It’s a hot day and all you want to do is sit down and enjoy a glass of chilled beverage. So you find a cosy-looking café, sit down and order a glass of iced lemonade. The cute waitress brings it to your table. “Enjoy your drink,” she says with a smile lingering at the corner of her mouth. So you bring the straw to your lips and sip the lemonade while maintaining eye contact with her but all of a sudden… “OWW! My teeth!”
Sounds familiar? I’m sure some of you must have experienced sharp, acute, penetrating pain like this when consuming cold and sweet drinks, or sometimes even when in contact with cold breeze during monsoon or winter. This painful clinical condition is known as dentine hypersensitivity (DH) and can occur in about 4-74% of the population.
Before we discuss further about the causes of DH, first, let me explain about the structure of a tooth. A tooth basically consists of 3 layers. The outermost layer which forms the protective layer covering the crown of a tooth is called enamel, while cementum covers the root. The second layer is dentine, which is situated directly beneath enamel and cementum. Dentine consists of canal-like spaces called dentinal tubules. Imagine a bundle of drinking straws; that is basically how dentinal tubules look like. The third and most vital layer is pulp. This is the ‘living part’ of a tooth that contains blood vessels and nerves, so if pulp is stimulated, you will feel pain.
Since dentine is a tubular or canal-like structure (again, try imagining a bundle of drinking straws) and is connected to the pulp, any harmful stimuli that reach the dentine will be transmitted to the pulp, where it will be perceived as pain. Basically, if the protective outermost layers (enamel and cementum) are lost and dentine is exposed, you may experience DH.
Now let’s take a look at the causes of exposed dentine:
Tooth decay/cavity
Decay of the enamel or cementum reaching dentine will cause the dentine to be exposed, hence the sharp pain experienced when consuming cold and sweet beverages.
Fractured teeth
Fracture or chipping off of enamel for any reason can leave the dentine exposed and vulnerable to the external environment which may be experienced as sensitivity.
Worn tooth enamel
Over the years, due to regular use, your tooth enamel may be worn out thereby exposing the dentine. Due to improper brushing technique and excessive brushing force. Continuous consumption of acidic beverages such as fizzy drinks or the habit of sucking sour food such as lemon and “asam”.
Gum disease
Severe gum disease can cause gum recession which can caused exposed root. Cementum covering the root surface is very vulnerable and this can eventually cause exposure of dentine.
Worn old filings
After several years, the old fillings may chip a bit around the edges and this may cause leakage of saliva and bacteria into the dentine, which is then relayed to the pulp and perceived as pain.
What is the treatment for DH?
There is no universally accepted treatment that will guarantee long-term relief of DH.The treatment mainly aims to eliminate the causes of sensitivity and to prevent further destruction of teeth. A dentist’s first recommendation is usually to modify your brushing habit and technique. After that, your dentist may perform necessary treatment to eliminate the causes of DH such as cleaning your teeth, filling up the cavities, etc. There are also several desensitising agents such as toothpaste that may be prescribed by your dentist to provide relief of pain.
Proper oral hygiene care is paramount to control and prevent tooth sensitivity as most of the causes of DH are preventable. Please consult your dentists if you have any questions regarding your daily oral hygiene care or any concerns about tooth sensitivity.
Dr. Husna Razak (BDS) (KLE VK) is a dental officer working in the Kelantan. Know more about her in The Team page.
References:
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010026/
- http://www.mouthhealthy.org/en/adults-under-40/concerns
- http://www.ada.org/sections/scienceandresearch/pdfs/patient_33.pdf
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]