Treating tooth hypersensitivity

Full disclosure: I love ice cream. Since I was very young, the way to my heart was through a Dairy Queen ice-cream cake. (You can’t tell me that you don’t love the creamy and crunchy combination of an ice-cream cake.) However, as a child who suffered from tooth hypersensitivity, sometimes as an adult I’ve felt myself turning away from my favorite cold treats. Although I have only practiced a few years as a dentist, I have spent many years as a patient with tooth sensitivity. With my empathy for other patients who suffer from this too, I have learned a few tips, tricks, and products that have helped both my patients and me combat cold sensitivity.

This article will not be discussing the scientific basis for tooth hypersensitivity. It is important for you as a provider to ensure that the tooth does not have a pathological reason for its sensitivity to cold. This article is geared toward providing some assistance to the patient with generalized tooth sensitivity. Since tooth sensitivity is a common complaint, ensuring that you have a number of strategies to treat the symptoms is important for your practice and your patients.1

The first type of patient who comes to mind is one who reports low-grade tooth sensitivity. When you ask the patient at a recare exam, “Have you had any concerns since your last visit?” sometimes the patient may respond, “You know, doctor, actually I do have a concern. Sometimes when I drink something cold, all of my teeth are sensitive. Not too bad. I mean, no pain, just a little sensitivity. You know?”

Of course I know. For the patient with generalized, mild sensitivity—after ruling out other reasons that might be the cause of the problem—my first course of treatment is to start with an over-the-counter sensitivity toothpaste and nutritional counseling to avoid foods or oral habits that cause sensitivity. This is a common first-line treatment recommendation among dentists and has been shown to be effective.2 For many patients the treatment stops here. If the patient has high caries risk, however, or if the over-the-counter product does not provide relief, then I prescribe a prescription 5,000 ppm fluoride toothpaste. I have learned from experience that this really helps with generalized tooth sensitivity.

The next type of patient is one who presents with a tooth that has mild recession resulting in sensitivity. This patient may say, while pointing to the tooth, “Doctor, sometimes this tooth is sensitive. I know my gums are not quite right in this area, but can you fix it?” There are multiple treatment options for patients who have mild gingival recession. However, if they choose not to move forward with more aggressive treatment, I will treat the recession and try to offer them some relief.

In my office, we have found that applying Gluma Desensitizer PowerGel (Kulzer International) locally over the area of recession works very well for our patients with sensitivity. If you have the Gluma that is a clear liquid, it will work well, too; however, the gel is great because it is green, which makes it highly visible. It is also more viscous so that it stays in one area and more concentrated with the active ingredient. Other localized treatments include fluoride varnish applications or bonding agent applications. We apply these types of treatments every six months at the patient’s recare visit, and it helps improve the symptoms.

The last type of patient who comes to mind is one who suffers from postwhitening sensitivity. For the longest time while I was in dental school, my teeth would be extremely sensitive after using any whitening product. I wanted the whitening results, but I didn’t want the sensitivity that accompanied using whitening trays. In a continuing education course, I found a product called Relief ACP Oral Care Gel (Philips Oral Healthcare). I love to use this product before I start a whitening cycle, and I even use it to alternate between whitening treatments. It is a great option for patients who want to whiten their teeth without any of the uncomfortable side effects.

The next time you are strolling down the streets and see a gelato stand or a Dairy Queen, I hope that you think of your patients who have sensitivity. But even more, I hope that you can start to offer products and solutions for their discomfort so that everyone can enjoy a cool and tasty treat comfortably.

References

1. Clark D, Levin L. Non-surgical management of tooth hypersensitivity. Int Dent J. 2016;66(5):249-256. doi:10.1111/idj.12247.

2. Bae JH, Kim YK, Myung SK. Desensitizing toothpaste versus placebo for dentin hypersensitivity: a systematic review and meta-analysis. J Clin Periodontol. 2015;42(2):131-141. doi:10.1111/jcpe.12347.

Erinne Kennedy, DMD, MPH, graduated from the Nova Southeastern College of Dental Medicine in 2015 and is a blogger and speaker for IgniteDDS. She is pursuing a dental public health specialty and a master’s in dental education at Harvard School of Dental Medicine, and serves as an interim director at a local health center in Boston, Massachusetts. Contact her at (937) 539-0629 or [email protected].