What is dentin hypersensitivity treatment and how do you know whether you need it?
Dentin hypersensitivity is a surprisingly common oral health condition, usually caused by exposed dentin. Dentine sensitivity manifest itself as hypersensitive teeth that may react to almost any kind of stimuli with a pain response.
Needless to say, dentine hypersensitivity is extremely unpleasant. We aren’t dealing with a health-threatening condition here, but the discomfort you may feel as a result of dentin hypersensitivity is plenty reason enough to seek treatment.
Dental practitioners are often weary of diagnosing dentin hypersensitivity right off the bat, but rather reach this diagnosis as a result of excluding other possible causes for the dental pain you are experiencing. The reason for this is that dentine hypersensitivity isn’t always visible to the naked eye, and there is no conclusive test you can take to see whether your discomfort is indeed caused by dentin hypersensitivity.
Once your dentist, through the process of eliminating all other potential causes of your pain has diagnosed you with dentin hypersensitivity, the next step is treatment and management of the condition.
In this article, we’re primarily going to be looking at the management and treatment of dentin hypersensitivity, but we will also be looking at how the condition is diagnosed, what might have caused it, and how to prevent it from developing in the first place.
The mystery of dentin hypersensitivity etiology
While there is no doubt about the fact that dentin hypersensitivity is real, dentin hypersensitivity etiology or causation remains a bit of a mystery.
There are several triggers that can set off dentin sensitivity, but what exactly it is that causes your tooth to elicit a pain response when it comes into contact with, say, cold water or a cold air jet from a dental instrument, is unclear.
Over the years, several different theories have been formed, each one seeking to explain why an intact tooth would react with pain to a simple stimuli like air or cold temperature.
The most commonly acknowledged dentin hypersensitivity etiology theory is called the hydrodynamic theory. The hydrodynamic theory holds that pain is felt in the sensitive tooth due to the liquids within the exposed dentinal tubules being set in motion by either thermal, physical or osmotic changes.
To be able to understand what this means, it is important to understand the organic matrix-like structure of dentin.
Unlike the tooth’s outer enamel, the protective layer of dentin that undergirds it is somewhat flexible and shot through with so-called dentinal tubules. These dentinal tubules are microscopic tunnels that radiate outwards from the dental pulp.
As you probably already know, the dental pulp is the soft and sensitive innards of your teeth. The pulp is made up of nerves and blood vessels, and the fact that tiny tunnels lead from the pulp the enamel means that the nerve bundles in the pulp may react to stimuli that doesn’t directly reach or affect the pulp.
Symptoms of dentine hypersensitivity
What are the symptoms of dentin hypersensitivity that you should be looking out for?
Dentin hypersensitivity does what it says on the tin; it causes the dentin layer of your teeth to become excessively sensitive to all kinds of stimuli. In other words, it causes excessively sensitive teeth.
If you are dealing with dentine hypersensitivity, you’ll feel pain as a result of normal stimuli that really shouldn’t be painful. We are talking stimuli like biting into a sour fruit, drinking an iced beverage or even just brushing your teeth.
Dentin hypersensitivity is usually triggered by temperature, pressure, sugary or acidic liquids, or any tool or instrument inserted into your mouth.
You will find yourself dealing with potential triggers every single day. All in all, it is easy to see how dentin hypersensitivity can quickly become an exasperating condition. While you probably won’t need to worry about dental instruments, air jets or electric pulp testers triggering your sensitive teeth on a daily basis, you will still have to eat, drink and brush your teeth.
Here is an overview of the key triggers for dentin sensitivity:
- Hot and cold temperatures
- Air jets from dental instruments such as the ones used for scaling and root planing (deep-cleaning your gums and gum pockets)
- Gastric or dietary acids, and acid-containing liquids used in dental treatments
- Sugary or acidic foods and liquids
- Dental probing with any kind of instrument, including electric pulp testers and examination probes
- Normal toothbrushing
Causes of cervical dentine sensitivity
So what are the potential causes of dentin hypersensitivity, also known as cervical dentin hypersensitivity? Let us cover the most common ones.
Cracked tooth syndrome
Cracked teeth are no joke, and they are just one of many potential triggers for dentin hypersensitivity.
Cracked tooth syndrome is defined as ‘an incomplete fracture of the dentine in a vital posterior tooth. Cracked tooth inevitably involves cracked and damaged dentine, but it may extend all the way into the pulpal nerves, in which case it is going to be even more painful.
The only positive thing to say about cracked tooth syndrome is that the cause is obvious – if your teeth is broken, cracked or fractured, you’re easily able to see what is wrong with it, which means you are much more likely to seek treatment right away.
Noncarious cervical lesions
A tooth doesn’t need to crack to cause you pain. Sometimes, the cervical (also called cementoenamel junction) part of the tooth can sustain lesions that cause the entire tooth to feel sensitive and painful.
Every tooth has a cervical line, which is the part of the tooth just above the gum line where the crown and the root meet on the tooth’s surface. Dentists refer to lesions on this part of the tooth as non-carious cervical lesions, as they only affect the cervical area of the tooth and aren’t caused by dental caries.
In most cases, damaged dentin is able to repair itself if optimal healing conditions are provided, lesions, cracks and chips in the enamel can only be repaired by a dentist.
Dentine hypersensitivity caused by dental wear and tear is typically much harder to spot and identify than sensitivity caused by chips, cracks or lesions.
Dental erosion can is an almost inevitable consequence of using your teeth to bite and chew every day. Over time, biting, chewing and potentially grinding your teeth, can cause the enamel to slowly break down and wear more and more thin, eventually exposing the dentin underneath.
For some, dental erosion happens much faster than it does for others. Whether you wear down your enamel and how quickly you do it depends partially on your genetic makeup (Some simply have stronger teeth than others), and partially on your oral hygiene habits. Your genetics are something you cannot control, but when it comes to maintaining your oral health, the reigns are very much in your hands. Learning how to brush your teeth properly yet gently is vital if you want to avoid developing dentin hypersensitivity.
Teeth whitening is great for aesthetic reasons, but frequently not so great for the health and strength of your teeth.
If you have recently been whitening your teeth and are experiencing excessive dentin sensitivity for the first time, the abrasive chemicals most dental whitening products contain could be to blame.
If you are going to whiten your teeth whether at home or with the help of a dentist, make sure you use a gentle, non-abrasive form of whitening.
Using most teeth whitening formulations is going to weaken your enamel, thereby exposing the dentin underneath and leaving it vulnerable.
Are you brushing your teeth too forcefully or too frequently?
It seems intuitive that the more frequently and the more intensely you brush your teeth, the cleaner and healthier your teeth will be. Unfortunately, though, this really is not the case. Brushing your teeth too much or too aggressively can cause the enamel to wear down much quicker than if you were to brush your teeth the recommend two times daily, and using only gentle pressure.
If you want to optimise your toothbrushing routine, the best thing you can do is to develop the right technique. The best toothbrushing technique is gentle and uses small, circular motions as you move the brush across the tooth surface.
In some cases, a bad case of periodontal (gum) disease might lead to exposed dentin and dentinal hypersensitivity.
When you develop gum disease, the first thing that happens is that your gums become irritated, red and inflamed. They may also start bleeding every time you brush your teeth. If given the optimal conditions to heal, inflamed gums will cure themselves, although they may need a little help in the form of antibiotics and professional deep cleaning of the gum pockets.
If left untreated, gum disease can bring with it all manner of truly unpleasant consequences. One of them is gingival recession, where your gums essentially recede back to expose the roots of your teeth. Where your teeth roots were previously covered and protected by your gums, they are now much more vulnerable to developing both decay and tooth sensitivity.
Treatment of cervical dentin hypersensitivity
What is involved in treating dentin hypersensitivity, and is there any particular treatment that is capable of completely curing dentinal sensitivity?
If you are suffering from dentin hypersensitivity, the first step towards getting the treatment you need is booking an appointment with your dentist. Your dentist will be able to see and access what is really going on, and will be able to rule out other causes for your dental pain. In some cases, it may turn out that you have a cavity somewhere that you were not aware of, or that your gums have become sore and inflamed.
Once other potential sources of dental pain have been ruled out, your dentist will then proceed to suggest a suitable course of treatment.
Give it two months
If your dentin hypersensitivity is caused by any kind of dental or periodontal damage, it is pretty clear that this underlying cause will have to be treated sooner rather than later. However, if there is no clear reason for the dentin hypersensitivity affecting you, your dentist may recommend that you give it a little bit of time before proceeding to laser or other forms of treatment.
The reason for this is that up to 45% of cases of dentin hypersensitivity without dental damage resolve themselves within a month or two of the symptoms developing. In other words, there is a rather good chance that you are among that nearly 50% for whom no further treatment is necessary.
Up your oral hygiene game
While you are waiting to see whether your dentinal hypersensitive is going to resolve on its own, you cannot go wrong with going over your oral hygiene habits with a fine-toothed comb in order to determine whether there is anything here that can be improved.
Tooth and root sensitivity are often symptoms of poor oral hygiene habits or alternatively of overly enthusiastic toothbrushing. You can prevent your enamel wearing thin by switching to a soft-bristled toothbrush and using a fluoridated toothpaste.
Use fluoride and potassium containing toothpastes
Before reaching for more heavy-handed or invasive forms of treatment, your dentist will usually start off by suggesting that you try switching to a toothpaste that is high in fluoride and minerals.
The best toothpastes for promoting remineralisation of teeth are toothpastes containing potassium salts and fluoride.
Laser (light) therapy can be used to either numb or heal dentin sensitivity by sealing off the painful area.
Laser treatment for dentin hypersensitivity works by a laser being aimed at the affected tooth. The laser produces a narrow, focused beam that is applied directly to the painful spot. Depending on the type of laser being used for the treatment, it can be used to either seal of the dentinal tubules or numb them so that no more pain will be felt by the tooth in question.
To get rid of dentinal hypersensitivity permanently.
Calcium carbonate is most frequently used as a dietary supplement in cases where the diet does not contain enough calcium. However, calcium carbonate can also be applied directly to the exposed dentin surfaces to seal off the dentin tubules and thus limit dentinal sensitivity.
Periodontal therapy and periodontal surgery
Periodontal treatment heals many ills.
In some cases, either non-surgical periodontal therapy or periodontal surgery may be needed to alleviate the pain caused by dentinal hypersensitivity. This is the case where gum disease is at play and the gums have receded to leave the cervical dentin part of the tooth or even the roots exposed.
Whether you will need periodontal therapy, which is really an umbrella term for any conservative, non-surgical treatment of gum disease, or gum graft surgery is going to depend on how far progressed your gum disease is, and on how far your gums have retreated.
If your gum disease hasn’t progressed very far, upgrading your oral hygiene habits and keeping your teeth and gums free of plaque buildup is usually enough to allow your gums to soothe and heal themselves. Periodontal therapy frequently includes a type of professional deep-cleaning of your gums called scaling and root planing.
However, in periodontal patients where the disease has already progressed to a more severe stage and you have lost a significant amount of gum tissue, you might have to get a gum graft to replace the tissue that has been lost.
Gum surgery sounds grim, but it is carried out by a type of expert oral surgeon called a maxillofacial surgeon. Maxillofacial surgeons are highly trained and specialized dentists whose areas of operation include the gums and other tissues within the mouth.
A gum graft is usually much smaller than you would imagine and is taken from a healthy part of your mouth and moved to where it is needed. If allowed to heal properly, a gum graft can cover exposed dentin surface and prevent the pain and irritation caused by sensitive dentin.
Management of dentin hypersensitivity
Treating dentin hypersensitivity is important, but so is managing the pain you experience while either waiting for your treatment or waiting for the steps you have already take to take full effect.
Management of dentin hypersensitivity can be achieved in a number of ways. Here is an overview over the most important ones.
Dentin desensitizing agents are frequently used to lessen the intensity of dentin sensitivity pain.
Desenitizing agents are available in many forms, including toothpastes, mouth senses and chewing gums. Many desensitizing toothpastes use potassium salts, which are also helpful for remineralizing and strenghtening your teeth.
Fluoride gel is a great at-home treatment option when you want to quickly reduce the discomfort you are experiencing while also supporting your teeth to heal and remineralize.
The best way to apply high-strength fluoride gel to your affected teeth is by first applying the gel to dental trays and then wearing the trays for 10-2o minutes.
Prevalence of dentin hypersensitivity
It might surprise you to learn that the prevalence of dentin hypersensitivity is extremely high. Dentin hypersensitivity is a very common dental issue and cause of dental pain, as exposed dental surfaces are exceptionally common.
Even if you take excellent care of your oral health and hygiene, there is a fairly high chance that you will experience dentine hypersensitivity at last once in your life. After all, you use your teeth to bite and chew every single day of your life, so your teeth are seeing a lot more action and withstanding a lot more than you may be giving them credit for.
Frequently asked questions
Can you get rid of dentin hypersensitivity?
Yes. Fortunately, dentin hypersensitivity is usually relatively easy to treat and cure.
In some cases, you may not need any treatment at all, as dentine hypersensitive can sometimes resolve on its own. Having said that, effective treatments are also available if your sensitivity does’t naturally go away.
Laser therapy has become a popular treatment of dentin hypersensitivity as it is both quick and permanent. In laser therapy, a small and pointed laser beam is aimed at the painful area on the tooth and the force of the beam is used to fuse or occlude dentin tubules which are responsible for transmitting the pain response. The result? The pain response that characterises dentine hypersensitivity has effectively been shut down.
Another popular and straight-forward treatment option is getting a sealing agent applied to the surface of the affected tooth or teeth, also with the purpose of sealing off the dentin tubules and eliminate the pain.
How do you treat dentine hypersensitivity?
There are numerous different treatment options if you have dentin hypersensitivity. Which treatment option is right for you is going to depend on whether or not the excessive levels of sensitivity you are experiencing have an underlying cause that has to be treated first, and how severe the pain levels are.
In up to 45% of cases where no dental defect or damage is to blame, dentinal hypersensitivity resolves on its own within one to two months. In other words, if your dentist isn’t able to easily identify a cause for your sensitivity, he or she is likely to suggest that you give it a month or two before proceeding with any treatment that is more invasive than improving your toothbrushing technique and switching to a more suitable toothpaste.
How long does it take for dentin hypersensitivity to go away?
If your dentin hypersensitivity isn’t caused by actual damage to your tooth, such as dental wear and tear or a crack or chip in your tooth, you may be among the lucky 2o to 45% for whom dentinal hypersensitivity goes into spontaneous remission within 4 to 8 weeks.
Even if your dentine hypersensitivity does not resolve naturally, it is possible to make it go a way both quickly and permanently. Using either a pointed laser beam or a sealing agent, your dentist will be able to occlude or fuse the dentin tubules, which essentially are the avenues through which a pain response can be transmitted from your pulpal nerves. Once these tubules have been sealed off, the pain is going to stop immediately.
What are the 2 goals for treatment of dentinal hypersensitivity?
Dentists have two important goals when treating dentinal hypersensitivity in patients.
The primary and most immediate goal is to target and eliminate the pain. This goal is usually achieved by either applying a sealing agent or fusing the dentinal tubules together. This has the effect of limiting or fully eliminating the pain response that is being transmitted.
The second goal is to remineralise the teeth and strengthen the dentin. When your dentin is strong and well protected, you are much less likely to develop hypersensitivity.
Your dentist will advice you on how to encourage remineralization of your teeth. Usually, this process will see you learning how to brush your teeth more gently, and switching to a toothpaste that is rich in fluoride and minerals.
Conclusion: Is there a cure for dentin hypersensitivity?
The first step to getting the correct treatment for dentin sensitivity is diagnosis and management of your symptoms. Your dentist can only reach the diagnosis of dentinal hypersensitivity through the process of eliminating other possible explanations for the excessive sensitivity levels you are experiencing.
The good news about dentinal hypersensitivity is that it is usually rather easy to treat and fully heal. If there is clear underlying cause, such as a cracked tooth or gum recession caused by periodontal disease, these will have to be treated first and foremost.
When treating dentine hypersensitivity, your dentist has two key goals. Most importantly, he or she will aim to reduce the pain symptoms you are reporting by targeting the pulpal nerves directly. This can be done either by applying a sealing agent to the affected tooth surface, or by fusing the dentinal tubules together using a laser beam to reduce dentin permeability. This has the effect of preventing your teeth from transmitting their ongoing pain response.
Once the pain response has been successfully dealt with, a secondary goal is to remineralise the dentin so that you don’t develop the same symptoms again. This secondary goal is usually up to you and has to do with you brushing up on on your oral hygiene habits and switching to a potassium and fluoride rich toothpaste.