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Sensitivity in the teeth is one of the most common problems patients all over the world experience. There are many possible reasons, but the underlying pathology is the same for all cases.

Why do we have sensitivity?

To understand why we suffer from sensitive teeth, it is important to understand the basic structure of the teeth. Following normal tooth development, the outermost surface of the crown and root is covered by a substance called enamel. This is the hardest structure in the body and it protects the teeth against all kinds of forces and temperature changes.

Below this layer of enamel, is the dentin and the pulp. Both of these substances are nerve rich and are not built to be exposed to the outer environment. Loss of enamel for any reason causes the sensitive part of the tooth to be exposed to a harsh oral environment.

Causes for Loss of enamel

Enamel can be lost for many reasons, resulting in sensitivity. Let's take a look at some of the more common causes

Tooth Decay

This is caused by a combination of bacterial colonization, suitable acidic environment and appropriate morphological characteristics of the teeth. Once the decay has started, the bacteria continue to destroy the normal structure of the teeth starting from the enamel and working inwards towards the dentin and pulp. Once a tooth is severely decayed, it will start causing continuous pain.

Tooth Brush Trauma

Overzealous brushing can damage your enamel. A clinical examination will show signs of wear. The symptoms associated with this kind of injury are a sharp, shooting pain after drinking cold liquids and eating sweet foods. This can progress to pain while eating or drinking anything in a short while as well.

Periodontal disease

A loss of the supporting structures of the tooth such as the gingival and the bone can cause the cementum, which covers the roots, to be exposed to the environment. This cementum is not hard like enamel and is easily destroyed. The resulting temperature changes and physical insults to the tooth result in sensitivity.

Vital Crown cutting

In the case of posterior teeth, clinicians occasionally choose to prepare a crown on a tooth which has not had root canal treatment. The process of crown cutting involves grinding away a part of the tooth. This is invariably at the expense of enamel.

Now, in most cases, this should not be a problem as the cement layer used to cement the crown will also provide some thermal insulation, however in some cases the dentin and the pulp become inflamed and the tooth becomes acutely sensitive.

The solution for this problem to both remove the crown and perform a root canal procedure, followed by the placement of a new crown or to drill through the crown and perform the root canal with the crown in place.

The problem of sensitivity is quite common and although it can be quite troublesome for the patient, it is easily dealt with once the proper cause is identified.

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