Simple sensitivity and tooth surface loss

Simple sensitivity is a very common condition and is related to exposure of the dentine and its associated porosities. The number of television advertisements about toothpastes to manage sensitivity is testimony to the frequency of this condition. Dentine can be exposed by:

  1. Direct trauma such as breaking a tooth during a fall or accident.
  2. Erosion of the protective enamel by acidic substances for example fruit juice and carbonated drinks or gastric contents. Erosion of the enamel on the roof of the mouth (palatal) aspects of teeth is a common finding amongst patients with bulimia. Erosion of multiple enamel surfaces is often seen in patients with alcohol misuse or who habitually chew acidic foods such as oranges.
  3. Attrition of the tooth enamel from grinding teeth without the presence of food. This is a common occurrence and can be related to stress and anxiety. Nocturnal grinding of teeth can involve forces far greater than those experienced during normal functioning.
  4. Abrasion from external substances such as bread made from stone ground flour or working in an environment that produces abrasive dust such as cement works. Poor tooth brushing technique may also cause loss of tooth substance particularly where the tooth and gum meet.
  5. Dental caries (tooth decay) is caused by the effect of acid produced by bacteria when fermenting carbohydrates in the mouth. The earlier stages of tooth decay can produce dentine sensitivity before leading on (over weeks and months rather than hours) to more pronounced dental pain.

Management of sensitivity is by identifying the cause; removing the cause and, where indicated, restoring the lost tooth substances with an appropriate restoration or using a desensitising agent.


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