Treatment Options for Teeth Sensations When Pressing Teeth Together
For teeth sensations when pressing teeth together, the most effective treatment approach begins with identifying the underlying cause, followed by appropriate non-invasive interventions such as desensitizing toothpastes, fluoride applications, and occlusal adjustments before considering more invasive procedures. 1, 2
Diagnosis of Teeth Sensations
Common Causes
- Infractions (cracks) - Small cracks in the enamel surface without loss of tooth structure 1
- Atypical odontalgia/persistent dentoalveolar pain - Localized pain to tooth or tooth-bearing area 1
- Dentinal hypersensitivity - Due to exposed dentin from enamel loss 2
- Occlusal trauma - From excessive forces when pressing teeth together 2
- Post-traumatic trigeminal pain - Often following dental procedures 1
Diagnostic Approach
- Visual examination - Use focused light source (like an otoscope) to visualize crack lines in the enamel 1
- Pain characteristics assessment:
- Location: Is it localized to specific teeth or generalized?
- Quality: Sharp, dull, aching, or throbbing?
- Timing: Continuous or only when pressing teeth?
- Severity: Mild, moderate, or severe?
- Aggravating factors: Chewing, temperature changes, or touch? 1
- Dental radiographs - To rule out dental pathology 1
Treatment Algorithm
Step 1: Non-invasive Approaches (First-line)
- Desensitizing toothpastes containing:
- Dietary modifications:
- Reduce acidic foods and beverages
- Avoid extreme temperature foods/drinks 2
- Oral hygiene adjustments:
- Use soft-bristled toothbrush
- Avoid aggressive brushing techniques 2
- Occlusal analysis and adjustment if teeth pressing sensation is related to malocclusion 2
Step 2: Minimally Invasive In-office Treatments
- Professional application of desensitizing agents:
- Fluoride varnish
- Bonding agents
- Dentin sealers 2
- Occlusal splint/night guard - Especially if bruxism (teeth grinding) is suspected 2
Step 3: More Invasive Treatments (For persistent cases)
- Restorative procedures:
- Composite bonding to cover exposed dentin
- Placement of crowns for cracked teeth 2
- Endodontic therapy (root canal) for severe cases where pulpal involvement is suspected 2
- Surgical interventions such as gingival grafting for recession-related sensitivity 3
Special Considerations
For Infractions (Cracks)
- If the primary tooth sustains a marked crack in the enamel without loss of tooth structure, placing a resin sealant over the infraction line may be indicated 1
- In many cases, no treatment is indicated; however, the tooth should be monitored for signs of pulpal necrosis 1
For Atypical Odontalgia
- Currently managed as other neuropathic pain conditions
- May require cognitive behavioral therapy
- High percentage of treatment failures noted 1
For Dentinal Hypersensitivity
- Treatment should follow a progressive approach from least to most invasive
- Only consider invasive treatments after conservative approaches have failed 3, 2
Common Pitfalls to Avoid
Misdiagnosis - Tooth sensitivity can be confused with other conditions like cracked tooth syndrome, pulpitis, or referred pain 2
Premature invasive treatment - Jumping to radical solutions like root canal therapy without trying conservative approaches first 4
Overlooking occlusal factors - Failure to evaluate bite relationships that may contribute to symptoms 2
Ignoring underlying causes - Treating only symptoms without addressing contributing factors like acid erosion, aggressive brushing, or bruxism 5
Inadequate follow-up - Not monitoring treatment effectiveness and adjusting as needed 2
Remember that tooth sensitivity treatment should follow a stepwise approach, starting with the most non-invasive options before considering more invasive procedures. Patient education about contributing factors is essential for long-term management.