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Are you having trouble drinking ice water? Or perhaps hot coffee? Maybe when you chew something just right you get a twinge that you feel down the back of your spine? So what causes these symptoms, and what can be done about them?
Some quick dental anatomy is in order. The top, white part of the tooth is called enamel. It’s not alive, it is simply a mix of organic and inorganic substances that serve as natures armor. Enamel also happens to be the strongest substance in the human body. That figures, since we expect the enamel to crush a lifetime’s worth of food! As one travels down along the tooth to the gum line, the enamel thins out and forms a butt joint (remember this butt joint) against our roots, which is comprised of something called cementum. Now, this yellowish cementum is not nearly as hard as enamel, and is completely buried under the gum line, at least in our younger years. Underneath both enamel and cementum, lies the softer dentin, which traverses the entire length of a given tooth and serves to house the living pulp of the tooth. The dentin has little tunnels filled with fluids that actually communicate with the pulp of the tooth. The pulp is very much alive and is comprised of blood vessels and nerves. Enamel is akin to the bark of a tree above the ground, and cementum is akin to the roots of the tree, a bit more vulnerable but covered by the earth (or the gum line in relation to teeth roots). Our teeth are formed from the inside out when we are very young. The pulp creates all of the dentin, enamel and cementum outwards from itself. Once that role is complete, the pulp really has completed its purpose in life, and serves only to warn us about thermal changes (hot/cold) and excess forces on the tooth. One last thing, the cementum covered root of all teeth are connected to the jawbones via very tiny little fibers known as periodontal ligaments, or PDL’s. These tiny “cables” suspend the roots in their bony sockets and have exquisitely sensitive nerve fibers that have a direct connection to our brain. When stimulated, the PDL’s actually have a role in the coordination of the muscular output that is generated by our teeth as we chew our food, via communication between the PDL’s and the brain. Have you ever bit into a seed or a hair in your food? Chances are you quit crushing your food pretty rapidly and in the blink of an eye you expelled the foreign substance without even thinking about it. That’s your PDL talking to the brain, and the brain telling the muscles what to do about it; “…get it OUT!”-all in about 0.006 seconds..!
So, now why are teeth sensitive? Well, it depends. The outer enamel of the tooth could have a crack in it, allowing the tooth to flex while chewing. A crack might also allow hot or cold fluids to percolate closer to the highly sensitive pulp. Bonding or crowning the tooth should solve this problem. In a worse case scenario, the crack has gone vertical into the roots below the bone and nothing can save the tooth. This is a quite rare occurrence…
It’s possible that the butt joint between enamel and cementum is partly open on a given tooth, exposing a bit of the underlying dentin, which is quite sensitive. If acidic, hot or cold substances touch this open joint, the little tunnels or tubules in the dentin let the pulp know that an irritant is present. Bonding or desensitizing agents are sometimes used to clog those tunnels, making communication to the pulp less likely.
Another possibility involves gum recession exposing much of the root cementum. This may or may not be due to periodontal, or gum disease. A dentist needs to determine whether or not you have this problem. If not, gum grafting to cover the exposed, sensitive root can solve that problem.
Sometimes the above treatments do not work on a permanent basis. If you have a sensitivity issue that has not resolved after exhausting the above treatments, be aware that new research suggests that this may be due to that tooth bearing an excessive load in the overall bite while chewing. This extra force can cause the tooth pulp to become chronically inflamed, and far more susceptible to overreacting to stimuli. Precisely adjusting the bite using digital sensor technology known as the Tscan® that measures timing and force, not just the traditional ink ribbon that dentists routinely use to check the bite (which only identifies where things touch, not when or how much), can identify the exact miniscule “rub” that does not belong, allowing effective elimination of the sensitivity issue by precisely adjusting the interference and allowing the inflammation to subside.
Lastly, if all else fails, it is possible that the pulp of the tooth has died for whatever reason. If this is the case, root canal therapy might be indicated. This involves removing the pulp of the tooth, which removes the nerve tissue so that the brain can no longer recognize the problem. If a tooth is still sensitive after a properly performed root canal, it is possible that the PDL’s of the tooth are picking up excess force. Again, a very precise bite adjustment might just be the ticket!
Sensitive teeth can be a debilitating problem that you may not be able to ignore. Traditional treatments for the reduction of tooth sensitivity may not always be effective. Dr. Nick has recently identified, studied, named, and published novel information in the dental scientific literature relating to the genesis and treatment of hypersensitive teeth in the 1st edition textbook, “The Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine”. Within a chapter of that textbook, he statistically validated a concept which he described to dental medicine known as Frictional Dental Hypersensitivity, or FDH, and explained that precise, objective, and digitally directed manipulations of the human bite with concurrent muscular responses (resultant of digitally-directed bite adjustment therapy), may readily be manipulated to eliminate hypersensitive teeth in patients with objectively confirmed stable and adapted TMJs. The usage of the Tscan® technology is required to identify these minuscule discrepancies in the functional bite in order to accomplish this task, and is often very effective when everything else fails.
Step into the future of dentistry,
Dr. Nick Yiannios
To view YouTube videos that Dr. Nick has created to compliment this article on tooth hypersensitivity, refer the the drnickdds homepage on YouTube, or watch this sample video:
“Curing a dentist’s sensitive teeth”