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Nearly 40 million
Americans suffer acute pain and discomfort when biting into a piece of
fruit, eating a salad, drinking hot liquids, brushing their teeth or having
their teeth exposed to cold air. Extreme sensitivity to hot and cold
temperatures or to having your teeth touched is known as “dentin
hypersensitivity.” Dentin hypersensitivity results when dentin, a soft
layer of tissue found beneath the enamel, is exposed. Dentin is made-up of
tubules that communicate with the nerve tissue or pulp. Temperature change
or touch stimulates the underlying nerve tissue and cause sensitivity or
pain. Dentin exposure is directly and indirectly caused by a variety of factors
that include teeth clenching and grinding, incorrect tooth brushing, gum
recession, leaky or decayed fillings, and bacterial build-up. This up-date
letter will highlight certain causes of dentin hypersensitivity, and
discuss the types of treatment available to alleviate sensitivity.
One common cause of
dentin hypersensitivity is teeth clenching and grinding. When an individual
repeatedly clenches or grinds their teeth the enamel on the tooth’s chewing
surface becomes worn leaving dentin exposed. Grinding and clenching can
also cause minute stress fractures in the enamel along the gum line. When
this occurs small portions of the enamel chip away leaving the underlying
dentin uncovered.
Another frequent cause
of dentin hypersensitivity is the use of an incorrect brushing technique.
An incorrect brushing technique will create gum recession and grooves in
the tooth along the gum line. Repeated brushing at the site of the grooves
causes the enamel to become worn through to the layer of dentin underneath
the enamel. In a manner similar to dentin exposure through incorrect
brushing, age combined with tooth brushing will also cause dentin
hypersensitivity. As we age our gums recede causing the tooth’s root
surface to become uncovered and leaving dentin exposed. An improper
brushing technique at the site of the uncovered dentin will cause further
damage by abrading the exposed dentin. Dentin hypersensitivity when caused
by clenching and grinding, incorrect tooth brushing or gum recession is
readily alleviated by using a composite filling at the site of the exposure
to cover up the dentin.
In other instances, dentin
hypersensitivity will signal the existence of a defective or leaky
restoration. When a filling is no longer functioning properly, the dentin
that is normally sealed becomes exposed to bacteria present in an
individual’s mouth. Dentin hypersensitivity often results when the bacteria
invades the uncovered dentin This is known as reversible pulpitis. In such
cases dentin hypersensitivity is simply alleviated by replacing the
defective restoration.
In some cases,
however, a defective or leaky restoration is left untreated in an
individual’s mouth for a long period of time causing the nerve to become
infected and damaged by the long-standing decay. This is known as
irreversible pulpitis. It is important to note that in cases of
irreversible pulpitis, the acute sensitivity to temperature and touch will
often diminish or end entirely. The cessation of pain in such a situation
is the result of the nerve having become so damaged that it has died. Once
the nerve dies, infections or abscesses result and are diagnosed by
swelling or pain when chewing. In other instances there are no initial
symptoms, and diagnosis is made only through an x-ray. Once the pulp
becomes damaged to the point where it no longer functions, a root canal is
necessary to remove the nerve.
Dentin
hypersensitivity can also signal the beginning of periodontal disease. As
gingivitis begins due to bacterial build-up under the gum line, an
individual can experience sensitivity throughout their entire mouth. A
simple cleaning combined with proper home care such as regular flossing and
brushing will alleviate the pain.
It is important to
treat dentin hypersensitivity at its onset. Sensitivity to temperatures and
touch is one way our mouths tell us that something is wrong. An invaluable
component in treating dentin hypersensitivity is to not ignore the symptoms
of pain and discomfort in hopes that the pain will simply stop. As
discussed, dentin hypersensitivity in its beginning stages is readily
treated with a composite restoration or a cleaning. If exposed dentin is
left untreated more serious dental problems can develop. For example, a
consequence of dentin hypersensitivity caused by toothbrush abrasions is
self-inflicted periodontal disease. An incorrect brushing technique will
cause attachment loss between the bone and gum and tooth. Once loss of
attachment develops, periodontal disease has begun and must be treated or
tooth loss can result. In other instances, sensitivity to touch makes
brushing so painful that in many cases individuals simply stop brushing. As
a result, decay develops at the area of exposed dentin and nerve damage
results. When dentin hypersensitivity is caused by bacterial build-up,
failure to reduce the level of bacteria in the mouth and gums will also
result in periodontal disease. Lastly, as discussed, if dentin
hypersensitivity is signaling the existence of a leaky or defective
restoration and the problem restoration is left untreated, decay will
ultimately destroy the nerve.
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