Why can a tooth feel cold at all?
The enamel is completely devoid of nerves and does not feel anything on its own. Beneath it lies dentin - tissue permeated with tubules thousandths of a millimeter thick, which stretch from the border with the enamel to the pulp, where the nerve and blood vessels are located. Inside each tubule there is liquid. When dentin is exposed, any sharp irritant - a stream of cold air, a sip of ice water, sweets - causes rapid movement of this fluid in the tubules, and the movement irritates the nerve endings at the entrance to the pulp. Hence the nature of the pain: it occurs instantly, feels like a lumbago and goes away as soon as the irritant disappears.
Dentin can be exposed in two ways. The first is from below: the gum moves down, exposing the neck and root of the tooth, which are not covered with enamel at all, but are protected only by a thin layer of cement, easily erased with a brush. The second is from above: the enamel becomes thinner or destroyed, and dentin comes to the surface of the chewing or front surface of the tooth. These two pathways require different treatments, which is why it is important to understand which one is yours.
- Gum recession - exposure of the necks and roots of teeth, the most common cause in adults
- Erosion of enamel from sour foods: carbonated and energy drinks, juices, citrus fruits, wine, as well as reflux of gastric contents into the esophagus
- Abrasive abrasion using a hard brush, abrasive bleaching pastes and powders, soda
- Wedge-shaped defects at the neck of the tooth - a characteristic step is formed at the border with the gum
- Pathological abrasion due to grinding and clenching of the jaws
- Temporary sensitivity after whitening, scaling or filling
Where does gum recession come from?
Exposure of the necks of teeth is almost never an accident, and in most cases there are three groups of reasons behind it, often acting together: mechanical trauma from cleaning, inflammation of the tissues around the tooth and structural features. It is important to figure out which of them is leading because it is the one that will have to be changed - otherwise the gums will continue to recede, no matter how many pastes are purchased.
- Cleaning with strong pressure, horizontal sawing movements and a hard brush is the most common mechanical cause.
- Chronic periodontitis and tartar, destroying tooth support
- Thin gum biotype and small volume of bone on the outside of the root are a congenital feature.
- Anomalies of tooth position in which the root stands outside the bone plate
- Short frenulums and strands of mucous membrane, pulling back the edge of the gums
- Orthodontic movement of teeth beyond bone support
- Grinding and clenching of the jaws, creating excessive stress on the necks of the teeth
- Habit of keeping foreign objects in the mouth, as well as lip and tongue piercings
An indicative sign of excessive pressure is a smooth, shiny platform or step at the border of the tooth and gum, more often on the canines and premolars, and at the same time more pronounced on the left in right-handed people. Such asymmetry almost always indicates a brush, not a disease. Changing a hard brush to a soft one and switching to sweeping movements from the gum to the edge of the tooth stops the process better than any drug from the pharmacy, although it does not return the already receded gum.
Hyperesthesia or no longer it: how to distinguish
This is the most practically valuable section, because the answer determines whether to go to the doctor as planned or today. The key symptom is the duration of pain after the stimulus is removed. The sensitivity of exposed dentin disappears in seconds. If the tooth continues to ache for a minute, two, five, it means that the pulp is inflamed, and no paste will help, and delay costs the tooth.
- Боль возникает мгновенно и проходит за несколько секунд после того, как раздражитель убран — типичная гиперестезия.
- Боль длится минуты после холодного или горячего, возникает сама по себе, усиливается ночью и в положении лёжа — воспаление пульпы, нужен врач срочно.
- Зуб успокаивается от холодной воды и обостряется от горячего — характерно для гнойного воспаления пульпы, это неотложная ситуация.
- Резкая боль при накусывании на определённую точку и особенно при разжимании челюсти после накусывания — вероятна трещина зуба.
- Реагирует один конкретный зуб, а не группа, и всегда одинаково — ищут кариес, негерметичную пломбу, скол.
- Реагируют сразу многие зубы, в основном у шеек и с одной стороны челюсти — это чаще гиперестезия от рецессии.
- Боль при кислом и сладком без реакции на холод — нередко признак кариеса, а не гиперестезии.
What helps at home and why it’s not enough
Home remedies work on two principles: some clog dentinal tubules, others reduce the excitability of nerve endings. Both approaches provide real relief, but both address the symptom. If you continue to brush your teeth with a hard brush with pressure and wash it down with a carbonated drink, no toothpaste will maintain the result.
- Special pastes for sensitive teeth - they are used in a course and continuously, and the effect accumulates in two to four weeks, and not in one day
- A technique that is often not known about: a small amount of this paste can be rubbed into a sensitive area with your finger and not washed off before bed.
- A soft brush and sweeping technique from the gum to the edge of the tooth, without sawing movements or strong pressure
- Refusal of abrasive whitening pastes, powders, soda and activated carbon - they aggravate dentin exposure
- Reducing the frequency of sour drinks; It’s better to drink them through a straw and in one go, rather than spreading them out over an hour
- Rinse with water after acidic and pause for at least half an hour before cleaning
- Fluoride rinses as recommended by a doctor
- If the sensitivity is associated with heartburn, it is not the teeth that need to be treated, but the reflux of gastric contents - otherwise the enamel will dissolve further
What you definitely shouldn’t do is switch to constantly sparing the sore side. When a person chews on one side for months and does not clean the sensitive area, plaque accumulates there, the gums become inflamed, and recession accelerates. The vicious circle is broken not by patience, but by selecting a suitable brush and treating the cause.
What does a doctor do
Professional treatment begins not with a procedure, but with a search for the source. Examination, assessment of teeth closure, checking for cracks and caries, taking a photo if necessary, talking about brushing habits and nutrition - only then choose a method. It often turns out that the reason for one person is twofold: both aggressive brushing and clenching of the jaws at night.
- Устранение очевидных причин: лечение кариеса, замена негерметичных пломб, снятие зубных отложений, коррекция завышающей пломбы.
- Покрытие чувствительных участков препаратами фтора и составами, закупоривающими дентинные канальцы, — обычно курсом of нескольких посещений.
- Восстановление клиновидных дефектов пломбировочным материалом: он и закрывает обнажённый дентин, и останавливает углубление ступеньки.
- Изготовление защитной капы при скрежете и сжимании челюстей, а при необходимости — коррекция смыкания.
- Treatment пародонтита, если рецессия связана с воспалением опорных тканей.
- Хирургическое закрытие рецессии лоскутом или трансплантатом — когда корень обнажён значительно, есть эстетическая проблема или чувствительность не поддаётся другим методам.
- Treatment канала — крайняя мера, к которой прибегают, если чувствительность оказалась проявлением необратимого воспаления пульпы.