Sensitivity vs. Toothache

Even if you are the “perfect” dental patient who flosses thirty times daily, carries a toothbrush in your pocket at all times, and devoutly obeys every word spoken by your hygienist, chances are good that at some point in your life you will experience discomfort or even pain because of a tooth. Other than routine cleanings and checkups or scheduled treatment, tooth pain is probably the most common reason dental appointments are scheduled. When you go to the dentist with tooth pain, one of two conditions will usually be found: tooth sensitivity or a “true” toothache. The purpose of this post is to help you understand each and give some helpful advice if/when you experience either.

Sensitivity

To understand tooth sensitivity, one must know something of tooth anatomy. Teeth are composed of three basic layers. The outermost is a hard, protective covering called enamel which covers an intermediate layer of dentin. Within the dentin is the pulp, a gelatinous core composed of nerves and blood vessels. The middle dentin layer is not as hard as enamel and is filled with millions of small channels or pores that are filled with fluid and a microscopically small nerve branch that comes from the inner pulp layer. Tooth sensitivity occurs when the dentin layer becomes exposed. Usually this happens when the enamel layer is worn away by overly-aggressive brushing, acid erosion, tooth clenching and grinding, etc. Root surfaces, which are lack enamel, can also become uncovered and exposed through gum disease and gum recession. Temperature changes, pH changes (sweet, sour foods), drying of the tooth, and mechanical touch each cause the fluid to move within the tiny dentinal pores or channels, which in turn tugs at the small nerve contained within and the result is a pain signal to your brain.

Fortunately, tooth sensitivity is rarely a serious condition and treatment, which focuses on relieving symptoms, is often quick and relatively inexpensive. All forms of sensitivity treatment are designed to seal the dentin pores, or block the small tooth nerves within from sending pain signals. Toothpastes containing high concentrations of fluoride or potassium nitrate may be prescribed, or commercially available pastes such as Sensodyne (which also contains potassium nitrate and fluoride, but at lower concentrations than prescription pastes) may be recommended. In more severe cases, small fillings to cover the exposed dentin or night guards to prevent grinding and clenching during sleep may be advised.

Toothache

True toothaches arise from many different conditions, among the causes of which are the following: shallow tooth decay (not to the nerve), deep tooth decay (that has penetrated the pulp of a tooth), trauma, cracked teeth, severe grinding and clenching, necrotic or dead teeth (which may have an abscess), and gum infection or disease. One common theme is present in treatment for each: the source of the pain needs to be dealt with; treating symptoms (as is the case with sensitivity) is not enough. Damaged tooth nerves and tooth infrastructures will not repair themselves, and bacterial infection left unchecked, will destroy a tooth (or jawbone). These problems often start small, but over time get larger, more dangerous, and more costly to treat. Fortunately, most painful teeth can be treated with fillings, crowns, and root canals, but if treatment is delayed, a tooth may be rendered non-restorable and extraction may be the only alternative (potentially leading to tooth replacement with dentures, partials dentures, bridges, or implants).

It must also be noted that many conditions can mimic a “true” toothache, among which are teporomandibular joint disorder, wisdom tooth impaction, sinus infection, trigeminal neuralgia, atypical facial pain, heart attack, and tumors. Obviously, some of these conditions are very serious and should receive immediate treatment.

“My tooth hurts; what should I do?”

Ask yourself the following questions in order to determine the next step:   What hurts? Discomfort from cold things, sweets, and sour things may indicate either sensitivity or a “true” toothache. Discomfort from biting usually means something more serious, like an abscess or cracked tooth.

•       Where on the tooth hurts? Discomfort on the tooth surface right by the gums usually indicates sensitivity, whereas discomfort between teeth or in other areas indicates something more serious.

•       How long does it hurt? Discomfort to cold things that doesn’t go away quickly often indicates irreversible nerve damage.

•       Does it hurt when you try to sleep? Teeth needing immediate treatment tend to get more painful when your body relaxes; fewer stimuli are being sent to the brain and so pain signals are harder to ignore. Sensitivity issues rarely hurt at night.

•      Can you see anything wrong in the mirror? Gum recession is very common in sensitive teeth. If you see any noticeable holes, cracks, discoloration, gum swellings, or sores, something more serious is likely to blame.

•       How bad does it hurt? Intense pain requires urgent treatment. Don’t be fooled by minor pain though; dental problems can start small and snowball into a very painful situation.

The purpose of the information in this post is not to cause worry or fear, but to inform. Too often we see problems left untreated for months and even years—sometimes with very costly and significant consequences. If you are experiencing discomfort in your teeth, we’d like to help you resolve your problem and improve your quality of life. If you believe you have sensitivity issues, and don’t have cause to suspect a “true” toothache from the above questions, buy a tube of Sensodyne toothpaste over the counter from any grocery store or pharmacy and try it for two to three weeks. If the problem persists, it is something that you should get checked. Few things can be as bothersome and painful as as a toothache, but please don’t hesitate to schedule an appointment if you see signs of more serious problems. As with most problems, dental or non-dental, early detection and treatment are critical.

Nicolas K. Young, DMD