Possibly one of the most annoying conditions to suffer from is tooth sensitivity. Not being able to drink your favourite beverage, or eat certain foods for fear of that stab of pain is devastating! Chemotherapy treatment does not directly result in tooth sensitivity but some of the oral complications can lead to it.
If tooth sensitivity occurs it’s important to determine whether the sensitivity is from pressure or thermal (hot/cold) stimuli. If the pain is a result of drinking something hot or cold, it implies that the enamel layer or gum has been compromised and that the underlying dentine layer is exposed to the oral environment. The resulting pain is a quick sharp stab. Pressure sensitivity causes a lingering pain and is either due to grinding and/or clenching or it may be indicative of a developing abscess.
Dentine exposure can be the consequence of a number of factors.
Common causes are:
Brushing too hard, hard tooth brush bristles, receding gums, tooth decay, chipped/cracked tooth structure, tooth erosion, grinding and clenching, tooth whitening products or dental treatment.
Brushing too hard is detrimental to the delicate gum tissue (mucosa) in your mouth. It results in exposure of dentine due to wearing down of the enamel. A consequence of chemo includes MUCOSITIS which compromises the strength and structure of the gums. By brushing too hard, one will aggravate this condition and prolong symptoms. If your toothbrush bristles are too hard, it will hurt the gums by thinning them and by triggering gum recession. By using a soft tooth brush, or by softening your tooth brush in hot water and applying light pressure, you will greatly reduce damage to your gums and enamel. The correct brushing technique is critical as scrubbing your teeth back and forth will result in gum recession and dentine exposure over time.
Massaging circular movements are gentle on gums and stimulates gum tissue.
Receding gums is the result of natural and unnatural influences. With advanced age, one’s gums will naturally recede exposing the dentine in the neck and root of the tooth. Gum diseases result in gingival recession. One of the signs of Gingivitis (inflammation of the gums) is gum recession and Periodontitis which results in gum and bone recession. Incorrect tooth brushing techniques and toothbrushes that are too hard, can cause gingival recession and tooth sensitivity.
Tooth erosion can be the result of excessive vomiting, reflux conditions and diet. Vomiting and nausea are unfortunate side effects of chemotherapy and one should manage and avoid them in order to prevent the acidic stomach contents from washing over your teeth. Acid demineralises, weakens and erodes the enamel structure of the tooth resulting in tooth sensitivity. Excessive fruit juice and fizzy cold drink consumption result in tooth erosion, as well as foods that have a high acid content like citrus fruits, pickles and tomatoes.
There are a number of ways to treat tooth sensitivity. At home you can brush with a sensitive toothpaste such as Sensodyne, Colgate ProRelief, Elgydium or Elmex to help reduce sensitivity. These toothpastes contain increased fluoride (which help to remineralise the demineralised enamel) and a combination of potassium nitrate, or strontium chloride minerals which helps to numb the exposed nerve endings in the dentine. After brushing you can place a pea-sized amount of toothpaste on your finger and rub it on all the sensitive areas to further help remineralise the teeth.
DO NOT RINSE YOUR MOUTH AFTER DOING THIS.
If you have a bite plate, or bleaching trays, you can place the toothpaste in it before positioning it in your mouth. Fluoridated mouth washes help remineralise the enamel and reach areas under the gum and in between the teeth. Be aware of what you eat and drink and cut out substances that have a high acid content and regularly rinse your mouth with water.
Your dentist can treat tooth sensitivity by firstly assessing the cause of the sensitivity and then treating it accordingly. Tooth decay can be removed and the tooth restored with either a white filling or a crown depending upon the extent of the damage. A fluoride varnish, or dentine sealant can be placed over exposed areas of the neck of the tooth to reduce sensitivity. Fillings are required to replace lost enamel in areas of tooth brush abrasion. A bite plate can be made to reduce the forces exerted on opposing teeth during grinding and prevents enamel wear and gingival recession. Please be aware that tooth sensitivity after dental treatment is normal as working on the teeth causes irritation of the dentine which leads to inflammation and sensitivity.
Written by Dr Carina van der Linden