SENSITIVE TEETH

There are two main types of problem teeth: Sensitive or painful teeth. Painful teeth are a result of dental nerve problems, with the more severe ones indicating nerve damage. Let’s take a look at both.

Most patients who come to us with complaints about sensitive teeth either have pressure-sensitive teeth or temperature-sensitive teeth.

• Pressure-sensitive: If your tooth hurts when pressure is applied or you take a bite of food, it is often because your dentin—the layer under your tooth enamel—is being exposed because of hard-tissue erosion or the loss of soft tissue. 
  
• Temperature-sensitive: Do you suffer pain when your teeth are exposed to the cold? Or to heat? You may be suffering from temperature-sensitive teeth. There are a variety of causes: chipped or cracked teeth, wear-and-tear, acidic foods and exposed dentin near the gum line are some common ones. 

Cracked teeth/cracked tooth syndrome:

Some patients also have cracked teeth/cracked tooth syndrome (a group of symptoms, sometimes unrelated). You can’t see this problem on X-rays or CT scans or in a dental exam. It is diagnosed based on symptoms.

There are three levels of cracked tooth syndrome, based upon depth in the tooth: 

Level 1: Enamel layer, visible crack but no symptoms, little to no pain.

Level 2: Extension of the crack into the dentin, the middle layer of the tooth. This usually gives rise to the sensitive teeth. 

Level 3: Crack that goes to the dental nerve. Usually a crack of this significance will be painful.

Diagnostic questions for sensitive or painful teeth:

In the case of painful, cracked or loose teeth, there are several questions your dentist will ask to arrive at a thorough diagnosis. Among the key questions are:

Is the tooth under consideration dead or alive? The diagnosis will then determine whether, a) the nerve is dead or dying; or b) the tooth is in a compromised state, due either to pain or sensitivity.

What is the structural condition of the tooth, gums and bone? Is the tooth fully intact, compromised or fractured? Do the gums present a “hermetic seal” so as to prevent infections from occurring? Are they inflamed or infected? Is the bone healthy and of adequate mass?

How much stress is being placed on the tooth or set of teeth from biting or clenching? 70% of all dental treatments are the result of excessive dental stress, and studies have found 90% of severe “clenchers” aren’t even aware that they’re clenching.

Once a thorough diagnosis has been performed, an accurate prognosis can be rendered. There are essentially two kinds of prognoses, good and bad. With a good prognosis the decision has been made that the tooth can be saved, and the patient must decide whether or not to do this. With a bad prognosis there is really only one option: to pull a tooth that is deemed unsalvageable.

PAINFUL TEETH

There are two types of pain that affects the teeth:

• Constant pain, unstimulated: This type of pain, which may be caused by trauma to the tooth or an abscess, can be so severe that it is hard to think about anything else. 
  
• Stimulated severe pain: This pain isn’t constant but you may experience it during activities such as chewing.  

If you are experiencing tooth pain, your dentist needs to do an exam to determine the cause. Painful teeth may involve the possibility of nerve regeneration (or nerve death), bone loss or fractures compromising dental integrity.

However, many conditions can simulate tooth pain. These include sinus infections, myofascial pain, neurovascular disorders, neuralgias (a common cause), neuritis (a viral infection of the tooth), neuropathy, and neuromas. Even heart attacks can refer pain to the teeth of the lower jaw.

Treatment options for problem teeth

In some cases, it is possible to use non-invasive treatments for problem teeth. For instance, for sensitive teeth, changing the toothpaste you use may help. If it is determined the tooth is dead or dying, then it’s necessary to extract the tooth or do a root canal. Our office does not perform root canals. We only perform extractions.

Once a tooth is extracted, you will have the option of a zirconia implant, a bridge or a removable partial denture. Our office performs all three of these.

If a patient has been designated as a suitable candidate for a dental implant, the following types of prostheses or implant restorations become possible.

Single Implant–Abutment–Crown: Almost 80% of implant cases involve a single tooth that is crowned. Again, 80% of these cases are considered “simple” in terms of implant placement.  Complications such as inadequate bone, sinus position, or position of the nerve may require additional bone grafting.

Multiple Implant–Abutment-Bridge: A bridge is simply a set of connected crowns that sit on top of the implants. For example, if three teeth are missing, two implants can usually support a three-tooth bridge. What makes the procedure more complex would once again be the position of the bone, sinus and nerves.

All on 4/ all on 8/ Full-Arch teeth (same-day teeth): When an entire arch- meaning, the whole set of upper or lower teeth, needs replacement by a prosthesis, we use the terms “All on 4” or “All on 8” to refer to the number of implants needed to hold and stabilize the teeth. Ceramic implants generally require more implants than those made of metal for reasons that will be explained later. But the cost for either type will be similar. Before this procedure can be done, an Implant assessment will need to be performed just to make sure one is a good candidate for a full-arch prosthesis.

All on 4 / All on 8/ Full Mouth Teeth (same-day teeth): A full mouth is similar to a single arch, except here both upper and lower teeth are being replaced.

Ultimately, every patient is different. Whether you have sensitive teeth or painful teeth, the first step to solving your pain is picking up the phone and scheduling an exam. We welcome the opportunity to help you to uncover the cause of your pain and find a solution that works for you.