Sensitive Teeth Treatment

A sharp pain that strikes when you drink something cold, breathe in cold air or touch the gum line with your toothbrush, and passes within a few seconds, is most often caused by dentine sensitivity. The enamel or the gum no longer covers the dentine, the inner layer of the tooth. Dentine contains a great many microscopic tubules running towards the nerve; cold, air or sugar moves the fluid inside these tubules, and the nerve registers that as pain.

Treatment rests on two things: sealing the open tubules or calming the nerve's response, and stopping whatever exposed the dentine in the first place. But there is one step that comes before either.

Is it really sensitivity, or something else?

What gets described as "sensitivity" is sometimes decay, a crack or an inflamed nerve, and none of these goes away with toothpaste. So at the examination we rule them out first: we look at the teeth, test them with air and cold, do a bite test and take an X-ray if necessary. The way the pain is described often points the way.

In other words, dentine sensitivity is a diagnosis of exclusion: the other possibilities are ruled out first, and only then is the name given. The two can also be present in the same mouth, and decay or a crack in a single tooth can hide among more general sensitivity. If an inflamed nerve is suspected, the treatment is no longer sensitivity treatment but, in most cases, root canal treatment. If you have swelling in your face or gum, a fever or difficulty swallowing, see a dentist without delay (the nearest one if you are not in İzmir) or, out of hours, seek emergency care.

Why does dentine become exposed?

• Gum recession: The layer covering the root surface is thin and soft; once the gum recedes it wears away easily and the tubules open up. This is the most common source. Its causes and treatment are on the gum recession treatment page.
• Enamel loss: Acidic drinks, reflux, pressing hard when brushing and clenching all thin the enamel. We cover this in detail on the restoring worn teeth page.
• Clenching: Clenching and grinding at night both wear enamel and can make teeth sensitive under load. Sensitivity that is worse in the mornings, together with a tired jaw, is a clue in this direction.
• Temporary sensitivity after treatment: After a scale and polish, whitening or a new filling there can be sensitivity for anything from a few days to a few weeks, and it usually fades on its own.

What helps at home?

For mild, widespread sensitivity the first step is taken at home, and for most patients it is enough.

• Desensitising toothpaste: Those containing potassium nitrate reduce the nerve's ability to pass on the signal; those containing stannous fluoride or arginine block the tubules. The effect builds up gradually: with regular use it usually becomes noticeable within 2–4 weeks, and it slowly wears off if you stop.
• Spit, do not rinse: Not rinsing with water after brushing keeps the toothpaste on the surface. Rubbing a small amount onto the sensitive area with your finger before bed also helps.
• Brushing: A soft brush and gentle strokes from the gum towards the tooth; keep away from whitening and abrasive toothpastes.
• How often you have acid: Do not spread acidic drinks across the whole day, and rinse with water afterwards.

If toothpaste is not enough, what can be done at the clinic?

If the sensitivity persists or is concentrated in one area, we step up gradually:

1. Varnish and tubule-sealing agents. Fluoride varnish or liquids that block the tubules are applied to the exposed dentine. It takes a few minutes and needs no anaesthetic; the effect lasts from a few weeks to a few months and can be repeated if needed. After varnish we ask you not to eat hard food for a few hours and to skip brushing that evening: the longer the varnish stays on the surface, the better it works.
2. Sealing with bonding. If a notch has formed at the neck of the tooth or the exposed area is large, the surface is covered with a thin layer of adhesive, or the notch is filled with a composite filling. This both reduces sensitivity and slows the notch from getting deeper.
3. Gum graft. If the recession has advanced, covering the root surface with gum again can improve both the sensitivity and the appearance. Not every recession is suitable for this; the level of the bone and gum between the teeth determines how much can be covered.
4. Root canal treatment. This is the last option for sensitivity that persists despite everything and disrupts daily life; it is rarely needed.

Why does sensitivity come back?

Varnishes and toothpastes seal the tubules, but if whatever exposed the dentine is still going on, new surfaces open up. As long as hard brushing, acidic drinks sipped through the day or clenching at night continue, the sensitivity keeps coming back from time to time; lasting relief often comes from a small change in habits. At our clinic in Bayraklı, İzmir, we identify the source of the pain at the first examination, then start with the simplest step. The cost depends on the method needed and the number of teeth to be treated; you receive a written, itemised quote after the examination.