At one time or another, drinking or eating something hot or cold can elicit an ‘ouch’ moment. Which leads to frequently asked questions of Drs. Hochberg & Diora: When is tooth sensitivity a problem? What causes it? How can I decrease tooth sensitivity?

Our teeth’s protectors

To understand why sensitivity occurs, it’s helpful to learn a bit about the structure of our teeth. Nerves, blood supply and connective tissues in the center portion of the tooth, called the pulp, are our teeth’s lifeline. Protecting these vital structures from exposure keeps us comfortable when biting into an apple, drinking coffee or even just breathing air. The first layer protecting the pulp is dentin. But that’s not enough – dentin has tiny tubules that transmit hot, cold and pain sensation into the tooth’s ‘inner sanctum’.  When teeth are healthy, the enamel, a substance harder than our bones, covers and protects the portion of the tooth’s dentin that is above the gum line. Similarly, the dentin of our tooth’s root, located below the gum line, is covered by its protective covering called cementum.  It’s when these structures are damaged either from the outside inwards or from an internal disruption that the nerve is alerted. And so are we!


Our teeth’s adversaries (enemies, foes ….)

Dental disease, including cavities, abscesses, internal fractures and periodontal concerns are some of the well-known causes for tooth sensitivity.

  • When a tooth is exposed to hot, cold or even a sugar treat, and there is an internal root fracture, or decay extends into the tooth’s pulp – containing the tooth’s nerves – the nerves respond and let’s us know that there is a problem.
  • When the tooth’s root is exposed, due to recession of the gum tissue, bacteria can develop in the spaces (pockets) where the gums have pulled away from the tooth’s root. Ultimately, the disease process can destroy the bone that supports the root of the tooth.

But, there are other reasons that sensitivity, impacting one or more teeth, occurs.

  • Brushing, flossing & rinsing – In our efforts to maintain oral health we can be contributing to, and even creating, a problem. Hard toothbrushes, or overzealous brushing at the gum line, could not only damage the gum tissue, but also can also cause our gums to to pull away from our teeth, exposing the tooth’s sensitive roots. The solution? Change to a soft toothbrush and use a lighter touch. And, while we all like whiter teeth, there are times we need to use caution when making a toothpaste selection. Some whitening toothpastes are abrasive, which can wear down the enamel, or may contain ingredients that contribute to sensitivity. Then there are our mouthwashes. Though they leave us with a fresh feeling, some contain acids, another potential agent for increased discomfort. Ask Drs. Hochberg and Diora for their recommendations. You may be benefit from the many enamel protecting or desensitizing toothpastes and neutral fluoride rinses.
  • Grinding or clenching – Be it a habit that’s hard to break or a nighttime occurrence, both grinding or clenching place additional stresses and undo pressure the enamel of our teeth. Even though it’s extremely strong, enamel can chip or even wear with these additional forces. Oftentimes, a night guard, also called a mouth guard, or behavioral therapy is recommended.
  • Eating and Drinking Even some healthy choices! – Oranges, pickles, tomatoes, coffee, wine, and sodas– even diet sodas – and the list goes on. Why? Foods that are high in acid can erode the tooth’s enamel. This is why some patients notice a change in their tooth’s color. Wearing away the enamel exposes the dentin, which is a yellowish color, and furnishes a pathway for sensation to reach the nerves. This doesn’t mean we have to give up all of our favorite foods, especially those that are good for us, but we do have to take care. There are a few ways to consume wisely:
  • Avoid sipping acidic drinks throughout the day
  • Eat foods that are high in acid along with foods that are low in acid content, such as: cheeses, whole grains, fish, nuts, vegetables, bananas and many more. These foods are not only healthy, but also they help balance the acid intake along with changing the acid content in our saliva – working to provide protection to the tooth’s enamel.
  • Yes, brush your teeth, but NOT right after eating or drinking acidic foods. Why? While the enamel is exposed to the acid it has a tendency to become softer, and more susceptible to enamel wear from brushing. Drink water and wait – just a bit.


Reducing tooth sensitivity

As you can see, the answers to the questions relating to an ‘ouch’ moment are not always clear-cut. It’s important to advise Drs. Hochberg & Diora of your symptoms, when you notice sensitivity and if the pain or discomfort is localized. Absent dental disease that requires attention, they will review your daily routines and help you answer the question:  Why are my teeth so sensitive?

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