spectrum:
I have several teeth that are sensitive to pain induced by cold, especially food and drink, probably due to thermally conductive amagam fillings. I know that when I start diving especially when doing skills in my check-out dives in 40 something F water they're going to take a beating. Short of root canals do I have any options to dull the pain? I see my dentist later this week and thought being an informed patient would be a good thing. Any ideas?
Thanks,
Pete
Hi Pete,
Teeth that are sensitive to cold is rather common especially from the mid twenties to about 50. Women are affected more than men.
Common causes are gum (gingival) recession, cervical erosions (wear at the neck of a tooth), bruxism/clenching, consumption of acidic foods like lemon and water on a daily basis or carbonated sodas. Individual teeth may become sensitive following restorative procedures...both silver fillings AND composite fillings have ways to make teeth sensitive. As you have already mentioned, metallic fillings are good conductors of temperature as can any other type of metallic crown, inlay or onlay.
Cold sensitivity is associated with some types of pathology within the tooth. Fractured teeth often become sensitive to cold and sweets if the nerve within is still normal. Sensitivity to cold and HOT is often a sign that there is a problem with the nerve and a root canal may be necessary. In general, temperature sensitivity that is a result of some sort of pathology is usually localized to individual teeth rather than generalized throughout the mouth. Some teeth with cavities will become sensitive...usually after the decay has gotten deeper...although some people get sensitivity as the first sign of a cavity.
A very common source of sensitivity to cold that occurs rather suddenly and then persists, is the use of "tartar control" or "whitening" toothpastes. The active ingredients that are used to control tartar or whiten teeth is the culprit. Switching to a regular, fluoride toothpaste with no other fancy ingredients will often reduce or eliminate the problem. The toothpaste manufacturers deny this as a cause but most dentists, including myself, have seen the effect. FYI...whitening toothpastes don't work very well to whiten teeth and may be abrasive. Tartar control toothpastes are only for persons with heavy accumulations of supra-gingival (above the gum) tartar. It does not work under the gum. You should ask you dentist if you would benefit before switching toothpastes.
Quarrior is correct in recommending Sensodyne toothpaste. The active ingredient is potassium nitrate. This can also be found in Crest Sensitive. Fluoride rinses may be helpful...even better is applied by the dentist (higher concentration). There are also fluoride varnishes, GLUMA, resin impregnation (applying a clear coat of plastic resin to the root surfaces). If you happen to have bleaching trays, you can actually apply Sensodyne to your teeth with the tray. Leave it in place for 5 minutes of more, then brush and rinse.
None of the above desensitizing techniques will work if there is underlying pathology.
Obviously, therefore you must rule out any dental pathology before trying to treat the sensitivity. You should see you dentist and discuss the problem. Root canal treatment is normally reserved for nerves that are irreversibly damaged or abscessed. Rarely, a severely sensitive tooth is treated with a root canal but this is a rare, last ditch treatment if the nerve is actually determined to be "normal".
Let me know how it goes.
Laurence Stein, DDS
