Tooth Sensitivity: Causes of Pain and Treatment

Tooth sensitivity is of concern to more than half of our patients to one degree or another.  Tooth sensitivity can be triggered by hot, cold, acidic foods, sweets, or biting. People have varying degrees of discomfort as well as different causes of hypersensitivity. For some people, they may feel a zinger (similar to and electric shock), or perhaps it is more like a dull ache. Others may feel a sensation that is truly painful. The first rule of thumb is that if it lingers for more than 15 seconds (at the same intensity), then the discomfort/pain is not just a nuisance. It is likely a symptom of trauma or deep decay. 

Let’s take ice cream as an example. As soon as the trigger is removed (ice cream) the discomfort should go away. This type of sensitivity is known as dentinal hypersensitivity and is more of a nuisance than anything. It is not a symptom of decay or of a larger problem.  People with gum recession (root exposure) experience this type of hypersensitivity.  Gum recession is most often the result of a patient’s chronic clenching and grinding and NOT from over brushing. Enamel is the strongest substance in the body and it helps to protect the other layers inside of the tooth. The loss of the outer layers of the tooth expose the root surface. When the root surface is exposed, it leaves the pathway to the nerve completely open. The best way to address a patient’s discomfort is with a high strength topical fluoride (such as a fluoride varnish applied in the dental office, or with a high strength fluoridated prescription toothpaste/cream), or with an over the counter sensitivity toothpaste. Fluoride acts as a natural desensitizer as it essentially blocks the pathway that leads to the innermost part of the tooth where the nerve lives. With the pathway blocked, the patient will likely not experience discomfort. Worn enamel (caused by chronic clenching and grinding),and acid erosion (from acidic foods and beverages) can also contribute to this type of sensitivity. 

If the uncomfortable sensation lingers and is more of a true pain (perhaps even has a pulse to it), the tooth is likely cracked, has deep decay, or may have both issues. A cracked tooth needs a crown to remove the pain, but not necessarily a root canal. If the tooth has deep decay as a result of an untreated cracked tooth, a patient would need a root canal in addition to the crown. Cracked teeth are symptomatic based on pain to biting and/or releasing. If you have either of those symptoms, call Dr. King immediately at (757)464-6228 as the pain from a cracked tooth will not go away until the tooth is properly restored. One thing to note is that sometimes a patient’s bite could be off due to an ill-fitting temporary crown or because a newly placed crown may need to be adjusted. It is important to call our office if you continue to experience discomfort, though studies have shown that pain caused by a root canal can sometimes take 30 days to subside.   

Identifying the root cause of the discomfort will help determine how to lessen (or completely remove) a patient’s tooth sensitivity. Research shows that anywhere between 5-57% of the population suffers from dentinal sensitivity, which is simply a general term for “sharp oral pain (similar to an electric shock to the tooth) of short duration in response to stimuli at sites with exposed dentin, which cannot be explained by any other condition.” Discuss this issue with Dr. King or your dental hygienist during your routine hygiene appointments. If the discomfort lingers or does not go away, trauma to the tooth is likely the cause and it can only resolved with restorative work.