enamel. Exposing the root of the tooth or deeper layers of the tooth will cause the tooth to become very sensitive. These teeth feel the same as teeth with a medium size cavity.

Fortunately, teeth that are sensitive due to tooth brush abrasion often respond well to treatment with desensitizing toothpaste such as Sensodyne. Use desensitizing toothpaste alone for a month. If the tooth becomes more comfortable, continue to use that toothpaste once or twice a week. If the tooth remains sensitive, the dentist may have other suggestions such as gum surgery to cover the exposed root surface, or painting a thin sealer over the root surface. Prevent toothbrush abrasion by using a soft brush and cleaning teeth gently. Plaque is soft and comes off of teeth easily.

Tooth enamel dissolves in acid. Acidic foods include lemons, limes, and carbonated beverages. Drinking as little as one can of soda a day - diet or regular - will cause tooth decay to develop at a higher than normal rate. Gastro-Esophageal Reflux Disease or GERD, heart burn, and the eating disorder, bulimia, dowse teeth with acidic stomach contents. The loss of the protective enamel increases the incidence of tooth decay and sensitivity. Treatment will range from the use of higher strength or desensitizing toothpaste, to root canal treatment and crowns (also known as a caps).

A worn or broken tooth may be sensitive just like teeth with decay. The treatment for broken teeth can be very simple - rebuild the tooth with a crown or a filling. Some broken teeth will need root canal treatment either to remove an exposed and sensitive dental pulp (nerve) or to clean out the root canal of the tooth so that the dentist is able to cement a post into the tooth to retain a crown on the root of the tooth. Some broken teeth are not salvageable. The dentist will have to remove the tooth and work with the patient to determine the best way to replace that tooth.

Some broken teeth look as if they are intact. Cracked teeth may be sensitive to cold. The hallmark of cracked teeth is that they are sensitive to release of pressure. The dentist will ask the patient to bite on something resilient such as a soft piece of wood (not recommended) or a cotton roll. Normally, there is no pain associated with chewing on a piece of cotton. A cracked tooth will have sharp pain on release of pressure.

Treatment depends on the depth and location of the crack. When a crack opens into the pulp of a tooth, that tooth may become very uncomfortable. Bacteria entering through the crack will infect and kill the pulp. Root canal treatment will not seal the crack; in spite of the treatment, time and expense, the tooth will be lost.

A reasonable initial treatment for a superficially cracked tooth is to replace any existing restorations (fillings) with new, tooth colored restoration that is chemically bonded to the tooth. If the tooth becomes more comfortable and remains so for a couple of months, it is safe to restore the tooth with a crown. Often, the crown and the bonded restoration will prevent the crack from progressing.

Sometimes, an uneven bite will cause the tooth to feel uncomfortable and sensitive. The dentist will say that the bite is high on that tooth. The tooth may be under pressure due to uneven wear, or a new restoration that is a tiny bit too thick. While evening the bite by shaving away a bit of tooth or restoration material may make the tooth feel somewhat better immediately, it may take a few days for the tooth to feel normal.

The most mysterious causes of dental pain are not the teeth. Sinuses are hollow places in the bones of the face and the back of the head. Sinuses can fill with fluid and infection. The roots of the upper back teeth are close to and may even press against the lining of the sinuses in the cheek bones. When the sinus becomes painful, it may feel as if the teeth in that area are sensitive; they might be sensitive to biting pressure or cold temperature. Once the dentist determines that the pain the patient feels in their teeth is due to sinusitis, the dentist will refer the patient to their medical doctor for treatment.

Facial muscle pain may feel so much like a tooth ache that a suffering patient might convince their dentist that they need root canal treatment or a filling. The dentist will figure this out by pressing and squeezing muscles on the forehead, cheek and neck. There are even muscles in the back of the mouth that might become uncomfortable. Sometimes, the patient does not believe the dentist's diagnosis of muscle pain.

Dentists call this kind of pain myo-facial pain. Myo-facial pain often relates to pain in the jaw joint (the temporo-mandibular joint or TMJ). Pain in the joint or musculature has a range of treatment options from simply avoiding over use of the jaw to changing how the teeth bite together with a device or by changing the shape of some of the teeth to surgery. Orthodontics (braces) may be a cure or a cause for myo-facial or TMJ pain.

Do you have sensitive teeth? Speak with your dentist. Expect the dentist to spend some time figuring out what is causing the problem. The treatment for sensitive teeth ranges from brushing with a special toothpaste to expensive dental treatments. Prevention is much easier. Avoid soda and acidic foods. Brush gently with a soft toothbrush. Speak with your physician about heartburn and eating disorders, and work with your dentist to decrease grinding and clenching.