Dental hyperesthesia: what causes increased sensitivity

Causes Forms of hyperesthesia Diagnostics How to reduce sensitivity? Possible complications Prevention
Hyperesthesia or increased sensitivity of teeth is pain that occurs in response to temperature, chemical, and tactile stimuli. Characteristics:

1. The pain is short-term but constantly recurring
2. It is not associated with oral or dental diseases

Hyperesthesia is caused by thinning of the enamel. The underlying dentin is no longer protected and responds to irritation. Another reason could be receding gums. In this case, the root is exposed and reacts.

In Russia, 62% of the population

[1]. The problem mainly occurs between the ages of 30 and 60 years.

Dental hypersthesia

Dental hyperesthesia is an increase in the reaction of enamel to chemical and temperature provoking factors. Also, painful sensations can occur with acidic foods - fruits and berries. Discomfort is possible when chewing food and hygienic cleaning with a regular brush.

Dental hyperesthesia according to ICD-10, this condition is assigned code K03.8. It is important to understand that in most cases, increased sensitivity of the hard tissues of dental units is not an isolated pathological process. It occurs as a response to concomitant diseases.

In the branches of West Dental family dentistry in Vsevolozhsk and Yanino-1, our specialists, dental therapists, will help solve this problem. They will select the necessary measures for the prevention and treatment of this disease. In this article we will talk in detail about what dental hyperesthesia is and its varieties. You will learn how to prevent its occurrence and fight it.

What to do if you have tooth sensitivity

When unpleasant sensations appear, the first reaction of a modern person is to look for advice on the Internet. Among the recommendations, the first place is occupied by the use of folk remedies. A decoction of chamomile, calendula or sage has a soothing and anti-inflammatory effect. Propolis has the same effect, but it should not be chewed on an empty stomach. Tea tree oil and saline solution disinfect the oral cavity.

The problem is that home remedies do not eliminate the cause, but only mask it. Treatment of dental hyperesthesia should be comprehensive. First you need to determine the factors that led to its development. If it is caries, it is necessary to treat carious cavities. In the case of periodontal diseases, the work begins with stabilizing the process. Common diseases require treatment from a specialist. Often, eliminating the root cause is enough. In any case, the decision on how to treat tooth sensitivity should be made by the doctor.

Causes

Hypersensitivity of hard tissue structures of teeth can develop for certain reasons:

• Mechanical trauma to enamel - when cleaning at home, using an excessively abrasive paste or a brush with hard bristles, applying a lot of force to the enamel.
• Multiple acid exposure - juices, carbonated drinks, fruits and berries.
• The presence of pathological conditions in the oral cavity that violate the integrity of the structure of enamel prisms: carious process, wedge-shaped defect, erosion.
• Gum recession is the exposure of the cervical area of ​​the teeth due to bite pathology, inflammation of the gum tissue, and vitamin deficiency.
• Exposure to radiation - increased occupational hazard, radiation exposure.

Hyperesthesia of tooth enamel may be a temporary phenomenon. Thus, it appears in the first 2 days after professional cleaning due to the removal of hard deposits or office lightening of the enamel.

There are factors that provoke symptoms - heavy smoking; dry mucous membranes due to endocrine pathologies; gagging; gastrointestinal diseases.

Tooth hypersensitivity after caries treatment

Hyperesthesia after medical intervention is associated with the use of phosphoric acid to treat the prepared cavity. This makes it possible to increase the adhesion of the filling material to the tooth tissues, but when it comes into contact with healthy enamel, the acid washes out calcium from it, so sensitivity increases. To avoid this phenomenon, the dentist treats the enamel after installing the filling with a special preparation.

Also, after caries treatment, tooth sensitivity to hot or cold temperatures may persist for several days due to the fact that when drying the prepared cavity before treating it with orthophosphoric acid, the surface was overdried, resulting in increased dentin sensitivity. After some time, the necessary moisture comes from the dental tissues into the surface layer of dentin, and the unpleasant sensations disappear.

If tooth hypersensitivity persists for a long time after treatment of caries, it is necessary to repeat the visit to the dentist to find out the reasons.

Manifestations

Dental hyperesthesia (according to ICD-10 K03.8) is manifested by a brief pain reaction when interacting with irritants. Unpleasant sensations usually do not exceed a few seconds in duration and appear with some regularity under the influence of a disturbing factor.

The severity of the pain varies - from inconvenience to difficulties with cleaning and standard meals. Such symptoms reduce the quality of life and can force you to change your usual diet and lifestyle.

Some of the most severe symptoms occur with improperly formed enamel; carious process at the neck of the coronal part; severe abrasion of chewing surfaces.

High enamel reactivity can occur in one unit or all of them in the oral cavity. With a single lesion, one unit reacts, and with a developing erosive pathological process, the entire row will be affected.

Doctor's advice

To reduce tooth sensitivity, it is necessary to follow measures to prevent hyperesthesia:

• stop smoking;
• change the hard brush to a softer one;
• When buying toothpaste, pay attention to its composition and abrasiveness. You should choose hygiene products with potassium, fluorine, calcium, and hydroxyapatite. Low abrasive compounds (RDA 0-70) are recommended for people with enamel hypersensitivity;
• exclude carbonated water, sweet drinks, and sour fruits from the diet;
• eat food warm;
• visit a dental hygienist twice a year for professional hygienic teeth cleaning and enamel remineralization.

Classification

Clinical studies have resulted in the most complete structuring of dental hyperesthesia (ICD K03.8), based on which the doctor will determine the causes of the pathology and will be able to differentiate it from other diseases. And most importantly, the specialist will be able to make a true diagnosis and formulate the correct treatment tactics. The classification allows us to systematize the factors influencing the occurrence of the disease.

By location:

• Limited - a limited number of units are affected (1-3). Teeth ground for orthopedic structures, or affected by cervical caries.
• Generalized - most of the dentition is affected, sometimes the entire tooth row. The reasons are erosion, gum recession, high abrasion.

By origin:

• due to a decrease in the volume of solid tissue structures.
• volumes of hard tissues do not affect. Associated with periodontal diseases, pathologies of the endocrine, nervous and gastrointestinal systems. Visually, the integrity of the enamel is not compromised.

According to the severity of the pathology:

I—response to temperature;

II - pain when interacting with sweet, sour and bitter foods;

III - pain is caused by all irritants, as well as hygienic cleaning.

The strength of pain reactions depends on the characteristics of the body.

The mechanism of development of hyperesthesia

Tooth enamel is not sensitive; its purpose is to protect softer dental tissues from external influences. Enamel consists of 96% mineral substances, so it is extremely durable. Its main components are calcium and phosphorus compounds; the properties of enamel and its hardness depend on their quantitative ratio.

Under the enamel there is dentin, penetrated by dentinal canals - the main tissue of the tooth, which has some sensitivity to external irritants. When the physicochemical properties of enamel change, its permeability increases and the level of dentin protection decreases. The nervous structures of the dentinal tubules are connected to the pulp of the tooth - its nerve, therefore, when exposed to any irritant, increased sensitivity of the tooth appears.

The occurrence of hyperesthesia is explained by the hydrodynamic theory: when intratubular pressure changes, the speed of movement of dental fluid in the dentinal canals changes, which causes irritation of the nerve endings and pain. In practice, this happens like this: due to thinning or damage to the enamel, the dentin is exposed, the dentinal tubules open and dental fluid comes out of them; As a result, the intracanalicular pressure changes, which, when exposed to external stimuli, causes sharp pain in the tooth. The reaction to cold is most acute; when exposed to hot stimuli, there is no significant change in the speed of movement of the dental fluid.

Sometimes tooth hypersensitivity occurs without damage to the enamel, which is explained by existing pathologies of other organs. The strength of pain depends on the number of dentinal tubules in the tooth, the diameter of their lumen, which are individual characteristics of the body. The severity of pain is also affected by the patient’s pain sensitivity threshold: if it is reduced, then sensitivity increases.

Complications

High reactivity of hard tissue structures of teeth can affect the general condition of a person. Diseases of the psyche and gastrointestinal tract may worsen. Soreness often disrupts the usual diet.

One of the most obvious and severe consequences of hypersensitivity is pulpitis - an inflammatory process that affects the neurovascular tissue inside the tooth. Constant exposure to irritants on the pulp can lead to aggravation of the process, as well as a deterioration in the general condition of the body. Treatment of such a complication is multi-stage and labor-intensive: the pulp is removed, endodontic treatment is carried out, and the coronal part is restored.

It happens that excessive sensitivity is only one symptom of pathology, for example, a harbinger of a wedge-shaped defect. Therefore, it is important to immediately make an appointment with a specialist with this problem in order to determine the provoking factors of the disease and avoid complications. Dentists at the West Dental clinic will help you with this and select fast and high-quality treatment.

How does hyperesthesia manifest (symptoms)

The main sign of dental hypersensitivity is intense but short-term pain (15-35 seconds) when exposed to temperature (cold, hot), chemical (sour, sweet, spicy), mechanical (percussion, brushing) factors. Increased reactivity is observed in one, several segments, or in all units of the series. A dental examination may reveal:

• atrophy of soft tissues in the cervical region;
• wedge-shaped defects on crowns;
• caries at different stages of development (from white spot to deep);
• cracks, chips of enamel;
• dental hypoplasia;
• enamel erosion;
• fluorosis, etc.

Diagnostics

When examined by a specialist, it is important to conduct a thorough differential diagnosis in order to distinguish hypersensitivity from other diseases with similar symptoms:

• pulpitis;
• caries;
• cracked tooth or filling material.

In case of dental hyperesthesia, differential diagnosis consists of a visual and instrumental examination; an X-ray and electroodontodiagnosis (EDD) may be necessary.

A characteristic feature of high enamel reactivity is quickly subsiding acute pain. To identify it, a specialist needs to check the condition of the pulp using X-rays or using EDI. If a preliminary diagnosis of hypersensitivity is made, the doctor performs diagnostic tests to determine the degree of reaction of dental tissues to irritants. Afterwards, the specialist draws up an individual detailed plan for the treatment and prevention of dental hyperesthesia.

Types of hypersensitivity

In 1981, Soviet dentists Yu. A. Fedorov and I. G. Lukomsky proposed a classification of dental hypersensitivity:

1. According to the clinical course, they are distinguished:
   1st degree of severity – the tooth reacts to temperature changes.
2. 2nd degree of severity - the tooth reacts to temperature and chemical influences.
3. 3rd degree of severity – sensitivity to mechanical stimuli is added.
4. According to the area of ​​distribution there are:
   Limited hyperesthesia, in which one or more teeth are sensitive.
5. Generalized hyperesthesia - all teeth or most of them are sensitive.
6. By nature of origin:
   With the loss of hard dental tissues (with caries, wedge-shaped defects, abrasion and erosion of enamel).
7. Without loss of hard dental tissues (for periodontal diseases, functional disorders in the body).

Hypersthesia in children

Dental hyperesthesia in children, in most cases, is associated with non-carious lesions of the enamel:

• Thinning of enamel prisms, resulting from microcracks and defects;
• Bite pathology leading to abrasion of hard tissue structures;
• Traumatization of teeth;
• Treatment not carried out in a timely manner, leading to exposure of the root parts of baby teeth;
• Abuse of soda and sugar-containing products;
• Adolescence (10-14 years) during the eruption of several permanent teeth with still immature enamel.

At the appointment, the dentist will examine the child and diagnose the pathology. He will tell you in detail about preventive measures (remineralizing therapy, fluoride pastes) and treatment.

What medications are used for hyperesthesia?

Drugs used for hypersensitivity are divided into two types:

• Means blocking dentinal canals.
• Drugs that block the nerve endings of the dentinal tubules.

Let's consider the classes of such drugs:

• Fluorides . Fluoride has been used in dental treatment for a long time. The peculiarity of fluoride ions is that they react chemically with calcium, forming calcium fluoride. It is a stable, insoluble salt that clogs the dentinal tubules. Thus, it is possible to significantly reduce irritation of the nerve endings in the dentinal tubules.
• Fluorinated varnishes . These remedies are used in cases where it is necessary to achieve a quick effect. Since fluoridated varnish wears off from the surface of the teeth within a few days, some patients are given several layers of such varnish.
• Pastes for remineralization . Such pastes are intended to restore the normal mineral composition of dental hard tissues. Currently, there are remineralizing pastes for home use and professional ones for use in dentistry. The choice of paste is made by a doctor after diagnostic procedures.
• Drugs that reduce sensitivity (desensitizers) . These are special drugs that clog dentinal tubules. This is achieved both by mechanical and biochemical blockade of the tubules. In the latter case, drugs that depolarize nerve fibers are used. In this way, it is possible to interrupt the transmission of the nerve impulse through which pain occurs.
• Oxalates . Like fluoride ions, oxalates also bind to calcium ions, forming insoluble salts. Calcium oxalate salt clogs the dentinal tubules, reducing tooth sensitivity several times.

Treatment

The main therapy for hypersensitivity focuses on eliminating provoking causes and slowing down the flow of dentinal fluid in the tubules. This therapeutic regimen is performed:

• Clogging of micropores and cracks in the hard tissue structures of dental units with desensitizers - specialized means that reduce tissue reactivity.
• Narrowing micropores with mineralizing agents. Specialized gels containing fluorine and calcium. Restoring the mineral balance in the hard tissue structures of teeth helps to achieve high results. This technique is a fundamental part of preventive measures to combat caries and other pathological processes.
• Narrowing or complete blockage of tubules in dentin under a directed laser beam.

It is important to know that sensitivity formed due to loss of gingival and bone tissue, gum recession, will require major therapeutic and surgical interventions. It is necessary to perform comprehensive treatment of periodontal disease to restore a full life and diet.

If the symptoms are caused by pathological closing of the jaws, then orthodontic treatment is necessary. So, when the carious process develops, the doctor will remove the affected structures and further restore it with specialized material. If the process is complicated by pulpitis, endodontic treatment will be necessary - extirpation of the pulp bundle, mechanical and medicinal cleaning of the root canals with their further filling. Finally, restoration of the anatomy of the cusps and fissures of the chewing surface with filling material.

West Dental specialists have all the necessary knowledge, and the clinics have high-tech equipment to select and provide suitable therapy, taking into account all the symptoms of the process. Today, gels, pastes, and varnishes with fluorine and calcium are widely used. It is possible to use electrophoresis and vitamin therapy.

Doctors at West Dental branches will provide highly qualified assistance in treatment of any complexity. You can make an appointment for a consultation by phone or on the website.

How to reduce tooth sensitivity

Medical intervention depends on what is causing the increased sensitivity. The main thing is to remove not the symptoms, but the cause.

When treating, follow the rule: from simple to complex. In dentistry this is called “from reversible to irreversible methods.”

1. Hygiene products
   . Special rinses and toothpastes to reduce tooth sensitivity. These measures are sufficient for minor manifestations. They are good for reducing tooth sensitivity after whitening.
2. Professional measures
   . Saturation of enamel with minerals, fluoridation, the use of dentin sealants and desensitizers and other drugs help combat hypersensitivity.
3. Laser therapy
   . Dentin is able to absorb the energy of a laser beam, and its tubules become clogged. This allows for a decrease in sensitivity.
4. Physiotherapy
   . The effectiveness of electrophoresis in reducing severe tooth sensitivity has been confirmed.
5. Endodontic treatment
   . If other measures do not help, the tooth is depulped.

All these methods are used after or simultaneously with the elimination of the cause that caused hyperesthesia. An integrated approach helps to remove tooth sensitivity to cold, hot, as well as mechanical and chemical irritants.

Where can they help get rid of hyperesthesia?

The dental clinic “Academy Dent” is one of the few medical institutions in all of Moscow where doctors pay due attention to the problem under consideration and treat any diagnosis with attention, trying to differentiate it as accurately as possible and determine the only correct tactics for managing the patient. In addition, an individual plan of examinations and analyzes is developed, taking into account the characteristics of the person’s objective condition and his medical history. The service of the medical institution will please you no less - at the Dent Academy you will never see queues, and the staff will treat you as a VIP client, regardless of your receipt!