Updated: Oct 15
Having sensitive teeth means that you'll feel discomfort while you're eating, drinking, or using your teeth in any capacity. The sensation can feel sharp and sudden but it could also linger for a couple of minutes afterwards. It doesn't have to affect all of your teeth either because you can have a single tooth sensitivity in lieu of the entire dentition.
This can be incredibly disruptive to the quality of your life when you're forced to stop what you're doing when you experience a sudden bout of extreme tooth sensitivity. After a couple instances of unbearable sensitivity, most people will start avoiding things that they normally find pleasure in doing or having such as eating a cold ice cream cone.
How unfortunate is that? Well luckily for you, we've put together a guide on sensitive teeth that will explain what it is all about and what you can do to stop it and return to enjoying the things that you want to do.
Table of Contents:
Types of Sensitive Teeth
Sensitivity in your teeth can be triggered by a variety of factors and no two persons are alike because they can be sensitive to different types of conditions. Depending on what the trigger is, can give us information about what the possible cause of it is. Once we understand the cause we can come up with a treatment to stop the teeth sensitivity.
Teeth sensitive to cold
This type of sensitivity is when your teeth show strong aversion towards cold foods and cold drinks. Whenever one of these two comes into contact with your chompers, you will feel a sharp sensation that will stop you in your tracks. The discomfort can range from mild to severe depending on the person.
Mild cold sensitivity - Those with the mild condition will feel the food foods but it is not enough to prevent them from eating it.
Severe cold sensitivity - Those with the severe condition tend to avoid all foods that are above room temperature.
Examples of what can trigger cold sensitivity:
Ice cold water
Sucking in cold air
Cannot eat anything straight out of the fridge
The most common cause for your teeth to develop cold sensitivity is gum recession. When the gums recede, it exposes the tooth root which is naturally more sensitive than the enamel, which is not alive. The root of the teeth are normally covered by the gums so they are not use to being in contact with stimuli with varying temperatures.
In addition to receding gums, there are other factors that can trigger it:
Exposed dentin. If one of your filling pops off, that tooth can be extremely sensitive if cold liquids or solids touch it. The dentin is suppose to be either covered by enamel or a dental filling.
Eroded enamel. A diet high in acidic foods can cause enamel erosion because the acidity can dissolve your enamel. This means eating a lot of sour or spicy foods can be detrimental to your teeth. Those who like to bite into lemons will quickly find the enamel of their front teeth eroding away. Aside from diet, health conditions such as Bulimia and GERD can also cause erosion.
Recent dental work. If you've had a new filling placed recently the teeth could be a little traumatized and be hypersensitive to temperature. The sensation should subside after the tooth gets some time to heal.
The primary treatment would be to use a toothpaste that is made for sensitive teeth. The desensitizing agent within it is called potassium nitrate and how it works is by interrupting the ability of the neurons lining the pulp from re-polarizing after firing. Essentially it prevents the nerve from sending pain or sensitivity signals.
However, this toothpaste does take about 2 weeks of use before it starts working because it takes awhile for the potassium nitrate to travel to the pulp. It also takes time for it to build up a sufficient concentration for it to be able to stop the firing of the nerves. Last but not least, you need to continually use the toothpaste so that the concentration around the pulp replenishes, otherwise it loses its effect.
Here is a full list of possible treatments for the cold averse teeth:
Sensitivity toothpaste. The toothpaste helps to prevent the nerves of the teeth from sending pain signals.
Gum grafting. Since the sensitivity is due to root exposure, your dentist can simply regrow the gums and cover it back up.
New filling. Alternatively, your dentist can place a filling over the exposed root surface to prevent outside stimulus from coming into contact with it.
Teeth sensitive to sweets
There are two reasons for your teeth to feel sweet sensitivity and they're both bad news.
Leaking old dental filling. If you have an old cavity filling that is starting to de-bond and leak, it means the inner dentin is being exposed to sweet. Normally with a properly bonded filling, there is no gap for the sweet to enter and come into contact with the dentin. If you're feeling a sensation to sweet, it means there is something wrong with the filling or it is defective.
Small cavity forming. You could have a small cavity that has already started forming. A cavity is literally a hole in your tooth and if you have one, it creates a pathway through the enamel and into the dentin. This allows the sweet to be detected by the nerves in the dentin and therefore causes you a sharp sensation.
Examples of sweet foods triggering a sensation:
Drinking sodas or other sweet beverages
Aside from eating or drinking anything sweet, the teeth are actually not sensitive to anything else. Cold beverages don't bother it nor do acidic foods. The only time you feel discomfort is when your teeth come into contact with irresistible desserts.
Since both of the causes have to do with tooth decay or cavities, the solution would be to get a new dental filling. If it is coming from a leaky filling, you would simply need to have it replaced. If it is coming from a small cavity that is forming, you would need a brand new cavity filling done.
This means that treatment for a tooth that is sensitive to sweets can only be done by your dentist. Therefore if you are feeling this sensation, you should probably schedule your dental check up. You should also stop consuming so much sugar so you don't keep getting new cavities!
Teeth sensitive to acidic foods & drinks
Your teeth can be sensitive to acidic foods only and nothing else. You won't even notice them bothering you the vast majority of time until you have a certain food or drink. The reason you may be experiencing the discomfort is due to low pH and eroded enamel.
Low pH. If eat a lot of acidic foods or drinks very quickly, it can drop the pH of the mouth into an acidic environment immediately. This sharp drop in pH is very inducive to cavity formation and enamel erosion. If you're feeling a sensation from that glass of wine, it means that your enamel may be trying to dissolve.
Eroded enamel. Enamel erosion is a result of being in a low pH environment. Essentially this is damage that was already done from consuming a lot of acidic foods and it'll only keep getting worse if you don't discontinue the dietary habit.
Situations where you may encounter acidic sensitivity:
Drinking wine or alcohol
Very tart salad
Biting into limes or lemons
Very spicy food
The first thing you need to do is to break that dietary habit of consuming a lot of acidic substances and then you need to think about repairing the eroded enamel.
Avoid acidic foods. As much as you like that tart salad dressing or biting into those refreshing lemons, you need to stop. It is not healthy for you and it is destroying your enamel.
Dental bonding. The eroded enamel should be repaired by bondings such as composite fillings or even dental veneers. The layer of bonding or porcelain can cover up the sensitive and exposed dentin. They will act as a replacement for the enamel layer that was eroded away. This can only be done by your dentist and there is no home remedy for it.
Sensitivity toothpaste. If you're not ready for dental treatment, you can use an anti-sensitivity toothpaste in the meantime to at least decrease the discomfort. You may want to look into a hydroxyapatite toothpaste that can build an additional layer that is similar to enamel over the eroded tooth surfaces.
Teeth sensitive when chewing
You may experience sensitivity only when you're chewing. This means that cold or acidic foods will not aggravate it. The only time you will feel discomfort is while you are eating but once you stop eating, it goes away. This condition usually affects a single tooth, which makes it a tooth sensitivity condition.
There could be a couple of reasons as to why your teeth feel sensitive when chewing:
Recent dental work. If you recently had a dental procedure done such as a cavity filling or a new dental crown, your occlusion could be high. This means that you may have an uneven bite because the restoration could be a little bit too big. All you may need is just to have your dentist adjust your bite if that is the case.
Broken filling. If you haven't had any dental work done recently, the sensitivity could be coming from a defective restoration. If you have a filling that is breaking down and needs a replacement, you should do just that, replace it.
Fractured tooth. If the tooth has never had any dental procedures done to it but it feels sensitive when you bite down onto it, you could have a fracture. This is actually called the cracked tooth syndrome where the tooth looks normal but has a fracture somewhere within it.
Depending on what is causing the chewing discomfort, the treatment may vary. It could be minor or it could be extensive such as for the tooth fracture.
Bite adjustment. You will need to see your dentist and have them polish down the high spots or areas of your filling where it is interfering with your bite. After the adjustment it should feel more comfortable to eat and chew on that tooth.
New dental filling. For defective dental restorations, you will need to have them replaced. Once the one filling is in your mouth, the chewing sensitivity should subside.
Tooth extraction. If the tooth is fractured or has a crack that renders it beyond repair, the only option for it would be to have it removed. Afterwards, you should consider options for replacing it with either an implant or a bridge.
Teeth feel sensitive after waking up
If you find your teeth sensitive in the morning when you wake up, you could have a para-functional night time habit such as teeth grinding or teeth clenching. Both of these activities put a lot of stress on not only your teeth but also your entire jaw. You're actively using the TMJ muscles to grind or clench the entire night so when you wake up, everything will feel sore and tender.
The cause for these conditions usually stem from stress in your life. You may be aware of what is causing the stress or you may not be aware of it. Some people grind and clench unconsciously because their body is trying to find a way to relieve stress. It just so happens that they've chosen to take it out on their teeth while they're sleeping.
Night guard. Your dentist can make you a customized night guard that you can wear when you go to sleep. The appliance will protect your teeth from being damaged from all of the teeth grinding. Chronic grinding can wear down the enamel and make the teeth a lot shorter looking.
Yoga and meditation. Participating in these activities can help you relieve some stress by helping you to relax. It can help decrease any pent up stress so that when you do go to sleep, you're not as tense.
Massage therapy. If you're a heavy grinder or clencher at night, the TMJ muscles will be working the entire night. This can result in sore muscles and development of muscle knots within those muscles. That can cause them to spasm can cause you jaw pain if you don't get the muscles into a better condition. Massage therapy can release the knots and help the muscles recover faster.
De-stress. Whatever it is that is causing you stress, you should find ways to minimize or mitigate it. If it happens to a toxic relationship, you may want to reconsider maintaining it. If it is your job, perhaps you should find a new one?
Sporadic and Random teeth sensitivity
If your teeth randomly feel sensitive without anything triggering it, it could mean that you have an unhealthy tooth nerve. Single tooth sensitivity usually indicates a problem with the nerve of your tooth, perhaps the tooth is about to die.
It is not a good sign when sensitivity is not triggered by an obvious stimulus because the diagnosis for that is irreversible pulpitis. Sensitivity that IS triggered by a stimulus is still considered reversible pulpitis. Therefore, if the sensitivity is random and sporadic, the nerve may need treatment.
There are many things that can cause a nerve to be unhealthy and potentially die.
Trauma. If your tooth sustains a heavy impact or force to it, it could die immediately or a few years later. Once the tooth dies it may cause you unbearable tooth pain or it could become dead quietly. The most common reasons for trauma would be a sports injury where you get elbowed in the jaw.
Fillings that are close to the nerve. Even if that cavity filling doesn't reach the nerve, the tooth could still die. The reason is because the pulp may like a certain amount of personal space away from any foreign objects like a cavity filling. If the restoration is too close, the nerve will be constantly irritated and end up being necrotic.
Infection. If you end up with some type of tooth infection, it could end up killing the nerve.
Tooth decay. If you have a cavity and leave it untreated, it could eventually progress into the nerve. Once the cavity eats into the nerve, it may cause you sporadic teeth sensitivity from time to time. Eventually it may just develop into a tooth abscess and cause your face to swell up.
Most of the causes involve an unhealthy tooth nerve or some type of infection, therefore the treatment will have to address that.
Root canal. An unhealthy nerve will need to be separated from the tooth. Afterwards the canal gets filled back in and a dental crown placed over the entire tooth.
Tooth extraction. If the tooth is beyond restoring, it may need to be removed completely instead of just the nerve.
Teeth sensitive when brushing and flossing
Your teeth feel very sensitive when you're brushing and flossing but otherwise they feel fine. Does that mean you should do it less often since it appears to irritate you?
In regards to brushing sensitivity, you may be cleaning your teeth too aggressively or you're using a hard brush. If you're heavy handed while brushing you can damage the gums and cause them to recede. Once the gums recede, it will reveal an exposed root surface which is more sensitive than enamel. In order to rectify this, you should brush with gentle circular motions and if you really don't trust yourself, you should switch to an electric toothbrush. A lot of them have a function where it stops spinning if you press too hard.
For flossing sensitivity, it usually means that you should be flossing more and not less. Most people will feel it if they do it infrequently because the gums are not use to the flossing pressure. Once you get into the habit of flossing multiple times a week, that sensitivity should subside. A bonus perk is that you'll also notice them bleeding less because they become more resilient from all of that flossing!
The Mechanism for Teeth Sensitivity
We will explain the science for how your teeth feel sensitive and it all has to do with smear plugs and dentinal tubules. The surface of our teeth may look solid but it is littered with pores that lead into tubules that go all the way to the nerve of the tooth. The nerve or pulp is where pain and sensitivity signals get triggered.
Here is a picture showing dentinal tubules with smear plugs, clogging up the pores:
Under normal conditions - the smear plugs clog up all of the dentinal tubule openings, thus preventing any stimuli from traveling through it to reach the nerve.
During acidic conditions - the smear plugs have been dissolved by acidic foods or whitening gels, thus opening up the pathway for stimuli to travel through the dentinal tubules to reach the nerve.
Essentially, when the smear plugs are missing, the dentinal tubules are wide open for all types of stimuli to enter and reach the nerve. Once the stimulus gets to the pulp, it will trigger a pain signal and that is when your teeth feel sensitive.
Your lifestyle choices can be hazardous to smear plugs
The presence of smear plugs help prevent the majority of teeth sensitivity but their absence will exacerbate pain and discomfort. You want the plugs to be present and stay put on your teeth because they are the first line of defense against sensitivity.
However, certain lifestyle choices can contribute to dislodging or dissolving the smear plugs and that is a major reason for having extremely sensitive teeth. Here is a list of things that you shouldn't do because they can wreak havoc on the smear plugs.
Aggressive brushing. You can mechanically dislodge the smear layer if you are heavy handed with your brushing technique. You can also injure the gums by brushing too hard and expose the root surface which lacks an enamel layer. Consequently there will be less smear plugs to block out sensitivity.
Acidic foods and drinks. All foods that will drop the pH down to the acidic level, have the ability to dissolve the smear plugs. This includes wine, salad dressings, sweets, spicy foods, sour, and basically anything with a low pH.
Teeth whitening. Whitening your teeth is notorious for making your teeth sensitive because it is one of the most acidic substances that you can put on your teeth. That means it is the most effective substance that can dislodge and dissolve the smear plugs! Even individuals who don't have sensitive teeth will end up with sensitivity after the whitening. On the other hand, those who are already sensitive before the procedure will experience extreme teeth sensitivity after they are done with the treatment.
The effect of an acidic environment on smear plugs and dentinal tubules
When the oral cavity is subjected to acids, detrimental effects occur for the smear plugs and dentinal tubules.
The smear plugs will either get dislodged or dissolved by the acids. This opens up a pathway for the acids to travel through the tubules and trigger pain signals at the nerve of the tooth.
The dentinal tubules become widened and flared out by the acids. This permits the acids to enter the tubules more easily and in greater numbers. It essentially exacerbates the sensitivity level.
Therefore consuming acidic foods is not linearly correlated with teeth sensitivity but rather exponentially correlated. The more of it you consume, the discomfort actually increases by multitudes.
How to fix sensitive teeth
Treatment for sensitive teeth revolve around two principles, recreate smear plugs or prevent the nerve from firing pain signals.
Prevent sensitive teeth from firing pain signals
Essentially what the majority of sensitivity toothpastes do is prevent the nerves of the affected teeth from eliciting pain signals. It accomplishes this feat via the active ingredient called potassium nitrate.
How it works: When you brush with this toothpaste, the potassium nitrate will travel down the dentinal tubules and start accumulating around the pulp of the tooth. Over time as you continue to use it and use it more frequently, more and more of the potassium nitrate will accumulate around the nerve. Once it reaches a certain threshold, it will stop the nerve from firing signals of discomfort.
However there are a couple of caveats:
You need to use it for at least 2-3 weeks before you start seeing effects because it takes time to build up to a sufficient concentration at the pulp.
If you stop using it, the effects will wane because the concentration slowly decreases over time.
What this means is that once you stop using it, the teeth sensitivity will return. It is practically a life sentence once you start enjoying the benefits of a sensitive toothpaste. You can't stop using it!
Replug the dentinal tubules
The vast majority of professional dental products attempt to replug or reclog the wide open dentinal tubules. The idea is based around trying to recreate what the smear plugs did, by blocking the tubules so stimuli cannot reach the nerve and trigger pain signals.
Protein precipitate. There are some dentin bonding materials, such as HEMA/glutheraldehide which act by blocking the tubules through protein precipitation
Calcium oxalate. Other products use oxalate which bind to the calcium in the tooth to form insoluble calcium oxalate crystals. These crystals clog up the tubules.
These products are only available at the dentist and it requires a dental license to purchase. They may be effective but they are still only a temporary solution, similar to potassium nitrate within toothpastes. Once you stop using it, the sensitivity will return.
Due to the fact that it is not permanent, makes it a non-practical treatment because you can't go to the dentist every week to get this desensitizer reapplied. It's much more practical for you to just use a sensitive toothpaste at home instead.
How to stop sensitive teeth pain immediately
If you're experiencing extreme sensitivity during the middle of a meal, there are three things that you should do to stop the sensitivity immediately.
Stop the offending activity. If you're eating or drinking something acidic like a glass of red wine, you need to stop drinking it. If you consume more, it will only make it worse.
Rinse out immediately. Even after you stop consuming it, the acid residues in your mouth will continue to act on your teeth. This is why you should rinse out your mouth as soon as possible to get rid of the acids that may be on your teeth. In fact, the longer that you rinse the better it will be because the rinsing will help buffer the oral environment and make it more alkaline. You can rinse with plain water but try to rinse for 5-10 minutes minimum, the longer the better.
Apply a desensitizing agent. After rinsing, you should apply some sensitivity toothpaste on all of the areas of the teeth that are feeling sensitive. The potassium nitrate within the toothpaste will help with preventing the nerves from firing pain signals. The longer you leave the toothpaste on the more effective it will be. In fact you can try leaving it on for 30-60 minutes.
Currently, the most effective toothpaste for teeth sensitivity and also the least likely to cause gum recession is the Sensodyne Pronamel intensive enamel repair. This is due to the toothpaste having these four qualities:
Potassium nitrate - it contains the desensitizing agent.
Sodium lauryl sulfate free (SLS-Free) - foaming soap that is known for exacerbating pain from canker sores.
Pyrophosphate free - tartar control ingredient that interferes with hydroxyapatite formation. This prevents tartar build up but also prevents smear plugs from reforming.
Very low abrasiveness - this toothpaste is very gentle and has one of the lowest abrasiveness out of all the toothpastes on the market. It has a RDA (Relative Dentin Abrasivity) value of 35, which is considered low because the american dental association considers all toothpastes with a RDA of 250 or below to be safe for use.
If you prefer to use a different toothpaste, you may do so but try to make sure it has similar qualities to the above four characteristics.
Sensitive teeth can be triggered by a lot of different conditions but the most common is to cold. The reason why they feel sensitive is because your lifestyle habits either dislodge or dissolve the smear plugs that block stimuli from triggering pain signals by the tooth nerve. However you can desensitize the teeth by using a sensitive toothpaste but it only works as long as you continue using it!
Last but not least, don't forget to go for your dental check up every 6 months so if you did have any questions, your dentist can answer them.
Author: Written by Dr David Chen, a dentist in long island city.