sensitive teeth

There are very few people who have never experienced that sudden jarring pain following a bite into ice cream or taking a sip from an ice-cold or hot drink.

This article will consider the causes, the dos and dont’s, the prevention and the maintenance of tooth sensitivity (fancy name: dentine hypersensitivity – DHS).

There is a wide variety of dental pains (aren’t we lucky!). If you’re suffering from sensitivity this will be a sharp, instantaneous, short-lived pain, which almost always will have a triggering cause.

DHS can have a detrimental effect on the quality of life. It causes a lot of discomforts, which can lead to a person avoiding particular foods, avoiding toothbrushing (which could lead to other dental conditions such as tooth decay and/or gum disease) and becoming fairly anxious (i.e. being constantly apprehensive about when the next episode will happen).

what triggers sensitivity

• Cold or hot drinks/food
• Eating something sweet
• Cool air
• Bleaching of the teeth
• Metal (e.g. biting on a spoon) (1)

what causes sensitivity

Sensitivity develops due to tooth surface loss, whereby the outside protective layer of the tooth (enamel) is lost and the dentine becomes exposed (which is a very sensitive tooth tissue).

causes of tooth surface loss:

• Damage caused by grinding or chewing (attrition) (2)
• Vigorous tooth brushing and/or using coarse toothpaste (abrasion) (2)
• Eating/drinking acidic food/drinks, regurgitating stomach acid (pregnancy, reflux, bulimia, anorexia) or taking oral medication with low pH (erosion) (2)
• Chipping of the enamel due to the teeth being poorly aligned or weakened because of restoration present (abfraction) (1)

how can you prevent tooth surface loss

• Use fluoride toothpaste. Fluoride strengthens the teeth; therefore making the teeth more resistant to any damaging effects. The ideal concentration is between 1350 and 1500 ppm (this information is displayed on the tube of the toothpaste). (3)
• Try to avoid using abrasive kinds of toothpaste. These include whitening or smokers toothpaste. Try not to fall into the trap of what they promise you. They only lighten the teeth slightly and often it is not worth these minor results if you consider the damage they can cause, due to their abrasive nature.
• Don’t brush too vigorously. If you are thinking of purchasing an electric toothbrush it is worth making sure that it has a pressure sensor (some light up or stop if you are pressing too hard). If you are using a manual toothbrush make sure you are not too overzealous with it. Ideally, choose a manual toothbrush which has soft bristles. (4)
• Don’t brush your teeth straight after eating or drinking (unless it is water). The by-product (acid) produced by the bacteria when we eat weakens the teeth //read my article ‘Is chocolate really bad for your teeth?’ for more explanation//, and if you brush straight after you can scrub away the weakened tooth tissue. (3)
• Don’t eat straight after tooth brushing. Let the fluoride do its magic. In both instances (this and the one above) wait at least 30 minutes to 1 hour in between.
• Spit the toothpaste out. Don’t rinse with anything. The toothpaste residue contains the very important fluoride and if you wash that away it was all in vain. (4)
• Try to avoid eating or drinking anything acidic (e.g. citrus fruits, fruit juices, fizzy drinks, white wine, cider, pickles etc). Preferably have those with meal times. If you want to drink fizzy drinks/fruit juices, use a straw (this way you won’t bath your teeth in them). (2)
• If you have an episode of emesis (vomiting), try to withstand the urge to brush your teeth straight away (the contents of your stomach are very acidic). Rinse your mouth with water or mouthwash. Alternately, you can chew sugar-free chewing gum. Wait at least 30 minutes for your mouth to recover from the acid attack before you brush your teeth. (3)

what can you do if you do have sensitivity

There are a few ways you can manage DHS at home. 

However, sometimes intervention by the dentist or dental therapist deems necessary. 

Some methods are (but not limited to): application of desensitising agents or fluoride varnish, prescription of toothpaste with high fluoride content, placing a filling on the affected area to protect the tooth from further damage and reduce the sensitivity.
Here’s a list of things you can do at home:

• Adhere to all of the above advice to make sure you are not causing further damage to your teeth.
• Use sensitive toothpaste (with the right amount of fluoride content). There are many different types of toothpaste with desensitising properties (possibly the most popular make is Sensodyne). You need to keep in mind, that none of these toothpaste will work immediately (you have to give it about 1 to 2 weeks of consistent use). (2)

Did you know?

Different types of sensitive toothpaste work differently. If you find that the one you use isn’t effective after using it for a while, try to switch to a different make.

• If you have an area of sensitivity you can use sensitive toothpaste as a varnish. Before you go to bed (after toothbrushing) rub a layer of sensitive toothpaste on the affected area and leave it on for the night.
• Use fluoride mouthwash for additional fluoride protection. Make sure you are using it at a different time than toothbrushing. (2)
• Make sure you visit the dentist regularly. Tooth surface loss needs to be monitored carefully, and if necessary (depending on the progress of the damage to the tooth/teeth) the treatment for it will have to be altered.

References

1. Felton, A., Chapman, A. and Felton, S. (2014) Basic Guide to Oral Health Education and Promotion. 2nd edn. Chichester: John Wiley and Sons Ltd.
2. Miller, M. and Scully, C. (2015) Mosby’s Textbook of Dental Nursing. 2nd edn. London: Elsevier Ltd.
3. Public Health England (2017) Delivering Better Oral Health: an evidence-based toolkit for prevention. (Accessed: 20 May 2020).
4. Levine, R.S. and Stillman-Lowe, C.R. (2014) The Scientific Basis of Oral Health Education. 7th edn. London: British Dental Association.

By Hajnalka Takacs
(qualified dental nurse and oral health educator)

N.B.: The author confirms that the content of this article is created solely for educational purposes. The content is for non-commercial use only, and in no ways, the author has gained any financial benefit from the platform it has been uploaded to or from any of the companies mentioned in the text of the article.