Dentin is the middle layer of the tooth. It is a collagen like material made up of microscopic tubes that run from the outside of the tooth, where the enamel is, to the inside of the tooth where the nerve is. In areas where the enamel is easily worn away the dentin can be exposed to the outside without a covering. This usually happens at the gum line where enamel is naturally thin and on biting surfaces where there is a lot of abrasion. Exposed dentin with open tubes can easily send signals to the nerve. Changes in temperature or touch are then perceived as pain.
The solution is to plug the tubes from the outside with ﬂuoride. Eventually the nerve will create a barrier on the inside of the tube with additional dentin but it can take a long time. Unfortunately, the plugs on the outside are easily removed with acids, aggressive brushing, whitening and tartar control products. So the key is to continue to replace the ﬂuoride plugs while limiting the things that remove them.
To create ﬂuoride plugs we recommend prescription strength ﬂuoride toothpaste such as Clinpro 5000 or Prevident, they have 5000ppm ﬂuoride and no whitening or tartar control ingredients. We also like to use Fluoride varnish in the oﬃce to get an immediate decrease in sensitivity. Don’t worry about getting too much ﬂuoride from toothpaste or rinses as long as you don’t swallow it.
Over the counter options are traditional ﬂuoride toothpastes like Crest Cavity Protection and Colgate Cavity Protection. These have 1000ppm ﬂuoride. Act Fluoride rinse or Fluoriguard rinse can also be helpful but they require another step in your home care routine.
When using over the counter products be careful to read the labels. There are a few brands that combine ﬂuoride with whitening or tartar control, eﬀectively causing the sensitivity that you are trying to relieve. Some brands use a pain killer to desensitize instead of ﬂuoride. This reduces sensitivity for a while but it does nothing to strengthen the tooth over time.
These are some of the products and food we have found to increase sensitivity:
Hard or Medium toothbrush