Tooth Sensitivity

 

✅ What Is Tooth Sensitivity?

Tooth sensitivity (dentinal hypersensitivity) is a short, sharp pain arising from exposed dentin in response to stimuli such as:

• Cold (most common)

• Hot

• Sweet

• Sour

• Air blast

• Touch (explorer/probe)

Pain is non-lingering and disappears once the stimulus is removed.

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🔬 Pathophysiology (Hydrodynamic Theory – Most Accepted)

Proposed by Brännström.

• Dentin contains open dentinal tubules

• Stimulus → fluid movement inside tubules

• Fluid shift → stimulates A-delta nerve fibers in pulp

• Result → sharp pain

Cold causes outward fluid movement → more painful than heat.

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📌 Common Causes

1️⃣ Gingival Recession

• Periodontal disease

• Aggressive brushing

• Thin biotype

2️⃣ Enamel Loss

• Attrition

• Abrasion (horizontal brushing)

• Erosion (acidic drinks, GERD)

3️⃣ Post-RCT or Post-scaling

• Recently exposed dentin

• Open tubules after ultrasonic scaling

4️⃣ Cracked Tooth

5️⃣ Whitening Procedures

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🔎 Differential Diagnosis (Very Important Clinically)

Condition	How to Differentiate
Reversible pulpitis	Pain lingers slightly
Irreversible pulpitis	Spontaneous + lingering pain
Cracked tooth	Pain on biting/release
Caries	Radiographic evidence
High occlusion	Tender on percussion

Sensitivity cases:

• Usually percussion negative

• No radiographic pathology

• Vital pulp test positive

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🧪 Clinical Examination

• Air blast test

• Cold test (brief sharp pain)

• Explorer over CEJ

• Check for:

  • NCCL

  • Recession

  • Wedge-shaped defects

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💊 Management

🏠 Home Care (First Line)

Desensitizing toothpaste:

• Potassium nitrate

• Strontium chloride

• Arginine

• Stannous fluoride

Use:

• Twice daily

• Smear technique at night

• 2–4 weeks for effect

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🏥 In-Office Treatment

1. Fluoride varnish

2. Glutaraldehyde + HEMA (e.g., Gluma)

3. Dentin bonding agent

4. Resin restoration (if NCCL deep)

5. Laser therapy

6. Gingival graft (if severe recession)

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⚠️ When to Suspect Something Else

• Lingering pain (>30 sec)

• Spontaneous pain

• Night pain

• Percussion positive

• Radiolucency

Then think:

• Pulpitis

• Apical periodontitis

• Failed RCT

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🛡️ Prevention Advice for Patients

• Soft toothbrush

• Modified Bass technique

• Avoid acidic drinks

• Wait 30 min after acid exposure before brushing

• Use fluoridated toothpaste

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