Tooth Sensitivity: Causes and Long-Term Solutions

Tooth sensitivity to hot and cold?

Hello, doctor.
About two months ago, I started experiencing sensitivity in my teeth when consuming cold food or inhaling cold air.
I visited a dentist (A) who diagnosed me with gum recession (without periodontal disease, attributing it to brushing too hard).
A total of ten teeth were affected.
Some repairs were made, but they gradually fell off, so my condition did not improve.
I then switched to another dentist (B), who performed additional repairs.
I now have four teeth remaining that are sensitive, located at the fifth and sixth positions from the midline of the upper and lower front teeth, one in each quadrant.
However, the sensitivity in the upper left sixth tooth is particularly severe.
The dentist discovered a small crack in the silver filling from a previous cavity, which they suspected was causing the sensitivity.
After addressing that, they still decided to perform a root canal treatment.
Now that the root canal has been completed, the sensitivity in those four teeth has not improved at all.
The dentist examined my gums and found no abnormalities, suggesting that there should not be any sensitivity.

What should I do in this situation?
1.
The tooth that underwent root canal treatment should no longer have sensation.
Why does the gum above it still feel sensitive when exposed to room temperature water?
2.
Are there any more long-lasting treatment options for sensitivity? Currently, topical medications and repairs seem to only provide relief for a few days.
The main issue is that the dentists believe no further treatment is necessary since everything appears normal, but I still feel very uncomfortable.

3.
The four affected teeth do not seem to be in a constant state of discomfort.
It feels like they alternate between being sensitive and not sensitive.
Sometimes, when eating, everything feels normal, but at other times, even with my mouth closed, I suddenly feel discomfort.
Cold air immediately triggers sensitivity.
I apologize for the trouble, and thank you for taking the time to respond.

Jessy, 40~49 year old female. Ask Date: 2013/07/17

Dr. Zhuang Suhui reply Dentistry

1.
A tooth that has undergone root canal treatment should not have any sensation.
Why does the gum above it still feel sensitive to room temperature water? A tooth that has had a root canal and the gum tissue itself should only experience pain, not sensitivity, which may be influenced by other teeth.

2.
Is there a more lasting treatment option for allergies? Currently, topical medications and restorations seem to only provide relief for a few days.
The issue is that doctors often feel no treatment is necessary because everything appears normal.
However, why do I feel so uncomfortable? Further examination is needed to confirm whether it is indeed an allergy.
3.
Those four teeth are not always in a state of discomfort.
It seems like they can be simultaneously allergic and non-allergic.
Sometimes, they feel completely normal while eating, and other times, I suddenly feel strange even with my mouth closed.
The moment air enters, it feels sensitive.
I am unsure and cannot pinpoint the cause.
Recommendation: Seek a detailed examination from the dental department of a medical center.

Reply Date: 2013/07/17

More Info

Tooth sensitivity can be a perplexing and frustrating issue, especially when it persists despite various treatments. Your situation highlights several important factors that can contribute to tooth sensitivity and discomfort, particularly after dental procedures. Let's break down the potential causes and explore long-term solutions.

Understanding Tooth Sensitivity
1. Gum Recession: As you mentioned, your dentist indicated that gum recession might be a contributing factor. When gums recede, the underlying dentin becomes exposed. Dentin contains tiny tubules that lead to the nerve endings in the tooth, making it sensitive to temperature changes and certain stimuli. This sensitivity can be exacerbated by aggressive brushing, which can further irritate the gums and lead to more recession.

2. Dental Restorations: The materials used in dental restorations can also play a role in sensitivity. Silver fillings (amalgam) can sometimes crack or develop microfractures, allowing bacteria to enter and cause further decay or sensitivity. If a restoration is not perfectly sealed, it can lead to sensitivity as well. The fact that you had a crack in your previous filling suggests that this could have been a source of your discomfort.

3. Root Canal Treatment: After a root canal, the tooth should ideally be free of pain because the nerve is removed. However, sensitivity can still occur in the surrounding tissues or from the pressure of the filling material. If the tooth was previously sensitive before the root canal, it may take time for the surrounding tissues to heal completely.

4. Nerve Sensitivity: Sometimes, even after a root canal, the nerves in the surrounding area can remain sensitive for a while. This can lead to intermittent discomfort, especially when exposed to temperature changes or pressure.

5. Psychological Factors: Anxiety and stress can heighten the perception of pain and discomfort. If you are particularly anxious about your dental health, this could amplify your sensitivity.

Long-Term Solutions
1. Desensitizing Toothpaste: Using a toothpaste specifically designed for sensitive teeth, such as Sensodyne, can help block the transmission of pain signals from the tooth surface to the nerve. It may take several applications to notice a significant improvement.

2. Fluoride Treatments: Professional fluoride treatments can strengthen tooth enamel and reduce sensitivity. Your dentist can apply a fluoride varnish to the sensitive areas of your teeth.

3. Dental Sealants: In some cases, applying a sealant to the exposed areas of dentin can help protect against sensitivity. This is particularly useful if gum recession is a significant issue.

4. Improved Oral Hygiene Practices: Switching to a soft-bristled toothbrush and using gentle brushing techniques can help minimize gum irritation. Additionally, incorporating an antibacterial mouthwash can help maintain gum health.

5. Regular Dental Check-ups: Continuing to see your dentist regularly is crucial. They can monitor your sensitivity and make adjustments to your treatment plan as necessary. If sensitivity persists, they may consider further diagnostic tests to rule out other underlying issues.

6. Consider a Periodontist: If gum recession is a significant concern, consulting a periodontist may be beneficial. They can provide specialized treatment options, including gum grafting, to restore gum tissue and reduce sensitivity.

Conclusion
Tooth sensitivity can stem from various factors, including gum recession, dental restorations, and nerve sensitivity. While it can be frustrating to deal with, there are several strategies you can employ to manage and potentially reduce your sensitivity over time. It’s essential to maintain open communication with your dental care providers, express your concerns, and work together to find the most effective treatment plan for your specific situation. If your symptoms persist or worsen, further evaluation may be necessary to ensure there are no underlying issues contributing to your discomfort.

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