An exposed tooth nerve is a painful dental condition because the nerve is not used to being openly stimulated. Under normal circumstances, the tooth nerve is insulated from external stimuli due to various layers of tooth structure protecting it.
The pulp is located in the middle of the tooth with the enamel and dentin protecting it above the gum line. Below the gum line, the nerve has the gums, alveolar bone, and cementum insulating it from stimuli.
As you can imagine, if a layer that is normally not supposed to be exposed to sensations suddenly becomes exposed, it will be painful. Just the thought of something touching the raw tooth nerve already hurts. Imagine hot soup coming into direct contact with your nerve.
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There are many signs and symptoms which may indicate that you have an exposed nerve. The most prominent ones would be tooth nerve pain, discomfort, and sensitivity.
How it looks
Hole in your tooth
Longer looking tooth
Eroded or missing enamel
Exposed root surface
How it feels
Sharp pain when stimulated
Sensitive to cold and hot
Discomfort eating and drinking
Non-painful when unprovoked
The tooth nerve becomes exposed when its protective layers are damaged or missing. These injuries may come from above the gum line or below it.
Tooth decay. Untreated cavities will make its way through the enamel, dentin, and ultimately the pulp.
Gum recession. Gingiva that is prone to receding will leave the root nerves exposed.
Aggressive brushing. Brushing too hard with a hard bristled brush can damage the gums and cause them to shrink.
Enamel erosion. Acidic foods like sour and spicy can erode the enamel, thus exposing the more sensitive dentin layer.
Teeth grinding. This parafunctional night time habit will grind through the protective layers of your teeth.
Broken tooth. Biting into hard foods can damage your teeth by chipping them.
Missing restoration. A filling of crown that fell off can leave the tooth exposed.
Once the nerve becomes exposed, it won't repair itself on its own. You will require professional intervention to treat it properly.
Depending on the severity of the exposed nerve in tooth, it may be managed with at home care or it may require a dentist.
Mild nerve exposure can be sealed the same way as exposed dentin by using a desensitizing toothpaste. These toothpastes can occlude open dentinal tubules or depolarize the nerve from firing sensitivity signals.
Occluding open tubules
Toothpastes with nano-hydroxyapatite or stannous fluoride can occlude dentinal tubules that may be open by sealing them.
They do so by inserting themselves directly into the orifices of the tubules. The result is a prevention of external stimuli from traveling into the tubules thus blocking nerve sensitivity.
Note: Sodium fluoride toothpaste does not possess this effect, only the stannous version does.
Alternatively, toothpastes which contain potassium nitrate (KNO3) can also desensitize an exposed nerve.
Consistent brushing with KNO3 will flood the extracellular space of the tooth nerve with potassium ions. An overabundance of K+ will disrupt the concentration gradient thus preventing an action potential from firing.
Moderate-severe tooth nerve exposure will require professional dental intervention. Desensitizing toothpaste will be inadequate for alleviating tooth pain for more severe cases.
Dental bonding - damaged or missing tooth structure can be replaced by bonding composite resin to it. That will cover up all of the exposed nerves.
Crown - the most severe cases may require a crown that covers the entire tooth.
Gum grafting - gum recession or root exposure can be treated by doing a gum graft.
Benefit of professional treatment vs at home care
At home care with a desensitizing toothpaste is how you manage the systems. By consistently using the toothpaste you can decrease the sensitivity. However once you stop using it, it will stop working. Therefore this form of treatment is considered temporary in nature.
Treatment with a dentist on the other hand is permanent. You don't have to keep reapplying the bonding, crown, or gum grafting. Once you get it done it should last for years. Therefore the difference between them is the longevity. Professional treatment lasts longer but the downside is that it also costs more.
After you get this condition successfully treatment there are things you should do to prevent it from happening again.
Brush with a desensitizing toothpaste
Maintain good oral hygiene
Use a soft bristled brush
Avoid acidic foods
Regular dental check ups
Wear a night guard if you grind your teeth
When in doubt, always schedule a consultation with your dentist to explore all of your options. Usually if you're unable to manage the symptoms with the toothpaste, it means your condition is more severe than you thought.