Understanding Tooth Sensitivity: Causes & Solutions

Teeth should not feel cold under normal conditions. Cold sensitivity (dentin hypersensitivity) indicates exposed dentin tubules transmitting stimuli to the pulp nerve.

Common Causes

1. Enamel Erosion/Wear

• Acidic diet (citrus, soda, wine, reflux)
• Aggressive brushing (hard brush, abrasive toothpaste)
• Bruxism (grinding/clenching)
• Abrasion from habits (pipe, nail-biting)

2. Gum Recession

• Periodontal disease
• Aggressive brushing
• Thin gingival biotype
• Orthodontic movement
• Aging
• Exposes cementum/dentin on root surface

3. Dental Procedures

• Post-operative sensitivity (fillings, crowns, scaling): usually transient (days-weeks)
• Whitening treatments (peroxide penetrates dentin)

4. Structural Damage

• Cracked tooth/fracture
• Dental caries (cavities)
• Worn/failing restorations
• Exposed root from failed restoration

5. Systemic/Nerve Factors (Rare)

• Trigeminal neuralgia
• Diabetic neuropathy
• Multiple sclerosis
• Post-herpetic neuralgia (shingles)

Management

At-Home

• Desensitizing toothpaste (potassium nitrate, stannous fluoride, arginine/calcium carbonate) — 2-4 weeks for effect
• Soft-bristle brush, gentle technique
• Fluoride mouthrinse
• Avoid acidic foods/drinks; use straw
• Night guard if bruxism

Professional

• Fluoride varnish, silver diamine fluoride
• Dentin bonding agents/desensitizing resins
• Gum graft for recession
• Restoration replacement
• Root canal if irreversible pulpitis

When to See a Dentist

• Sensitivity persists >2-4 weeks with desensitizing toothpaste
• Spontaneous pain, heat sensitivity, pain on biting
• Visible crack, cavity, or gum recession
• Post-dental work sensitivity not improving

Early intervention prevents progression to irreversible pulpitis requiring root canal.