When you develop a cavity in your mouth, you notice some discoloration along with the pain. Or, you will feel like a part of your tooth structure is missing.

However, some dental problems clinically don’t show up right away. Since it is difficult for the layman to look for its symptoms, we often end up ignoring it.

Sensitive teeth don’t present with any noticeable change in your teeth, but you feel discomfort when you have something hot, cold or sweet.

Sensitivity is because of the foods we eat, attrition of the tooth and gingival diseases. It is controlled by altering your brushing methods and getting suitable dental treatment.

What is tooth sensitivity?

The enamel is the outermost layer which protects the bulk of the tooth crown. Dentin, which is inner to the enamel contains the dentinal tubules.

When the enamel wears off because of a particular reason, the dentinal tubules become exposed. The tubules have nerve endings which are receptors to pain and temperature.

This is why sensitivity occurs. When you have something hot or cold, the tubules react to it, and you feel a pain or tingling sensation.

In the roots, the cementum plays the same role as that of enamel. As the cementum wears off, you develop sensitivity in your root. Sensitivity is a symptom of gingival disease too. This happens because the gums recede and expose the sensitive roots.

Causes of sensitivity

There are many different causes of tooth sensitivity, most of them linked to faulty habits.

Improper Brushing

When you brush, your dentist always recommends that you use a soft-bristled toothbrush with gentle pressure. If you brush too hard, the abrasive action wears off the enamel from the tooth. This leaves the dentin exposed.

Gingival Disease

Our gums fit onto the teeth at their neck and protect the roots from external agents like strong chemicals in food. When you develop gingivitis, the gums recede below their usual level, exposing the roots. Tooth sensitivity develops as a consequence of this.

Other symptoms of gum disease are bleeding, loose teeth or a foul smell from the mouth. The foul odor is because of tartar build up.

Decay

A decayed tooth means that some part of the tooth may wear off. Even if a thin layer of enamel is lost to decay, you begin to experience sensitivity to hot and cold food.

The decay may look minor to you, but even that much is enough to destroy enamel. If you have a fracture of the tooth, the nerve is exposed, subjecting you to sensitivity. (1)

Diet

The enamel is a superficial layer which receives the particles, pigments, and gases of all the food that we eat. When we drink acidic beverages in excess quantity, the acids attack the tooth and cause enamel erosion. (2)

In this condition, the enamel thickness reduces, and it cannot serve its purpose of protection. The acidic agents dissolve the enamel matrix. Consequentially, the dentin tubules are exposed, and the sensitivity develops.

Citrus fruits, sports drinks, and carbonated beverages also have the same effect on the enamel.

Dental Work

As bizarre as it sounds, temporary sensitivity develops secondary to teeth whitening procedures. When you get your teeth bleached, you feel sensitive for some time.

This happens because whitening removes all the surface debris, making the enamel utterly free of anything that may be blocking the tubules.

Sometimes, other dental work like getting a filling can also lead you to develop temporary sensitivity. However, most often this resolves within two weeks without any treatment. Faulty crowns, incomplete root canals can also cause sensitivity.

Hypomineralisation

In some congenital conditions, the enamel is not mineralized fully. This is termed as enamel hypoplasia. This makes the matrix week since the development of the tooth itself. Hypomineralised enamel makes your teeth more susceptible to sensitivity.

The mineral deficiency can affect a single tooth or multiple teeth. The etiology of this may be uncertain, but it can be because of developmental defects, disorders in a pregnant mother, or anomalies at birth. (3)

Gastric Disorders

Conditions like GERD, bulimia, or frequent vomiting attack the enamel with acids. (4)

In this situation, there is a reflux of stomach acid into the food pipe. The strong acids reach the enamel and cause it to dissolve. The underlying layers of the tooth are exposed, and you develop sensitivity.

Bruxism

Bruxism or night grinding is a habit where a person tends to exert excessive pressure on the teeth while sleeping at night-primarily due to stress. (5) Bruxers will develop sensitivity over time because continuous pressure causes attrition of the enamel.

Symptoms

The symptoms of sensitivity are quite standardized for most people. Sensitivity can affect just a single tooth, a group of teeth or your entire mouth.

As soon as you put something hot or cold in your mouth, the teeth begin to have a tingling sensation or even a pain. This happens because the nerve fibers are conditioned for one kind of response only. The discomfort can persist for some time or normalize when you remove the stimulus.

In severe cases, even drinking water at a regular temperature can give you sensitivity. Other triggers of sensitivity are mouthwashes, cold drinks, sweet food, ice creams and even a wisp of cold air.

Diagnosis

When you visit your dentist with the complaint of sensitivity, he or she will first check the status of your teeth and gums. Since the dentinal tubules are microscopic, it is not always necessary that a clinical sign may be accompanying your complaint.

If the sensitivity is into a single tooth, the dentist will check for any cracks, broken fillings or decay in that tooth. If the clinician feels that unhealthy gums are causing sensitivity, you should go in for cleaning.

The dentist can also use diagnostic instruments to assess for sensitivity clinically. If required, the practitioner takes a radiograph of the affected tooth or the entire mouth.

The intra-oral radiograph, called an IOPA can indicate tooth fracture, attrition, decay or bone loss.

Treatment

The treatment of sensitivity lies in eliminating the causes.

Toothbrushing

If your dentist tells you that your sensitivity is because you are not brushing right, change to a soft-bristled toothbrush immediately. Watch your brushing action, do not exert undue pressure on your teeth or gums for brushing.

If you have a recession in your gums, there are special brushing techniques that you can use. On the advice of your dentist, using a de-sensitizing toothpaste can help too.

Dental Treatment

Sensitivity often takes care of itself if the underlying dental problem is resolved. Gingival recession is managed by scaling. If the gums have receded way below the gum line, then just scaling is not enough.

You may have to go in for gingival surgery, to regain the lost gum level. If the nerve is sensitive because of a faulty root canal, filling or crown, the dentist will re-do the root canal or give you a new crown.

You should get the primary dental problem treated so that the issue of sensitivity disappears.

Keep a hold on bleaching or teeth whitening procedures till the problem resolves. Fluoride varnish is a dental agent that seals the dentinal tubules.

This will block them from receiving the attack of acids. Consult your dentist to get fluoride treatment in the dental clinic. (6)

Improve your Diet

There is a range of foods that you should avoid to tackle sensitivity. In general, don’t consume anything too cold or too hot. Ice, cold drinks and ice creams are some things you should avoid.

Reduce your intake of excessively acidic drinks, sugary food or candies. High carbohydrate foods are not friendly to your enamel. Instead, eat food that is rich in fiber, and food that will keep your mouth moist to fight bacteria. Dairy products are good for this purpose.

Tackle Bruxism

Once you have been with bruxism, work to eliminate that habit. Work on your mental health, and if needed you can wear a night guard for the same.

There are other causes of bruxism that can cause tooth sensitivity too. Find the reason for your night grinding and consult your dentist for treatment.

To wrap up

Tooth sensitivity is a problem that plagues most of us at some time or the other. If it persists despite diet modification, visit your dentist so that you can get rid of the problem before it worsens to an irreversible state.

Extreme tooth sensitivity doesn't present with any noticeable change in your teeth, but you feel discomfort when you eat hot, cold or sweet.