Sensitive teeth: Sore no more

Rarely do we come across a person who does not enjoy ice-cream. But what if your teeth experienced a painful sting every time you had a bite of your favourite flavour? Wouldn’t be fun, would it? Tooth sensitivity is a condition that affects many and can prevent you from relishing the foods you love. So what causes this sensitivity and what can you do about it?

Why do your teeth sting?

Sometimes a tooth, which is otherwise healthy, becomes vulnerable to temperature changes. You get a sharp pain which, depending on the severity of the condition, may be only for a second or could linger on for a couple of minutes. The stimuli could be foods such as ice-cream, aerated beverages or even the simple action of rinsing your mouth with cold water in winter!

The tooth is made up of several layers. The topmost layer or visible white coating is called enamel. It is highly mineralised and protects the inner structure from the assault of bacteria and the acids in your saliva. The enamel, however, is brittle and highly prone to wear and tear.

Below the layer of the enamel is dentin, which is slightly yellow in colour. Dentine is not as hard and is made up of nerve endings emerging from the centre of the tooth. At the neck of the tooth near the gum line is a thin layer called cementum. This is harder than dentin but is more easily eroded than enamel.

Tooth sensitivity happens when the enamel or cementum wears away and exposes the dentin to the attack of the fluids in the mouth. The nerve endings in the dentin quickly respond to temperature changes and also to sour or sweet foods, and this reaction gets perceived as pain.

How does it all begin?

There are various ways the enamel or cementum could wear away.

• Firstly, this could be a part of the normal ageing process. Hence the loss of protective enamel is commonly seen in older people.
• Overzealous brushing of teeth, use of a hard-bristled tooth brush, the wrong brushing technique and abrasive toothpastes can also cause physical trauma to the structure of the tooth.
• Habits like chewing tobacco or betel nut in which the teeth are continuously rubbing against each other could be another factor.
• Clenching or grinding the teeth during sleep [bruxism] can also damage the enamel.
• Consuming excessive amounts of sour or acidic foods, fizzy beverages and chronic acidity or vomiting also cause the dissolution of enamel coating.

What you shouldn’t be doing

Here’s an example of how a bad case of sensitive teeth was made worse by sheer negligence. Recently, a woman in her mid-40s visited my clinic with a complaint of overly sensitive teeth, so sensitive that even drinking water kept at room temperature triggered the pain. She had a history of acidity and frequent episodes of regurgitation of food, so she used to suck on lemons to get some relief from the vomiting. One day, she observed her teeth were looking yellow so she started brushing thrice a day to take care of the yellowness. The discolouration never went away and, in due course of time, her teeth became hypersensitive.

In this case, the continuous contact with acids thinned the enamel and the underlying yellowish dentin started showing through. To make matters worse, the excessive force used while brushing continued to affect the structure of the tooth resulting in tooth sensitivity. The problem was that she sought help too late—only when she realised that drinking water at normal temperatures stung too.

Other causes and factors

Temporary hyper-sensitivity might occur after dental treatments too. For example, after getting your teeth professionally cleaned, getting a deep filling for tooth decay or the removal of braces. Ideally your dentist will inform you in advance about a probable intolerance to cold liquids you may experience for a few days. If the condition persists, it is best to see your doctor for a follow-up.

Sometimes sensitivity might be a symptom of a problem that’s even worse, such as a fractured tooth or tooth decay. The latter involves bacterial invasion and might give rise to infections if left untreated. So it is advisable to get a thorough evaluation done from a doctor rather than a self-diagnosis to find out the exact cause for pain.

How do you treat it?

The problem seems elaborate but the solution can be very simple. The right toothpaste can play an important part in dealing with sensitivity. Not your normal everyday toothpaste though but ones that are specifically designed with sensitive teeth in mind. You should switch to such a toothpaste the moment you notice your teeth are aching after eating or drinking certain foods. Using them regularly can nip the issue in the bud and prevent the condition from getting worse.

Depending on the kind of ingredients present, a toothpaste meant for sensitive care will have a different effect on the teeth.

If the active element is potassium nitrate, it works by numbing the pain and desensitising the nerve. It does this by having minuscule particles or ions of potassium penetrate the dentine layer. This then reduces the pain by getting in the way of pain signals from the nerve going anywhere near the brain.

All of us know about the positives of using fluoride toothpastes but if they happen to have a particular kind of fluoride called stannous fluoride, we would benefit even more. When we use this, the ions react with the dentine and create a layer on top which helps build the enamel back and also protects the tooth from the effects of acidic foods. As an additional benefit, it even kills bacteria in the mouth.

The latest development is the emergence of toothpastes containing calcium sodium phosphosilicate, which work by actually replacing the dental layer that’s worn away. It does this by providing calcium and phosphate that the body uses to create a layer over the tubules [just like the original enamel once did] and protect the dentin that was exposed before. The kind of toothpaste you use will depend on how advanced your sensitivity problems are. But whichever kind you opt for, brushing with it two times a day is a must to get rid of your hypersensitivity and pain.

If things get really bad

If after six weeks of using a sensitivity relief toothpaste, you see no improvement, consult your dentist, who might suggest having your teeth coated with a fluoride varnish. The worst-case scenario would be to have the tooth undergo root canal treatment or get a cap fitted to totally mask it from oral stimuli that might cause it pain.

Tooth sensitivity can be an irritating condition. However, with patience and timely advice, it can be cured. Seek the right treatment and it won’t be long before you welcome your favourite ice-cream flavour back into your life!

This was first published in the August 2013 issue of Complete Wellbeing.