Drill and fill? Not always

PEARLS OF WISDOM

‘Oooh, aaah, ouch’! These expressions of pain are commonly seen in TV commercials for toothpaste, in which a model with sensitive teeth shrieks while drinking something cold or slurping on an ice-cream. Although it may be yet another advertisement for just another toothpaste, it could very well be your own sorry story. Sensitive teeth are a very common problem.

Actually, ‘sensitive teeth’ is a misnomer for the electrifying, stinging sensation that someone with this condition experiences when eating anything cold or hot.

Consuming cold or hot foods, beverages, sweets, or anything acidic like a soda pop, can trigger the pain, which, in medical parlance, is called ‘dentin hyper-sensitivity’.

It generally happens when the roots of the teeth are exposed due to many reasons. But, there’s no need to spend sleepless nights, worrying about tooth sensitivity, because this is a treatable condition.

It is important to know the anatomy of teeth in order to understand how and why this condition occurs.

Teeth are made up of a hard tissue casing, which encloses a ‘pulp’ organ, containing sensitive nerve tissue. The hard-tissue cover of the tooth is made up of an outermost layer of enamel on the crown and cementum on the root. Beneath this outer hard tissue there is relatively softer ‘dentin’, which surrounds the underlying pulp in both the crown and root of the tooth. Dentin is made up of numerous small dentinal tubules, which provide a direct pathway to the pulp. When these tubules get exposed, due to loss of the overlying hard-tissue cover, stimuli like cold water, a blast of cold air or sour food can stimulate the pulpal nerves and result in agonising pain.

Triggering trouble

*Poor dental habits: Brushing too hard or brushing for too long, and use of tooth powder or coal powder can wear away the enamel. Overzealous brushing is associated with wedge-shaped defects on the teeth, specifically near the gum-to-tooth junction. Such defects are commonly observed on the left side of the mouth. As most people are right-handed, they tend to brush teeth on the left side of the mouth rather vigorously!

*Dental erosion: This is characterised by the loss of tooth enamel, caused by attacks of acid from food and drink. It leads to exposure of dentin and enhances sensitivity.

*Gum recession: Gums may naturally recede (shrink), exposing the roots of teeth, leading to sensitivity.

*Gum disease: A build-up of plaque or tartar can cause the gums to recede, resulting in enhanced sensitivity.

*Tooth grinding: This is a habit which involves clenching and grinding teeth. It can cause the enamel of the teeth to wear away, making the teeth very sensitive.

*Bleaching: Some individuals experience sensitivity for a short duration of time when having their teeth bleached.

Sensitivity may also be caused by a cracked tooth or filling, or due to excessive attrition (wearing away of enamel due to friction). Nocturnal gastro-esophageal reflux disease (acid reflux), where stomach acid can reach the teeth and cause enamel loss and prevent re-mineralisation, also causes sensitivity. Canines and pre-molars are the commonly affected teeth.

Treatment

In mild cases: Correct method of brushing, avoiding acidic food, maintaining oral hygiene, avoiding use of abrasive toothpaste, gentle brushing and flossing, and avoiding use of toothpicks help control the condition.

Dentists recommend the use of medicated toothpaste or mouthwash, which contain active ingredients like salts of potassium, calcium or strontium.

These ingredients, called ‘desensitising agents’, work either by forming a physical barrier blocking the stimuli or by inactivating the nerve transmission pathway.

Treatment with desensitising agents constitutes home therapy. This is recommended for about two or three weeks.

In moderate cases: Home therapy is advised, except that it should be continued for three to six months.

In severe cases: In addition to this basic treatment at home, the patient is advised to visit his/ her dentist, who can either fill the exposed defect or seal the area with a suitable material. Materials and techniques to treat teeth hyper-sensitivity include the use of fluoride varnish, dentin sealers, composite resins, iontophoresis, laser therapy, coverage of exposed root with soft tissue grafts etc.

Tips

*Brush twice a day, for two minutes, with a fluoride toothpaste. Use small circular movements with a soft- to medium-bristle brush.

*Try to avoid brushing from side to side. Change your toothbrush every three months or sooner if it becomes worn out.

*Avoid sugary foods and fizzy drinks.

*If you grind your teeth in your sleep, use a mouth guard at night.