How to manage sensitive teeth?

Management of Sensitive Teeth

For effective management of sensitive teeth, the first-line treatment should be the use of desensitizing toothpaste containing 5% potassium nitrate, applied twice daily for at least 1 minute, focusing on all sensitive areas. 1, 2

Understanding Tooth Sensitivity

Tooth sensitivity (dentinal hypersensitivity) occurs when dentinal tubules become exposed, typically due to:

• Gingival recession exposing root surfaces
• Loss of enamel from toothwear
• Exposure of dentin following dental procedures

The pain mechanism is explained by Brännström's hydrodynamic theory, where external stimuli cause fluid movement within exposed dentinal tubules, triggering nerve endings 3.

Diagnostic Approach

Before initiating treatment, it's essential to:

1. Rule out other causes of tooth pain (fractures, decay, pulpitis)
2. Identify contributing factors:
   • Aggressive tooth brushing
   • Acidic diet
   • Grinding/clenching
   • Recent dental procedures
   • Gingival recession

Any oral ulcer or persistent sensitivity beyond 4 weeks requires dental evaluation to rule out serious conditions 4, 1.

Treatment Algorithm

Step 1: At-Home Interventions

• Desensitizing toothpaste with 5% potassium nitrate

  • Apply at least a 1-inch strip on a soft-bristled toothbrush
  • Brush thoroughly for at least 1 minute, twice daily
  • Focus on all sensitive areas
  • Minimize swallowing and spit out after brushing 1
  • Continue for at least 4 weeks to evaluate effectiveness 1, 2

• Modify oral hygiene practices

  • Use a soft toothbrush
  • Apply gentle brushing technique
  • Consider alcohol-free mouthwash 4

• Dietary modifications

  • Avoid acidic, spicy, and extremely hot/cold foods and beverages
  • Reduce carbonated drinks 4

Step 2: Professional Interventions (if Step 1 is ineffective after 4 weeks)

• In-office application of desensitizing agents

  • Fluoride varnish (2.26% sodium fluoride) 5
  • Professional fluoride gel application 5

• For localized areas with gingival recession:

  • Consider dental restorations to cover exposed dentin 3, 6
  • In severe cases, gingival grafting may be considered 6

Important Considerations

• Timing: Desensitizing toothpaste typically requires 2-4 weeks of consistent use before significant improvement 2

• Warning signs: Stop treatment and consult a dentist if:

  • Sensitivity persists or worsens
  • Pain/sensitivity still persists after 4 weeks of use 1

• Avoid common pitfalls:

  • Moving to invasive treatments (restorations, grafting) too quickly before trying conservative approaches 6
  • Neglecting to identify and address underlying causes (e.g., aggressive brushing, acidic diet)
  • Inconsistent application of desensitizing agents

• Special populations:

  • For children under 12 years: Consult a dentist before using desensitizing products 1
  • For patients with exposed dentin due to periodontal disease: Professional fluoride application may be particularly beneficial 7

Regular dental follow-up is essential to monitor progress and adjust treatment as needed, especially if sensitivity persists beyond the expected timeframe.