How does sensitivity develop?
The crown of a tooth is covered by enamel, the root by a thin layer of cementum. Beneath both lies the dentine. According to the patient information of the American Dental Association (ADA), dentine is less dense than enamel and is crossed by microscopic channels. When enamel is worn away, or the root is exposed because the gum has receded, these channels carry stimuli such as cold, heat, sweet or acidic food to the nerve of the tooth.
The most widely accepted explanation is the hydrodynamic theory. An evidence-based overview for dental practitioners in BMC Oral Health (Liu and colleagues, 2020) describes how a thermal, mechanical or chemical stimulus moves the fluid inside the channels and so irritates nerve endings. The pain is typically short and sharp. How many people are affected is hard to say: according to the same review, reported figures range from 1 to 98 percent, mainly because definitions and methods differ.
Why do my teeth react to cold?
Almost always, something has exposed dentine. The Oral Health Foundation, Cleveland Clinic and Mayo Clinic name above all:
- Receding gums: when the gum pulls back, the neck of the tooth, which is not protected by enamel, is exposed. According to the Oral Health Foundation, this becomes more common with age. See our guide on receding gums.
- Brushing too hard or hard bristles: both can wear enamel away and encourage gum recession.
- Acid erosion: fizzy drinks, fruit juice, citrus fruit and stomach acid can attack enamel. Brushing straight after acidic food or drink increases the wear.
- Teeth grinding and clenching: the heavy load wears enamel down. See our guide on teeth grinding.
- Cracks in the tooth: according to the American Association of Endodontists, a cracked tooth can cause sudden pain when it is exposed to very hot or cold temperatures, as well as pain on chewing.
- Gum disease: according to Mayo Clinic, periodontitis destroys the bone that supports the teeth and makes the gums recede, so that the teeth look longer; the exposed root surfaces are often sensitive.
- Dental treatment: according to Cleveland Clinic, fillings and professional cleaning can make teeth sensitive for a short time; the Oral Health Foundation also names tooth whitening.
Sensitivity, decay or an inflamed nerve: how do they differ?
According to the review by Liu and colleagues, dentine hypersensitivity is a diagnosis of exclusion: decay, a cracked tooth, a leaking filling and inflammation of the nerve (pulpitis) cause similar complaints and have to be ruled out first. The table is a first orientation; the diagnosis is made at an examination.
| Complaint | More likely to be |
|---|---|
| Short pain with cold, heat or acid that stops as soon as the trigger is gone | Exposed dentine (sensitivity) |
| Pain that lingers after the trigger | Inflamed nerve |
| Sudden pain on biting | Cracked tooth or leaking filling |
| Pain that starts suddenly in a single tooth | Decay, crack or infection |
| Throbbing pain without a trigger | Inflamed or infected nerve |
According to the review, lingering toothache usually points to inflammation of the nerve. To tell the causes apart, the dentist uses cold and heat tests, a bite test and, where needed, X-rays. What helps with pain until your appointment is explained in our guide toothache: what to do.
What can you do at home?
Mild sensitivity can often be reduced with small changes:
- Soft brush and gentle technique: the Oral Health Foundation recommends a soft brush and small circular movements without pressure. Mayo Clinic advises against scrubbing and against abrasive toothpastes.
- Toothpaste for sensitive teeth: it is designed to reduce the transmission of stimuli from the tooth surface to the nerve. The Oral Health Foundation advises spitting out after brushing and not rinsing; in the evening a little toothpaste can be rubbed onto the sensitive spot and left there.
- Managing acid: limit acidic and sugary drinks. The Oral Health Foundation recommends waiting at least an hour after acidic food or drink before brushing; Mayo Clinic suggests drinking water after acidic drinks.
- Addressing grinding: Mayo Clinic recommends that people who grind their teeth discuss a protective splint with their dentist. Whether a splint is suitable for you is assessed at the examination.
- Regular care: brush twice a day with fluoride toothpaste, clean between the teeth daily and keep your check-ups.
According to Liu and colleagues, the active ingredients differ in effectiveness; most products that block the channels did better than placebo in studies.
What can the dentist do?
Treatment depends on the cause. The ADA, Mayo Clinic and Cleveland Clinic name these options:
- Fluoride: fluoride varnish or gel applied at the practice can strengthen enamel and reduce sensitivity. According to the Oral Health Foundation, a high-fluoride toothpaste for home use can also be prescribed.
- Sealing the exposed surface: a bonding agent or protective varnish can be applied to the exposed root surface; wedge-shaped defects at the neck of the tooth can be covered with a filling.
- Treating the cause: decay, cracks or old fillings are treated with a filling, inlay or crown. Gum disease is treated first.
- Gum graft: where a lot of gum has been lost, the root can be covered with tissue from another part of the mouth. According to Liu and colleagues, the long-term effect is still under discussion; whether it makes sense for you is decided at the examination.
- Root canal treatment: according to the ADA, it is an option for severe, persistent sensitivity that cannot be resolved any other way.
If you suspect that stomach acid is reaching your mouth, mention it at the examination: as long as the cause of the erosion remains, the sensitivity returns.
Is sensitivity after whitening, cleaning or crowns normal?
Usually yes, and usually only for a while. According to the Oral Health Foundation, whitening often makes teeth temporarily sensitive; what to do afterwards is in our guide on teeth whitening aftercare. Cleveland Clinic also names fillings and professional cleaning as triggers of short-term sensitivity, and Liu and colleagues point out that gum treatment can expose root surfaces, so some sensitivity should be expected.
Sensitivity is also common in the first weeks after new crowns. What is normal and what you should have checked is described in our guide on sensitive teeth after crowns. In most people this sensitivity settles on its own; if it persists or increases, have it examined.
When should you not wait?
According to the Oral Health Foundation, these signs can point to decay, a crack, a gum problem or an infection:
- severe pain
- sensitivity that lasts longer than a few weeks
- only a single tooth is affected
- the pain came on suddenly
According to the American Association of Endodontists, a crack that is left untreated gets worse and can lead to the loss of the tooth, so pain on chewing that comes and goes should also be checked. With swelling of the face, fever, or difficulty swallowing or breathing, go to an emergency department.
What does this mean for treatment in Türkiye?
Sensitive teeth alone are not a reason to travel; the cause can be clarified by a dentist near you. The topic matters when you are planning treatment with us anyway: at the examination at our clinic in Serdivan, sensitive teeth, the gum line, fillings and crowns, and signs of wear are assessed. If the cause is decay, a crack or gum disease, the plan follows from that; if a crack or root fracture needs to be clarified, a cone-beam CT (CBCT) is available. Endodontics (root canal treatment), cosmetic dentistry and prosthodontics are among our fields.
Before treatment starts, you receive a written treatment and cost plan. If some sensitivity is to be expected after crowns or whitening, we discuss before you leave what is normal and when you should contact us. Once you are home, you can reach us on WhatsApp at +90 532 363 49 54; during opening hours we reply to messages in English and German within 15 minutes. How follow-up works after your return is described on our page on aftercare and follow-up.