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What Exactly is Tooth Sensitivity?

First of all, how do you differentiate sensitivity (also known as hypersensitivity) of your teeth from dental decay? It's not as straightforward as you think, the best way is to consult your dentist to make sure it is not a decay, and to rule out all other dental diseases.

What you see in local TV commercials when they mention sensitivity of the teeth is actually referring to "Dentine Hypersensitivity".

Anatomy-tooth-dentistsnearby

You may ask, what is dentine?
Dentine is the second layer of your teeth, which is surrounded by the outermost layer of your teeth called the enamel. In "healthy" teeth, your dentine is completely covered by the enamel except for your teeth's roots.
The enamel is harder & denser than your dentine in general.

"Dentine hypersensitivity is characterised by short, sharp pains arising typically when thermal, evaporative, mechanical or osmotic stimuli are applied to the exposed dentin that cannot be explained by any other form of dental defect or pathology."

Exposed dentin in the neck area of the tooth accounts for most of the cases diagnosed as dentine sensitivity.

Also by the definition quoted above, you will normally feel the pain when you consume very hot, or very cold, food (Based on the laws of physics, heat will cause the fluid inside the "tubules" to expand while cold will shrink it); or perhaps when you open your mouth in a cold environment and breathe deeply; or even through the simple act of chewing your food, which exerts pressure on your teeth. These are just a few examples in which you can feel pain.

dentinal-tubules-tunnels

Therefore, exposure of your dentine layer is a predisposing factor to hypersensitivity, which in turn causes you to feel the sharp intermittent pain.

The mechanisms underlying dentin sensitivity have been a subject of interest in recent years in dentistry.

That being said, what are the possible causes of dentine "exposure"?
- Brushing too hard / using the wrong brushing technique
- Consuming too much acidic drinks or food, which wears off your enamel layer
- Gum Recession, where your gums have "shrunk" due to gum diseases
- After certain surgical gum treatments
- Faulty restorations

animated-hypersensitivity-diagram-dentistsnearby

But why does dentine exposure leads to sensitivity of your teeth?
The most widely accepted theory is that your dentine is, in fact, porous, with tiny tunnels if you may; and inside these hollow tunnels are organic fluids. Presume if by any one of the reasons above your dentine is exposed to the environment outside, the fluids in these tunnels will move.
Movement of the fluids will in turn stimulate nerve endings in your pulp that will cause the pain. It is based on this theory that most anti-sensitivity toothpaste is developed.

By the way, this theory is scientifically known as the "Hydrodynamic Theory" developed by Barnstrom & Astron. Hydro = Water, Dynamic = Movements.

What these anti-sensitivity toothpaste do, is block out the exposed tunnels leading to the outside environment, sealing the tunnels and causing the fluid inside it to not move.

dentine-hypersensitivity-dentistsnearby

What are the treatments for dentine hypersensitivity?
They can be divided into 2 categories:
The in-office treatment done by your dentist; or the over-the-counter treatment done via dental dentrifices.

The in-office/clinic treatment:
- Your dentist will identify the areas of dentine exposure, and treat it with:

> Fluoride compounds to form an insulating barrier to cover the exposed dentine.
> Calcium compounds, such as calcium hydroxide, to block out the dentine "tunnels"
> Dental resins to seal the dentinal tubules
> Laser treatments to fuse (close) the tunnels.

Over-the-counter solutions:
- Toothpastes are by far the commonest form of dentifrices:
> Toothpastes containing 10% strontium chloride hexahydrate as a densensitzing agent have been widely available for a long time.

How do you prevent hypersensitivity?
- First of all, brush your teeth with the correct toothbrush, method and technique.
- Try to monitor your dietary intake in regards of acidic food and drinks.
- Be on the safe side and attend regular dental check-ups to deter gum diseases.

Note: This article does not mention about the other theories of hypersensitivity or the role of "Odontoblastic Process" for easier understanding of a lay person. To find out more, feel free to contact the author of this article.

Article written by
Dr. Nicholas Yap - DDS (Mahsa)
Dr. Ng Rou Hui - DDS (Mahsa)

Proofread by
Hong Zhang (Mahsa)



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