Sensitive teeth

The problem of dental sensitivity

Sensitive teeth are associated with acute and pungent painful stimuli, brief but at the same time violent, which arise when sweet, acidic, hot or cold foods come into contact with the teeth. Even a too vigorous brushing, the water or the pressure generated by the masticatory activity can produce these often intolerable annoyances.

Causes

More than sensitive teeth, dentists prefer to talk about dentinal hypersensitivity, a condition that can have directly pathological causes:

sign of incipient or advanced caries (depending on the patient's sensitivity threshold)
sign of tooth crack (due to major trauma or repeated micro traumas)

or not pathological:

consequence of the slight denudation of the roots of the teeth, caused by certain types of periodontal surgery
consequence of gingival retraction (from too aggressive and technically incorrect brushing, or from gingival inflammation).
simple physiological variant in hypersensitive patients, therefore with low pain threshold.

Dentin hypersensitivity is that sensation of discomfort, and sometimes pain, caused by the exposure of the teeth to physical stimuli (hot and cold), chemical and osmotic (sweet and salty), and mechanical (contact with the toothbrush).

Nail polish wear

In the image to the side we can observe the anatomical structure of a tooth. Outside there is the enamel, a white fabric, very resistant and mineralized, which has the task of protecting the tooth from external aggressions.

However, this protective layer can be eroded by acids produced by bacterial plaque, by particularly acidic foods (grapefruit, fruit salads, oranges, lemons, cold teas, orange juice, juices, carbonated beverages, tomatoes, etc.) or by inappropriate use of toothbrush or aggressive toothpastes (such as bleaching ones).

Under the enamel there is dentin, a very resistant yellowish bone tissue, which has the function of protecting the underlying pulp from temperature variations and mechanical stress.

Sensitive teeth: possible causes

Clumsy oral hygiene for too much force with brushes with too hard bristles.
Toothpastes that contain too abrasive substances, such as bleaching ones
Incorrect use of dental floss.
Gastric acids in patients who have gastric reflux or bulimics (because they vomit voluntarily).
Acid foods and beverages (fruit, fruit juice, yogurt, coca-cola).
Nighttime grinding (grit your teeth during sleep).
Poor oral hygiene that causes inflammation and retraction of the gums.

When the layers of enamel and dentin become thinner, then the aforementioned stimuli indirectly reach the innermost dentine layer, which covers the dental pulp, a structure particularly rich in blood vessels and nerve endings. In fact, the dentin is crossed by microscopic canaliculi called tubules, connected to the pulp part, vital and sensitive, where there are nerve endings which, once irritated, cause pain.

Gingival recession

In addition to enamel erosion, another rather common cause of dentinal sensitivity is the gingival retraction, which follows the inflammatory phenomena of the gums, representing the "second stage of gravity" of periodontal disease. In such circumstances the collar of the teeth is discovered, that is the passage area between the crown and the root, normally protected and "sealed" by the gum. Consequently, the dentin of the dental collars is exposed, tender, porous and therefore sensitive to painful stimuli - such as cold, heat or pressure - which are transmitted to the pulp nerves through the tubules contained in the exposed dentin. Furthermore, in the deeper layers, the dentine is no longer covered by the enamel but by a thin layer of

Treatment of sensitive teeth

In case of altered sensitivity of teeth and gums, the first thing to do is contact the dentist, to ascertain the absence of pathological causes such as caries, fractures or periodontal disease. If sensitive teeth are separated from similar pathologies, it is useful to use specific mouthwashes and dentifrices, containing fluorine or other substances. As is known, in fact, fluorine exhibits a mineralizing action on the surfaces of the tooth enamel ("hardening") of young people and of remineralization on that of adults. This action is positively associated with a slight anti-plaque power and a clear desensitizing activity (in adults), as it determines the formation of a calcium fluoride layer which forms a protective, remineralizing and desensitizing film, thanks to the ability to clog the exposed dentinal tubules, especially if fluoride is associated with powerful desensitizers such as strontium chloride, potassium nitrate and zinc citrate. Some fluoride toothpastes, specific for sensitive teeth, are found in the form of gel, to be spread two or three times a day on the teeth without rinsing. In the presence of sensitive teeth, hydroxyapatite-based toothpastes are also potentially useful, a natural component that acts by creating a physiological barrier against hypersensitivity, plaque, tartar and caries. Not surprisingly, hydroxyapatite is the predominant component of bones and teeth.

In cases of greater dental sensitivity, there are also professional interventions, based on the application of fluorinated resins that seal the dentinal tubules. These preparations are applied in sensitive areas of the enamel. The dentist can also make use of electromedical devices (lasers, iontophoresis) to favor dental remineralization and canalicular closure, while the last beach for the "treatment" of sensitive teeth is devitalization (to be avoided if possible). Finally, if the sensitivity is caused by gum recessions, it is possible to treat the problem with a gingival surgery, in order to provide a new root coverage and a protection that can solve the problem of sensitive teeth.