Tooth Sensitivity: Causes, Prevention, and Management

What tooth sensitivity is

Tooth sensitivity, or dentin hypersensitivity, happens when dentin is exposed. Dentin is the layer that sits under the enamel on the crown of the tooth and under the cementum on the root. It is full of microscopic tubules that run toward the pulp, where the nerves are.

When enamel wears away or the gums recede, those tubules are left open. According to the hydrodynamic theory, cold, heat, acidic or sweet foods move the fluid inside the tubules, and that movement triggers the nerve endings. The result is a short, sharp pain that fades as soon as the trigger is gone.

Common causes

The ADA lists tooth decay, fractured teeth, worn fillings, gum disease, worn enamel and exposed roots as possible causes (Sensitive Teeth, ADA MouthHealthy). In practice, one of these is usually behind it:

• Gum recession. Receding gums uncover the root, which has no enamel and is more sensitive. Recession can come from gum disease, brushing too hard or simply age.
• Aggressive brushing. Hard bristles or heavy pressure wear down the neck of the tooth and encourage the gums to pull back.
• Grinding (bruxism). Clenching or grinding, especially at night, wears enamel down.
• Decay, cracks or worn restorations. A filling or crown that no longer seals well lets stimuli reach the dentin.
• Acid erosion. Soft drinks, citrus juices, wine and energy drinks soften and wear enamel when they are part of your daily routine.

A sensitive tooth does not automatically mean a cavity, but it does not rule one out either. That is why it is worth having it checked.

What you can do at home

Brush gently. Use a soft-bristled brush, light pressure and short strokes, and avoid scrubbing side to side. Two minutes, twice a day, with fluoride toothpaste.

Look after your gums. The NIDCR, the dental research institute of the U.S. National Institutes of Health, notes that early gum disease caused by plaque buildup can often be reversed with daily brushing and flossing (Periodontal Gum Disease, NIDCR). Healthy gums are your best defense against further recession.

Cut back on acids. Limit soft drinks, citrus juices and energy drinks. If you have them, use a straw and drink them in one sitting rather than sipping all afternoon. Rinse with water afterward and hold off on vigorous brushing right then, because the enamel is softened.

Try a desensitizing toothpaste. It contains compounds that help block sensation from traveling from the tooth surface to the nerve. The ADA notes that it usually takes several applications before sensitivity drops.

If you clench or grind, mention it. A custom-made night guard protects your teeth from wear while you sleep.

In-office treatment

When changes at home are not enough, treatment depends on the cause. These are the options the ADA describes:

• In-office fluoride. Applied to the sensitive areas, it strengthens enamel and reduces the transmission of sensation.
• Bonding, an inlay or a crown. These correct a flaw, a cavity or a worn restoration that is causing the sensitivity.
• Gum graft. If gum tissue has been lost from the root, a graft can cover it and reduce sensitivity.
• Root canal treatment. Considered when sensitivity is severe, persistent and does not respond to other measures. You can read more about endodontics.

Which option makes sense depends on what is leaving the dentin exposed. On our treatments page you can see the restorative and cosmetic treatments planned at Gloss Dent.

Frequently asked questions

Does sensitivity mean I have a cavity? Not necessarily. It is often caused by enamel wear or receding gums. Decay or a crack can also cause it, though, and only an exam can tell.

Will any desensitizing toothpaste work? They work with consistent use, and relief usually takes several applications. Ask your dentist which one suits you, especially if you have already tried one without much change.

Can I whiten my teeth if they are sensitive? Whitening can make sensitivity worse for a while. It is wiser to find the cause first: receding gums, decay or worn restorations should be addressed before whitening.

Is sensitivity permanent? It depends on the cause. When the habit behind it is corrected or the underlying problem is treated, it often eases. Pain that lingers for several seconds after cold or heat, or that shows up on its own, is not typical sensitivity and should be checked soon.

Next steps

You can read more in the sources consulted: Sensitive Teeth, ADA MouthHealthy and Periodontal Gum Disease, NIDCR.

If a tooth bothers you with cold, heat or sweets, you can schedule an individualized assessment. During the assessment we can review your case, find the cause and suggest a treatment designed for you.