Unexplained Tooth Sensitivity: Possible Causes and Solutions

Q: Unexplained Tooth Sensitivity: Possible Causes and Solutions

Hello： The main causes of bodily pain are twofold： injury to tissues or organs, or disruption in nerve signal transmission. <br>If you believe the discomfort is caused by injury to the teeth or surrounding tissues, it is recommended that you return to a medical center for a 3D X-

The cause of tooth sensitivity cannot be determined?

Hello Doctor, I have discomfort in my lower left first molar (tooth #36) that sometimes feels acidic and dull (when there is no discomfort, it feels normal).
However, the timing and circumstances are not very consistent; sometimes it occurs while chewing, sometimes after meals, and sometimes during vibrations (like riding a bike or running).
This situation does not happen every time; sometimes it does, and sometimes it doesn't.
Occasionally, there is no discomfort in the tooth itself, but I can feel swelling in the gingival papillae between teeth #35 and #37.
Sometimes, using dental floss causes sensitivity, and pressing on the alveolar bone below tooth #36 can also be slightly uncomfortable.
Drinking hot or cold water does not cause discomfort, but I feel that tooth #36 is more sensitive to temperature changes compared to tooth #46.

About 3-4 years ago, I had a small cavity filled on the occlusal surface of tooth #36 during a dental cleaning.
In mid-December last year, I experienced discomfort accompanied by pain in tooth #36.
After examining it in the mirror for a long time, I noticed a small hole on the occlusal surface.
When I visited the clinic, the dentist diagnosed it as a small cavity, and after treatment, the pain subsided, reducing the discomfort to about 10-20%.
However, the discomfort still persists.

Two weeks ago, during a dental cleaning, I asked the dentist about the discomfort in tooth #36.
The dentist reviewed the full-mouth X-rays and checked the interproximal areas with dental floss, stating that there were no abnormalities and that I should continue to monitor it.

I would like to ask what possible issues tooth #36 might have and what further examinations you would recommend.
Additionally, my lower left and right wisdom teeth are horizontally impacted and completely buried in the gums.
Could the pressure from the wisdom teeth be causing discomfort in tooth #36, bypassing tooth #37? I apologize for the lengthy question, and I appreciate your time in answering it.

S, 20~29 year old female. Ask Date: 2021/04/19

Dr. Lin Jiayong reply Dentistry

Hello: The main causes of bodily pain are twofold: injury to tissues or organs, or disruption in nerve signal transmission.
If you believe the discomfort is caused by injury to the teeth or surrounding tissues, it is recommended that you return to a medical center for a 3D X-ray of the oral cavity (CBCT) for confirmation.
If no abnormalities are found, it may be advisable to seek assistance from a neurologist to determine if it is related to trigeminal nerve issues.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/04/19

More Info

Tooth sensitivity can be a perplexing issue, often stemming from various underlying causes. In your case, the discomfort in your lower left first molar (tooth 36) could be attributed to several factors, including previous dental work, gum health, and even the presence of impacted wisdom teeth. Let's delve into the potential causes and solutions for your situation.

Possible Causes of Tooth Sensitivity
1. Gum Health: The sensitivity you experience, especially when pressing on the gums or using dental floss, may indicate gum inflammation or periodontal issues. Swollen gum papillae around teeth 35, 36, and 37 suggest that there might be some underlying gum disease or irritation, which can lead to sensitivity.

2. Dental Work: You mentioned that tooth 36 had a small cavity filled a few years ago. If the filling is too high or improperly placed, it can cause discomfort when chewing or during other activities. Additionally, if the filling is near the nerve, it can lead to increased sensitivity.

3. Temperature Sensitivity: Although you do not experience discomfort with hot or cold beverages, the fact that tooth 36 is more sensitive to temperature changes than tooth 46 could indicate that the nerve within the tooth is reacting to stimuli differently. This could be due to the proximity of the filling to the pulp or other factors affecting the tooth's nerve health.

4. Impacted Wisdom Teeth: The presence of horizontally impacted wisdom teeth can indeed exert pressure on adjacent teeth, potentially causing discomfort or sensitivity in tooth 36. This pressure can lead to inflammation of the gums and surrounding tissues, contributing to your symptoms.

5. Occlusal Issues: If your bite is misaligned, it can lead to uneven pressure on certain teeth, resulting in discomfort during chewing or other activities. This misalignment can also cause the surrounding gum tissue to become inflamed.

Recommended Actions
1. Dental Examination: Since your dentist has already performed X-rays and a thorough examination without finding any significant issues, it may be beneficial to seek a second opinion, particularly from a specialist in periodontics or endodontics. They can provide a more detailed assessment of your gum health and the condition of the tooth's nerve.

2. Gum Health Assessment: A periodontal evaluation can help determine if there is gum disease present. Treatment may involve professional cleaning, scaling, or other periodontal therapies to reduce inflammation and improve gum health.

3. Check the Filling: If the filling is suspected to be the cause of your discomfort, your dentist may need to assess its placement and consider replacing it if necessary. Sometimes, a filling can irritate the nerve if it is too close or if there is an underlying issue with the tooth.

4. Wisdom Teeth Evaluation: If your wisdom teeth are indeed impacted, it may be worth discussing their removal with your dentist or an oral surgeon. Removing the wisdom teeth could alleviate any pressure they are exerting on your other teeth.

5. Sensitivity Treatment: In the meantime, using desensitizing toothpaste can help manage sensitivity. These products work by blocking the pathways that lead to nerve endings in the teeth.

6. Monitoring Symptoms: Keep a diary of your symptoms, noting when they occur and any activities that seem to trigger discomfort. This information can be invaluable for your dentist in diagnosing the issue.

Conclusion
Tooth sensitivity can arise from a variety of factors, and it’s essential to approach it holistically. Given your history and the complexity of your symptoms, further investigation into your gum health, the condition of your fillings, and the status of your wisdom teeth is warranted. Regular dental check-ups and open communication with your dentist about your symptoms will be key in finding a resolution. If the discomfort persists or worsens, do not hesitate to seek further evaluation to ensure that any underlying issues are addressed promptly.

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