What causes tooth sensitivity to cold, heat, and pressure?

SENSITIVE TOOTH!

 
"I was eating a cold ice cream fruit bar and suddenly my tooth started to ache.  I must have bit down wrong!"

Patients occasionally come to me complaining their teeth are sensitive.  The pain may come suddenly, other times it may be a gradual onset.  Even simple oral hygiene techniques like flossing, brushing, eating, and drinking can cause a temporary pain and discomfort in the teeth.  Discomfort can range from mild to excruciating, and can be lingering or nonlingering.  Sometimes it is obvious as to the cause of the discomfort, sometimes it may not. 

WHAT ARE SYMPTOMS OF TEETH SENSITIVITY?

Tooth discomfort can be subjective; some common symptoms include:

• Throbbing pounding acute pain that occurs by itself
• Pain that is temperature dependent to cold and/or heat, such as drinking cold water or hot coffee
• Pain that comes about from eating and biting pressure
• Bleeding and sore gums
• Pain caused from breathing in cold air

CAUSES OF SENSITIVE TEETH

While the causes may vary, it is likely that the tooth's nerve has been affected.  Within the inner most layer of the tooth is a pulp chamber consisting of live nerve tissues.  If the nerve has been affected, the result may be sensitivity and/or pain.  The dentist will need to do an evaluation via an examination to determine the cause of the sensitivity; an x-ray may also be necessary to determine if there is decay, fracture, or infection.

• Tooth decay (also known as caries) that has invaded the pulp
• Tooth decay that has not invaded the nerve
• Broken teeth that has pulpal involvement
• Fractured cusp that has caused the tooth to weaken
• A chipped tooth that has caused worn enamel
• Root exposure
• A root fracture that violated the tooth's root
• Tooth has localized abscess and infection
• A tooth that has exposed dentinal tubules
• Periodontal involvement with bleeding gums/gingiva

TREATMENT OF SENSITIVE TEETH 

To bring adequate relief of the sensitive or painful tooth, it may be necessary via a process of elimination to rule out certain causes first.  A conservative approach is usually taken so as to appropriately treat the condition.

• A tooth colored filling if the sensitivity is from decay that has not intruded onto the nerve
• A porcelain crown if it's due to cusp fracture or weakened cusp
• A root canal and crown if the nerve has been affected to either a fracture or abscess
• Tooth extraction if the tooth is not restorable due to extensive coronal and/or root fracture
• Fluoride varnish for exposed dentinal tubules
• Dental cleaning to remove plaque, bacteria, calculus, and tartar buildup along the gumline
• Antibiotics and analgesics as necessary adjunctive treatment
• Anti-sensitivity toothpaste (ie. Sensodyne) for exposed dentinal tubules, exposed enamel and root surfaces

Generally speaking, if you develop any of the above mentioned sensitivity and discomfort with your teeth, be sure to schedule an evaluation with your dentist.  It may also warrant emergency dentistry treatment if you have tremendous lingering tooth ache pain, discomfort, and/or swelling.  If you have any questions on the causes and treatment of sensitive teeth, be sure to consult your family dentist.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600