Tooth sensitivities

Tooth sensitivity, medically known as dentin hypersensitivity, is a common dental condition characterized by short, sharp pain arising from exposed dentin in response to external stimuli such as thermal, tactile, osmotic, or chemical triggers.

It commonly occurs due to:

• Tooth attrition (tooth wear)

• Abrasion from aggressive brushing

• Gingival recession

• Enamel erosion

• Periodontal disease

The condition affects approximately 10–30% of adults worldwide, most commonly between ages 20–50 years, particularly involving cervical areas of canines and premolars.

Pathophysiology

The most accepted explanation is the Hydrodynamic Theory proposed by Brännström.

Mechanism

1. Loss of enamel or cementum exposes dentinal tubules.

2. Dentinal tubules communicate directly with pulp nerve endings.

3. External stimuli cause rapid fluid movement within tubules.

4. Fluid shift stimulates mechanoreceptors in the pulp.

5. Sharp, short-lasting pain occurs.

Stimuli capable of triggering pain include:

• Cold air

• Hot or cold drinks

• Sweet or acidic foods

• Tooth brushing

• Dental instruments

Factors contributing to dentin exposure:

• Gingival recession

• Acid erosion

• Occlusal stress

• Periodontal therapy

• Aging-related tissue loss

Signs and Symptoms

Common clinical features include:

• Sudden sharp pain lasting seconds

• Pain triggered by cold or hot beverages

• Pain during tooth brushing

• Sensitivity to sweet or acidic foods

• Discomfort when breathing cold air

• Localized pain affecting specific teeth

Characteristics of Hypersensitivity Pain

• Rapid onset

• Short duration

• Non-spontaneous

• Stops after stimulus removal

Diagnostic Criteria

Diagnosis is clinical and based on exclusion of other dental diseases.

Essential Diagnostic Features

• Sharp pain from exposed dentin

• Pain provoked by thermal or tactile stimulus

• No spontaneous persistent pain

• Absence of caries or pulpal pathology

Differential Diagnosis to Exclude

• Dental caries

• Cracked tooth syndrome

• Pulpitis

• Defective restorations

• Post-restorative sensitivity

• Tooth fracture

• Periodontal abscess

Investigation

Clinical Examination

• Visual inspection for exposed dentin

• Gingival recession assessment

• Tooth wear evaluation

• Air blast sensitivity test

• Explorer tactile stimulation

Radiological Investigation

Not routinely required but indicated to rule out:

• Dental caries

• Periapical pathology

• Pulpal disease

• Root fracture

Investigations include:

• Periapical X-ray

• Bitewing radiograph

Treatment

Management focuses on:

• Eliminating underlying cause

• Blocking dentinal tubules

• Reducing nerve excitability

Non-Pharmacological Management

Identification and Correction of Cause

• Modify brushing technique

• Treat periodontal disease

• Correct occlusal trauma

• Manage acidic diet exposure

• Replace defective restorations

Home-Based Management

Recommended measures:

• Use soft-bristled toothbrush

• Brush using modified Bass technique

• Avoid aggressive brushing

• Limit acidic foods and beverages

• Avoid tooth whitening overuse

Desensitizing Agents

Patients should brush twice daily using:

• Potassium nitrate toothpaste

• Stannous fluoride toothpaste

• Strontium chloride toothpaste

Fluoride gel application every 12 hours may enhance tubule occlusion.

Professional Dental Management

When symptoms persist:

• Fluoride varnish application

• Dentin bonding agents

• Glass ionomer restorations

• Resin sealants

• Laser therapy

Advanced cases may require:

• Surgical gum graft (for recession)

• Root canal treatment when pulpal involvement develops

Pharmacological Management

Routine systemic medication is not required.

According to Tanzania STG:

Analgesics may be used temporarily if pain severe:

• Paracetamol 500–1000 mg every 8 hoursOR

• Ibuprofen 400 mg every 8 hours

Antibiotics are not indicated unless infection exists.

Prevention

Primary Prevention

• Proper oral hygiene education

• Use of fluoridated toothpaste

• Avoid excessive brushing force

• Reduce acidic dietary intake

• Regular dental visits

Secondary Prevention

• Early treatment of gingival recession

• Management of tooth wear

• Treatment of periodontal disease

• Monitoring after scaling and root planing

Tertiary Prevention

• Restoration of cervical defects

• Occlusal adjustment

• Periodontal surgery where necessary

Patient Education

Patients should be advised:

• Sensitive teeth are treatable

• Use desensitizing toothpaste continuously (minimum 2–4 weeks)

• Do not rinse immediately after brushing

• Avoid brushing immediately after acidic drinks

• Seek dental care if pain persists

Prognosis

Excellent when underlying causes are corrected.

Most patients experience symptom improvement within 2–6 weeks of appropriate therapy.