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Sensitive Teeth

What about it: Sensitive teeth or simply Tooth sensitivity is tooth discomfort in one or more teeth that’s

triggered by hot, cold, sweet, or sour foods and drinks, or even by breathing cold air. The pain

can be sharp and sudden and can shoot deep into the nerve endings of your teeth. The most

common trigger is cold, with 75% of people with sensitivity reporting pain upon application of a

cold stimulus.

Types of stimuli may also trigger pain in Teeth sensitivity, including:

Thermal – hot and cold drinks and foods, cold air, coolant water jet from a dental

instrument.

Electrical – electric pulp testers.

Mechanical–tactile – dental probe during dental examination, periodontal scaling and

root planning, tooth brushing.

Osmotic – hypertonic solutions such as sugars.

Evaporation – air blast from a dental instrument.

Chemical – acids, e.g. dietary, gastric, acid etch during dental treatments.

The frequency and severity with which the pain occurs are variable

There are two types of tooth sensitivity:

Dentinal sensitivity: normally this occurs when the dentin (middle layer) of a tooth is exposed.

Normally, the dentin is covered by enamel above the gumline and by cementum below the

gumline. Dentine has tiny tubes ('tubules') that lead to the nerve and are filled with fluid. Eating

or drinking foods and drinks that are hot, cold or sweet can cause a change in fluid movement.

This fluid movement causes the nerve endings to react in response, triggering a short, sharp pain.

This causes sensitivity. Dentin becomes exposed when the outer protective layers of enamel or

cementum wear away. Images below

are Cross sections of teeth.

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Pulpal sensitivity: is a reaction of the tooth's pulp. The pulp is a mass of blood vessels and

nerves in the center of each tooth. Pulpal sensitivity tends to affect only a single tooth

What Causes Sensitive Teeth?

Brushing too hard. Over time, brushing too hard or using a hard-bristled toothbrush can

wear down enamel and expose the dentin. It can also cause the gums to recede (the gum

tissue pulls away from the teeth). Also Brushing shortly after acid challenge can cause

the enamel to be more easily worn away, as during this time the enamel is softened and

more vulnerable.

Tooth decay near the gum line.

Recession of the gums. As gums move away from a tooth due to conditions such as

periodontal disease or brushing too hard, the root surface becomes exposed.

Gum disease (gingivitis). Inflamed and sore gum tissue may cause the loss of supporting

ligaments, which exposes the root surface that leads directly to the nerve of the tooth. If

left untreated, gingivitis can lead to periodontitis. Periodontitis is when gum disease gets

worse and damages the tissues and bone that support the teeth. One sign of periodontitis

is sensitive teeth, as the receding gums leave dentine exposed.

Cracked teeth. Chipped or broken teeth may fill with bacteria from plaque. The bacteria

can enter the pulp, causing inflammation.

Grinding. If you grind your teeth when you sleep or during the day, or if you clench your

teeth, you may be wearing down enamel and exposing the underlying dentine layer of

your tooth.

There is decay around the edges of fillings. As you get older, fillings can weaken and

fracture or leak around the edges. It’s easy for bacteria to accumulate in these tiny

crevices, which causes acid build-up and enamel breakdown. See your dentist if you

notice this type of tooth sensitivity between visits; in most cases, fillings can be easily

replaced.

Tooth whitening products. These products may be major contributors to sensitive teeth.

Hydrogen peroxide, in the form of carbamide peroxide, is a tooth whitening ingredient

which is known to cause sensitivity. Speak to your dentist about sensitivity if you are

considering having teeth whitening treatment.

Your age. Tooth sensitivity is highest between ages 25 and 30.

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Plaque buildup. The purpose of flossing and brushing is to remove plaque that forms

after you eat. An excessive build-up of plaque can cause your enamel to wear away.

Again, your teeth can become more sensitive as they lose their enamel protection.

Long-term use of some mouthwashes. Some over-the-counter mouthwashes contain

acids that can worsen tooth sensitivity if you have exposed dentin (the middle layer of the

tooth). The acids further damage the dentin layer. If you have dentin sensitivity, ask your

dentist about the use of a neutral fluoride solution.

Acid erosion e.g. related to gastro esophageal reflux disease, bulimia or excessive

consumption of acidic foods and drinks such as citrus fruits, tomatoes, pickles, and tea,

can cause enamel erosion.

Recent routine dental procedures. Sensitivity can occur following teeth cleaning, root

planning, crown placement, and tooth restoration. Sensitivity caused by dental procedures

is temporary, usually disappearing in 4 to 6 weeks.

Symptoms

Both dentinal and pulpal sensitivity usually involve reactions to temperature or pressure.

Sensitivity to cold drinks or foods is the most common symptom. Less often, the teeth are

sensitive to hot temperatures. If a single tooth becomes sensitive to heat, the tooth's nerve is

dying. In this case, root canal treatment is necessary.

When to See a Doctor about Tooth Sensitivity

While you can often self-treat generalized tooth sensitivity, see your dentist if:

Your teeth are persistently sensitive to pressure.

A single tooth is persistently sensitive, which could indicate that its pulp is infected or

dying.

Sensitivity doesn't decrease after two weeks of using desensitizing toothpaste.

You have dental pain that lasts more than an hour.

The gums around a sensitive tooth change color.

You have any obvious decay.

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Diagnosis

Your dentist will look at your dental history and will examine your mouth. You also will need X-

rays to show if there is decay or a problem with the nerve. The dentist will ask about your oral

habits. Grinding or clenching your teeth can contribute to sensitivity. Your dentist also will look

for decay, deep fillings and exposed root surfaces. He or she may use an explorer — a metal

instrument with a sharp point— to test teeth for sensitivity.

A tooth may be sensitive to cold for several weeks after you get a filling. The metals in amalgam

(mercury) conduct the cold very well, transmitting it to the pulp. Bonded (tooth-colored) fillings

require etching the tooth with acid before the filling is placed. In some cases, this etching

removes enough enamel to make the tooth sensitive. However, advances in bonding now make it

less likely to cause tooth sensitivity.

Your dentist or endodontist can do tests to see if you need root canal treatment.

Epidemiology

Tooth sensitivity is a relatively common condition. Due to differences in populations studied and

methods of detection, the reported incidence ranges from 4-74%.Dentists may under-report tooth

sensitivity due to difficulty in diagnosing and managing the condition. When questionnaires are

used, the reported incidence is usually higher than when clinical examination is used. Overall, it

is estimated to affect about 15% of the general population to some degree.

It can affect people of any age, although those aged 20–50 years are more likely to be affected.

Females are slightly more likely to develop tooth sensitivity compared to males. The condition is

most commonly associated with the maxillary and mandibular canine and bicuspid teeth on the

facial (buccal) aspect, especially in areas of periodontal attachment loss.

Prognosis

Tooth sensitivity may affect individuals' quality of life. Over time, the dentin-pulp complex may

adapt to the decreased insulation by laying down tertiary dentin, thereby increasing the thickness

between the pulp and the exposed dentin surface and lessening the symptoms of sensitivity.

Similar process such as formation of a smear layer (e.g. from tooth brushing) and dentin

sclerosis. These physiologic repair mechanisms are likely to occur with or without any form of

treatment, but they take time.

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Prevention

Gingival recession and cervical tooth wear can be avoided by healthy dietary and oral hygiene

practices. By using a non-traumatic tooth brushing technique (i.e. a recommended technique

such as the modified Bass technique rather than indiscriminately brushing the teeth and gums in

a rough scrubbing motion) will help prevent receding gums and tooth wear around the cervical

margin of teeth. Non-abrasive toothpaste should be used, and brushing should be carried out no

more than twice per day for two minutes on each occasion. Excessive use of acidic conditions

around the teeth should be avoided by limiting consumption of acidic foods and drinks such as

wine, vinegar salad dressings and soft drinks, and seeking medical treatment for any cause of

regurgitation/reflux of stomach acid. Importantly, the teeth should not be brushed immediately

after acidic foods or drinks. A non-abrasive diet will also help to prevent tooth wear. Flossing

each day also helps to prevent gum recession caused by gum disease. Avoid grinding your teeth

or clenching during the day by asks your dentist about a mouth guard for night time use.

See your dentist for regular check-ups, dental care recommendations and advice for your

sensitive teeth.

How to Manage Sensitive Teeth

Treatment

There is no universally accepted, gold-standard treatment which reliably relieves the pain of

tooth sensitivity in the long term, and consequently many treatments have been suggested which

varying degrees of efficacy when scientifically have studied. Generally, they can be divided into

in-office (i.e. intended to be applied by a dentist or dental therapist), or treatments which can be

carried out at home, available over-the-counter or by prescription.OTC products are more suited

for generalized, mild to moderate tooth sensitivity associated with several teeth, and in-office

treatments for localized, severe tooth sensitivity associated with one or two teeth.Non-invasive,

simple treatments which can be carried out at home should be attempted before in-office

procedures are carried out.

The purported mechanism of action of these treatments is either occlusion of dentin tubules (e.g.

resins, varnishes, toothpastes) or desensitization of nerve fibres/blocking the neural transmission

(e.g. potassium chloride, potassium citrate, potassium nitrate).

Home treatment

At-home treatments include desensitizing toothpastes or dentifrices, potassium salts,

mouthwashes and chewing gums. A variety of toothpastes are marketed for teeth sensitivity,

including compounds such as strontium chloride, strontium acetate, arginine, calcium carbonate,

hydroxyapatite and calcium sodium phosphosilicate. Desensitizing chewing gums and

mouthwashes are also marketed.

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Potassium-containing toothpastes are common; however, the mechanism by which they may

reduce teeth sensitivity is unclear. Animal research has demonstrated that potassium ions placed

in deep dentin cavities cause nerve depolarization and prevent re-polarization. It is not known if

this effect would occur with the twice-daily, transient and small increase in potassium ions in

saliva that brushing with potassium-containing toothpaste creates. In individuals with teeth

sensitivity associated with exposed root surfaces, brushing twice daily with toothpaste containing

5% potassium nitrate for six to eight weeks reduces reported sensitivity to tactile, thermal and air

blast stimuli. However, Meta analysis reported that these individuals' subjective report of

sensitivity did not significantly change after six to eight weeks of using the potassium nitrate

toothpaste.

Desensitizing toothpastes containing potassium nitrate have been used since the 1980s while

toothpastes with potassium chloride or potassium citrate have been available since at least

2000.It is believed that potassium ions diffuse along the dentinal tubules to inactivate intradental

nerves. However, as of 2000, this has not been confirmed in intact human teeth and the

desensitizing mechanism of potassium-containing toothpastes remains uncertain. Since 2000,

several trials have shown that potassium-containing toothpastes can be effective in reducing teeth

sensitivity, although rinsing the mouth after brushing may reduce their efficacy.

Studies have found that mouthwashes containing potassium salts and fluorides can reduce teeth

sensitivity, although rarely to any significant degree. As of 2006, no controlled study of the

effects of chewing gum containing potassium chloride has been made, although it has been

reported as significantly reducing teeth sensitivity.

How to use: Brushing at least twice a day with desensitizing toothpaste by soft-bristled brush.

Try putting some of the toothpaste on your finger or on cotton swab and spreading it over the

sensitive spots before you go to bed. Spit, but don't rinse. Within a few weeks, your teeth should

begin to feel less sensitive.

Try a fluoride rinse. Fluoride rinses, available without a prescription at your local pharmacy or

in the dental section of grocery stores, can help decrease sensitivity, especially for people

plagued with decay problems.

How to use: Use it once a day. Swish it around in your mouth, and then spit it out. Sometimes,

people with sensitive teeth need a stronger fluoride rinse or gel than the ones available over the

counter. For example, some treatments for gum disease, such as root planning (which reduces

plaque), can leave sensitive teeth even more sensitive than usual. In such situations, dentists can

apply a fluoride gel that helps relieve the problem.

In-office treatment

In-office treatments may be much more complex and they may include the application of dental

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sealants, having fillings put over the exposed root that is causing the sensitivity, or a

recommendation to wear a specially made night guard or retainer if the problems are a result of

teeth grinding.

Other possible treatments include fluorides are also used because they decrease permeability of

dentin in vitro. Also, potassium nitrate can be applied topically in an aqueous solution or an

adhesive gel. Oxalate products are also used because they reduce dentin permeability and

occlude tubules more consistently. However, while some studies have showed that oxalates

reduced sensitivity, others reported that their effects did not differ significantly from those of a

placebo. Nowadays, teeth sensitivity treatments use adhesives, which include varnishes, bonding

agents and restorative materials because these materials offer improved desensitization.

Low-output lasers are also suggested for teeth sensitivity, including GaAlAs lasers and Nd: YAG

laser. They are thought to act by producing a transient reduction in action potential in C-fibers in

the pulp, but Aδ-fibers are not affected.

Special Desensitizing Toothpaste I choose to discuss!

NOTE: This Desensitizing Toothpaste I selected to discuss is not of matter of advertising

BUT it due to long story of this toothpaste!

Sensodyne is an oral health brand targeted at people with sensitive teeth. Sensodyne products are

applied at home by the patient to treat this condition. Sensodyne is owned by GlaxoSmithKline

and is marketed under the name Shumitect in Japan.

History

Sensodyne is a brand of toothpaste that was first sold by Block Drug, a Brooklyn, New York-

based Company established in 1907 by pharmacist, Alexander Block. The toothpaste was first

marketed in 1961 as desensitizing toothpaste based on a strontium chloride formulation.

In 1980, Sensodyne launched a new toothpaste containing potassium nitrate, a mild local

sedative. In 2000 Block Drug was purchased by GlaxoSmithKline. In 2006, Sensodyne Pronamel

was released and is marketed as toothpaste that protects against the effects of dental erosion.

How Sensodyne Works

Sensodyne toothpastes work in one of three ways to relieve the pain of sensitive teeth.

Depending on the product's active ingredient - Potassium Nitrate, Strontium Acetate, or

NovaMin technology.

Potassium Nitrate: The potassium ion in Sensodyne is believed to soothe the nerves inside the

teeth.

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Clinical studies show potassium nitrate progressively reduces the pain of sensitivity over a

period of weeks. As long as a toothpaste with potassium like Sensodyne is used twice daily in

brushing, the nerve response will gradually be reduced and sensitivity pain is relieved.

Strontium Acetate: Sensodyne Rapid Relief contains strontium acetate, which is similar to

calcium. The strontium in Sensodyne Rapid Relief replaces some of the calcium lost from the

dentine and blocks the exposed tubules in the dentinal tissue. This helps prevent the movement

of the fluid within the tubules in response to a sensitivity stimulus that could otherwise cause

tooth pain.

Sensodyne Rapid Relief: relieves sensitivity pain when directly applied to the sensitive area of a

tooth with a fingertip for one minute. This is because it is formulated to create a physical seal

against sensitivity triggers.

Bioactive glass: Sensodyne contains calcium sodium phosphosilicate (Brand name NovaMin)

which some studies have shown to reduce tooth sensitivity and cause remineralisation.

REFERENCES:

1. Clark, Andrew (October 7, 2000). "SmithKline to swallow Sensodyne". The Guardian. Retrieved July 20, 2013.

2. http://www.gsk.com/products/our-consumer-healthcare-products/sensodyne.html 3. Ramirez, Anthony (May 13, 1990). "All About/Toothpaste; Growth Is Glacial, but the Market Is

Big, and So Is the Gross". The New York Times. Retrieved July 20, 2013. 4. http://adr.sagepub.com/content/21/1/35.full.pdf+html 5. Medical Subject Headings". National Library of Medicine. Retrieved 21 December 2013. 6. Miglani, Sanjay; Aggarwal, Vivek; Ahuja, Bhoomika (2010). "Dentin hypersensitivity: Recent

trends in management". Journal of Conservative Dentistry 13 (4): 218–24. doi:10.4103/0972-0707.73385. PMC 3010026. PMID 21217949.

7. Canadian Advisory Board on Dentin Hypersensitivity (2003). Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. Journal of the Canadian Dental Association 69:221-226.

8. Sensitive teeth. American Dental Association. http://www.ada.org/3058.aspx?currentTab=1 9. Root canal treatment (endodontic treatment). American Dental Association.

http://www.ada.org/5899.aspx?currentTab=1 10. Cleaning your teeth & gums. American Dental Association. http://www.ada.org/2624.aspx. 11. Cunha-Cruz J, et al. Treating dentin hypersensitivity: Therapeutic choices made by dentists of

the Northwest Precedent network. Journal of the American Dental Association. 2010; 141:1907. 12. Do you have a cracked tooth? Journal of the American Dental Association. 2003;134:531. 13. Parolia A, et al. Management of dentinal hypersensitivity: A review. Journal of the California

Dental Association. 2011;39:167.