Dr. Ravi Sharma

Losing a tooth to infection (decay) or trauma can be a painful experience. Imagine that you are in a dental chair and just got a new tooth or a bridge fitted. It is a joyous experience, almost like a new found lease of life, to be able to eat better and look better. However, even after a few days to a week, you realize that the new crown is just not settling down completely. There is a constant sensitivity that exists and is not allowing you to enjoy the new tooth.  

There are various reasons that the new crown can be sensitive, some of them including:

1. A high point: On the new crown, there could be small points that do not allow for a bite as earlier. This can lead to sensitivity and minor jaw discomfort. 
2. Improper fit with exposed dentin: This can happen at the neck area, where the crown is not fitting the tooth, leaving a small part of dentin exposed. This can lead to sensitivity once the crown is fixed in.
3. Other decayed teeth: If there is a decayed tooth adjacent to the crown, it could be confusing and sometimes difficult to pinpoint the exact area.

If it persists for more than a week, check with your dentist on the following:

1. Severity of decay: The extent of decay in the first place should be considered, especially if you have had crown as a result of extensive tooth decay. If it was involving a large portion of the dentin, the changes of having sensitivity are high, even after a crown placement.  In these cases, there could be silent abscess, which may never manifest as symptoms, but can cause a gnawing sensitivity issue with each bite.
2. Area of decay: Root caries and cervical caries are more prone to have sensitivity compared to the crown of the tooth. The enamel layer in these areas is thin and the chances of dentinal involvement is high. The rate at which the decay will reach the pulp and cause pain is also higher.
3. Type of dental treatment: If extensive metal work is done, the sensitivity might last longer than a week, which is the norm.
4. Triggering factors: Make a note of what triggers the sensitivity, hot, cold or sweets. 
5. Management: As mentioned, expect the sensitivity with your new crown to last for up to a week. In some cases, it may be longer, depending on, as noted above, the severity of the original decay, the area, triggers, etc. 

While some cases may be managed with a small trim of the crown, some may need the crown to be re-fitted, and some may even require re-treating the tooth completely.

Dental problems can be very painful and take the smile off your face completely. Those who have experienced sensitivity would vouch for it. It just will not allow you to enjoy the hot coffee or a favourite sweet or a cold smoothie.  The pain that shoots down the tooth after any of these would leave the person shuddering.

The tooth has 3 layers, from the outside in these are the enamel, the dentin and the pulp.  The outermost enamel is mineralized and the hardest structure in the body. The next layer, dentin, has fine tubules and when the enamel is worn off exposing the dentin, sensitivity sets in. The enamel is thinner in some portions of the tooth like the neck and the roots, therefore sensitivity onset is quicker in these areas.

Some of the common reasons for sensitivity are listed below:

1. Tooth decay:  As caries progresses from enamel to dentin, sensitivity sets in, especially to hot and cold foods.
2. Wear and tear:  Excessive brushing of teeth can lead to wearing of teeth, especially near the neck areas, leading to loss of enamel and resulting in sensitivity.
3. Dental damage:  Chipped or broken tooth can lead to sensitivity.
4. Gingival disease: This leads to loss of gum cover over the tooth, leading to exposure of dentin and therefore sensitivity.
5. Bruxism: Clenching of teeth, common in people with high levels of stress, can lead to enamel wearing and subsequent sensitivity.
6. Dental treatment: Some dental procedures like scaling, crowns, root planing, and some fillings can cause transient sensitivity.
7. Highly acidic food items: Citrus fruits, tomatoes, tea, etc. can lead to tooth sensitivity.
8. Bleaching agents:  Most tooth whitening agents result in sensitive teeth.
9. Excessive use of mouthwash: The mouth rinses contain high amount of alcohol which can also lead to tooth sensitivity.

Management: As with all health conditions, the first step in management is to identify the problem.  Whether it is dental decay or recent dental treatment, food habits or tooth whitening agents, the cause needs to be identified and then treatment begun accordingly.

1. For lost enamel, be it decay or damage, the tooth again needs to be restored to its original form to cover the dentinal tubules and reduce sensitivity.
2. For habits, be it food related or bruxism, in addition to treating the tooth, the habit per se needs to be addressed to prevent recurrence.
3. For associated dental products like whitening agents or mouth rinses, talk to a dentist to switch to a less harmful product.
4. De-sensitizing pastes are also available that can be used on a regular basis to reduce the problem.

Tooth sensitivity is annoying but there are ways to manage it effectively.

Gum disease is characterized by inflammation of the gums caused by the bacteria present in plaque (a colorless and sticky film on the teeth). This disease affects the soft tissue and the bones surrounding the teeth. The bacteria causes irritation in the gums leading to infection and bleeding, while brushing your teeth.

The symptoms of gum disease are bleeding gums, over sensitive gums, continuous bad breath, change in the normal placement of teeth etc.

Following are a number of reasons why gum diseases occur, some of them are: 

1. Prevailing diseases: Sometimes diseases, such as malignant tumors and AIDS can disrupt the immune system of the body. Due to the malfunctioning immune system, the gums become vulnerable to issues such as cavities.
2. Smoking and alcohol consumption: Smoking and alcohol consumption cause problems in the gum tissue as the gums lose their ability to repair themselves effectively.
3. Hormonal changes: Changes in behavior of the hormones in the body can increase sensitivity in the gums. This can make the gums prone to diseases.
4. Not following proper dental hygiene: Not brushing and flossing on a regular basis can cause plaque accumulation in the teeth. The bacteria present in the plaque may cause gum diseases.
5. Family history: If many people in the family have suffered from gum disorders, then your chances of getting gum diseases are relatively higher.

How can you prevent gum disease?
Gum diseases can be prevented by following proper dental hygiene. Brushing twice a day and flossing on a regular basis are the best methods of preventing gum diseases. Regular dental checkups are also recommended to identify any gum problems early and also prevent them. Modifications in lifestyle such as limiting smoking, eating a diet rich in antioxidants and reducing stress can also help in preventing gum diseases.

Severe cases of gum diseases may require surgery but mild cases can disappear by following a proper dental hygiene. Gum diseases have also been known to be associated with diabetes and heart diseases.