What is Dentine Sensitivity?
Dentine hypersensitivity is a condition where a person suffers from sensitivity to certain types of tooth enamel. The condition was first described in the 1970’s. Since then there have been many studies which have confirmed the existence of this condition.
The symptoms of dentine hypersensitivity include:
– burning sensation when brushing teeth or eating food with enamel (like some fruits)
– redness, swelling, pain and itching when brushing teeth or eating a food
– discomfort and pain when chewing hard foods.
When the dentin in teeth is exposed, it’s covered with enamel, which protects the inner part of the tooth (dentin). However, when this enamel is lost due to tooth decay or other conditions, the dentin is sensitive to external stimuli.
There is also another type of dentine hypersensitivity called post insertion sensitivity. It is caused by poor-fitting dentures. The metal framework of the denture irritates the nerve endings in the teeth, which triggers a pain response.
Types Of Dentin Hypersensitivity
There are many types of dentin hypersensitivity. These include:
– Occlusal (bite) hypersensitivity. In this condition, the patient has pain only in certain areas of the mouth. The pain is usually triggered by chewing harder foods or sweets.
It’s caused by poorly aligned teeth and severe wear in molar areas. If the patient wears dentures, he or she must have an assessment by a denture therapist to ensure they fit well.
– Whole mouth (generalized) dentin hypersensitivity. This type of the condition is quite common in older people and those who have experienced the wearing down of enamel (for example due to fluorosis).
In this case, the patient has pain in most areas of the mouth. A patient with this condition often has severely worn teeth. The person could experience tooth wear that’s so severe it reaches the dentin.
The condition can be made worse by:
– using a hard-bristled toothbrush
– aggressive brushing technique
– teeth grinding (bruxism)
In this case, the patient would benefit from softer bristles and a gentler brushing approach.
Other causes of dentin hypersensitivity include:
1. Abnormal tooth formation
2. Tooth wear or bruxism (tooth grinding)
3. Worn dentures
4. Certain medications, such as antibiotics, anti-inflammatory drugs and HIV medication
5. Gum disease or injury
6. Poorly fitting dental work such as crowns, bridges and fillings
How Is Dentin Hypersensitivity Diagnosed?
The patient’s medical history and dental history are usually enough to identify the condition. The dentist or hygienist can easily see if there’s wear of the enamel and dentin. A dentist can also use an explorer (a small dental instrument) to feel for exposed dentin.
A blood test can rule out various medical conditions that can cause symptoms similar to dentine hypersensitivity. These include:
1. Low levels of calcium, vitamin D or phosphorus
2. Acid attack of the teeth (discoloration and loss of minerals)
4. Neuromuscular disorders that affect the nerves of the teeth
What Are The Treatment Options?
Dentin hypersensitivity can range from mild to severe. A dentist will decide on the treatment after examining the patient’s mouth and medical history.
Here are some of the treatment options for dentin hypersensitivity:
1. Protective coatings
One way to treat dentin hypersensitivity is to protect the exposed inner parts of the tooth. This can be done with a protective coating such as:
1. Glass Ionomer Cement (GIC)
2. Mineral Trioxide Aggregate (MTA)
Either of these materials are mixed with a solvent and painted onto the tooth. They form a thin, protective layer that sits on the dentin. This protects the nerve inside and stops the hypersensitivity.
The process is relatively inexpensive and has few, if any, side effects. However, it’s only effective in the short-term as the layer will eventually wear away. If that happens, the hypersensitivity returns.
2. Using an fluoride varnish
This treatment involves the application of a fluoride varnish directly to the exposed part of the tooth.
It’s effective in reducing the pain caused by dentin hypersensitivity. The varnish contains a low concentration of fluoride and is painted directly on to the affected area. It forms a protective coating that sits on the sensitive part of the tooth.
The varnish is safe and has few side effects. It can be reapplied as often as necessary.
3. Using a desensitizing tray
A desensitizing tray is made up of a plastic mold that’s filled with a gel or paste. It fits over the patient’s tooth and is designed to be worn at night. When the patient wears the tray, it prevents them from grinding their teeth (bruxism).
The paste in the tray contains various ingredients such as:
1. Amorphous Calcium Phosphate (ACP)
2. Strontium Chloride
3. Potassium Nitrate
These ingredients can reduce or even prevent dentine hypersensitivity. They work by forming a protective barrier over the sensitive part of the tooth.
A desensitizing tray is effective in relieving the pain of dentin hypersensitivity. It can also be used while the patient sleeps to prevent bruxism and further damage to the tooth. The main drawback is that the patient needs to wear it at all times, otherwise the pain will return
Which Is Better: Desensitizing Gels Or Treating With Fillings?
Many dentists use a combination of approaches to treat dentine hypersensitivity.
For example, they may first use a desensitizing gel to provide quick pain relief. They then use a protective coating (such as GIC or MTA) to offer long-term protection.
However, other dentists believe that treating dentine hypersensitivity with a filling offers better results.
They drill a hole into the tooth and fill it with composite resin. This protects the tooth and also offers longer-term relief. The downside is that it involves a small degree of tooth drilling.
What Are The Alternatives?
If the dentist believes that the tooth requires a filling, the patient may wish to consider other options. Here are some of them:
1. Have a root canal treatment instead
In this procedure, the nerve of the tooth is removed. As a result, the patient can’t feel sensitivity anymore. This is an invasive procedure and also has its own risks.
If the patient still feels pain in the treated tooth, they may need to have a dental crown fitted.
2. Have a dental crown fitted instead
A dental crown completely covers the tooth. If a filling has been used to treat a cavity, it will usually be covered with a dental crown. Dental crowns can also be used to cover teeth that are badly chipped or worn down.
3. Consider having dental implants instead
A dental implant is a good option if a filling has been used to cover a badly damaged tooth. Dental implants are artificial tooth roots, and they can be used to anchor a dental crown over the tooth.
What Happens If The Teeth Aren’t Treated?
If the problem of dentine hypersensitivity isn’t treated, there are a number of complications that can develop:
1. Sensitivity remains
If the patient continues to experience dentine sensitivity, there are some long-term effects that can occur. These include:
– The tooth may become increasingly discolored over time.
– A filling may become infected or may fail completely. This will cause the tooth to become increasingly damaged.
– The tooth may eventually become so badly damaged that a root canal treatment is necessary.
2. Swelling of the gums
If a filling fails and results in an infection, the patient may develop a severe gum disease known as periapical periodontitis. This can cause the gums to swell up around the tooth. It can also cause a bad taste in the mouth and pus discharges from the surrounding tissues.
3. Pain when eating
If the tooth continues to be damaged by the exposed dentine, the patient may experience aching pain while chewing food. This pain gets worse over time.
4. Spread of the infection
If a root canal treatment is done to remove part of the nerve, the patient may experience some spread of the infection along the surrounding nerves. This can cause swollen lips and a drooping eyelid. It may also lead to the development of chronic facial pain.
5. Spread of the infection
If the infection spreads through the blood vessels to other parts of the body, it can cause life-threatening conditions such as sepsis and pneumonia.
What Are The Complications Of Treating Dentin Hypersensitivity?
The complications associated with treating dentine hypersensitivity can be broadly divided into two: immediate complications and long-term complications.
1. Immediate complications
The most common immediate complication is the development of a dry socket. This is a painful condition, with the surrounding tissues becoming inflamed. If this occurs, you should contact your dentist immediately.
2. Long-term complications
On a long-term basis, damage to the tooth can occur during the treatment process. This includes damage to the nerve and supporting structures within the tooth. There is also a small risk that the tooth will become discolored after the treatment is complete.
What Should I Know About Dentin Hypersensitivity?
Dentin hypersensitivity is a common condition that can occur after a tooth has had a filling or root canal procedure. If it is left untreated, it can cause pain and discomfort to the patient. The condition can be treated using a filling or a root canal, but there is always a risk that complications may occur. It is also important to remember that root canal procedures cannot be performed on baby teeth, so it may be necessary to have a tooth removed if the condition is left untreated.
How Are Dental Implants Placed?
Dental implants are a great option for people who have lost teeth and want to replace them. However, dental implants are not right for everyone. Implants can only be used to replace single or multiple missing teeth. They cannot be used to anchor dentures. They are also not recommended if you have severe bone loss or an infection in the jaw. Your dentist will help you determine if dental implants are right for you.
Before having dental implants placed, you must have adequate jawbone density. This means that the bone in your jaw must be thick enough to support an implant. You also need to take care of your gums and teeth to help ensure that there is enough bone to support dental implants.
How Do I Know If I Have Enough Jawbone Density?
If you had bone grafting done in the past, your dentist can determine if the jawbone is dense enough to support a dental implant. The dentist will check the records to see if you had the procedure 5 or more years ago. If this is the case, then the bone grafting is usually successful enough to place implants.
Your dentist will also examine the jawbone to see if it is dense enough to support an implant. He or she will press a hole into your jaw with a finger. If the jawbone completely closes over the hole within 2 seconds, then you have enough bone to support a dental implant.
If you do not have enough bone to support an implant, there are a few things you can do. You can have a bone grafting procedure to thicken the jawbone. You can also choose a different tooth replacement option, such as a bridge or denture.
How Do I Care For My Implant?
Dental implants require special care to help keep them strong and healthy. Your dentist will give you strict instructions on how to care for your implant and the surrounding implants. You should follow these instructions carefully for optimal results.
If you have missing teeth, talk to your dentist about dental implants. They are a great solution to help you smile with confidence.
If you have any questions about dental implants & sedation, or would like to schedule an appointment, please contact us or book an appointment online.
Sources & references used in this article:
- Managing dentin hypersensitivity (R Orchardson, DG Gillam – The Journal of the American Dental Association, 2006 – Elsevier)
- Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. (… Advisory Board on Dentin Hypersensitivity – Journal (Canadian …, 2003 – ncbi.nlm.nih.gov)
- Etiology of dentin hypersensitivity. (M Brännström – Proceedings of the Finnish Dental Society. Suomen …, 1992 – europepmc.org)