WHY ARE MY TEETH SENSITIVE TO COLD?

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When a patient comes into my office with a toothache, I want to know if the patient is experiencing cold sensitivity. Cold sensitivity is the symptom that tells me, as a dentist, the most about the cause of their pain so that I can accurately diagnose and treat their pain. I want to know three things about a patient’s cold sensitivity: How intense the cold pain is? How long does the cold sensitivity last? And, where specifically does the cold pain originate? Those answers will tell me almost everything I need to know about their pain to differentiate between the two main routes of cold sensitivity in teeth.

You have teeth sensitive to cold for two main reasons: Pulpitis and dentin hypersensitivity. The rest of this article will further break down what is triggering either pulpitis or dentin hypersensitivity and causing teeth sensitivity to cold. Then, once we find what is triggering the cold sensitivity in teeth, we will recommend the best remedy for your cause of cold sensitivity. 

Causes of Teeth Sensitive to Cold

Tooth Decay

Gum Recession

Worn-down Teeth

Cracked Teeth

Tooth Trauma

Dental Work

Teeth Whitening

Acidic Foods

What is Dentin Hypersensitivity?

If you removed the enamel from your tooth and looked at the underlying levels of your tooth with a microscope, you would see a surface of tubules. It’s like looking at the end of a bundle of PVC pipes. These tubules connect to nerves that ultimately branch to the center nerve in the tooth's pulp chamber. The bigger the diameter and the more of those tubules there are, the more likely each individual will experience pain when the tubules become exposed. Also, the wider the surface area of exposure to those tubules, the more likely cold will cause sensitivity. Most of the underlying exposed tooth surface is called dentin. That is why this condition is called dentin hypersensitivity. Dentin hypersensitivity is when your tooth becomes sensitive to due to the exposure of the dentinal tubules. The question is “if” and “what” is causing dentin hypersensitivity?

How Do You Know If You Have Dentin Hypersensitivity?

The next step is placing cold on each tooth to determine which of these two kinds of pain you are experiencing. Suppose anything cold is placed on a tooth with dentin hypersensitivity. In that case, a tooth with dentin hypersensitivity will experience any variety of intensities depending on the tooth and the person experiencing the sensitivity. In other words, dentin hypersensitivity pain can be very painful or very subtle, which varies from person to person and even tooth to tooth. More important than the intensity of the pain is how long the pain lasts. Dentin hypersensitivity pain will likely normally only last a few seconds: fading away right after removing the cold object. To test cold sensitivity, dentists use a cold Q-tip to illicit a cold response from each tooth and then note the duration of the pain. You can also perform this test with a corner, or shard, of an ice cube. Either way, if the cold pain lasts longer than 3 to 4 seconds, it likely is not dentin hypersensitivity causing the pain. Instead, it is probably due to inflammation or pulpitis in the tooth, which I will explain in a second.

What Are Dentin Hypersensitivity Treatments & Remedies?

There are a few remedies for dentin hypersensitivity. If you find the exposed surface, the first remedy is to cover the exposed sensitive surface. A dentist can cover the tooth with fillings or crowns, depending on the tooth's needs. If you are in a lot of pain and can’t immediately see a dentist, some pharmacies have temporary fillings. I will link to a temporary filling here and all my favorite dental products here, including my favorite toothbrush and floss.

Okay, The second remedy for dentin hypersensitivity is anti-sensitivity toothpaste. While it doesn’t work for everyone, anti-sensitivity toothpaste will relieve most of the pain for some people. The longer you use the toothpaste over days and weeks, the better it works. Potassium nitrate in the toothpaste plugs off the tiny tubules, so they don’t become triggered easily. I will link to my favorite anti-sensitivity toothpaste here.

The third remedy, sort of, is to stop whatever is making dentin hypersensitivity worse and let the tooth build protection against the sensitivity. For some people, their tooth will lay down more dentin to prevent sensitivity over months and years. So stopping whatever is causing sensitivity and letting the body do its job is a type of remedy. I will go over these causes in more detail in a moment.

The last permanent remedy is to have a root canal. It is the last resort for hypersensitivity relief, but sometimes it is the only viable option. Root canals aren’t as bad as everyone makes them out to be, and sometimes they are the only way to get rid of tooth pain and cold sensitivity.
Dentin tubules that cause cold sensitivity.
Dentin tubules have different diameters and densities.
Cold test with ice.

What is Pulpitis?

Pulpitis is the inflammation of the center pulp chamber and canals in a tooth. If a tooth has inflammation in its center, called the pulp chamber, the nerve in that chamber becomes more easily excitable or “stimulated.” Therefore, it takes less stimulus to set off a pain signal, which means a normal amount of cold causes the tooth’s nerve to become painful. On top of that, the cold constricts the tooth, increases the inflammatory pressure in the tooth, and sets off a more intense pain response. The question here is “what” and “if” something is causing pulpitis?

If tooth pulp has inflammation or pulpitis, it can be further divided into “possibly reversible pulpitis” or “irreversible pulpitis.” Teeth are pretty bad at healing themselves, unlike most other body parts. However, they can sometimes heal independently, depending on the amount of inflammation. What happens is the tooth pulp will recognize some sort of insult to the tooth. For example, let’s say you bumped a tooth hard. The tooth pulp will then become inflamed to repair the damaged tissue itself. However, in other cases, it will not repair itself. Instead, the inflammation will increase until the tooth pulp eventually gives out, dies, and becomes infected due to the lack of blood supply. Ultimately this will cause more pain once the infection has progressed far enough.

What is Irreversible Pulpitis?

Irreversible Pulpitis is when inflammation in your tooth has reached the point that the tooth will never fully heal.

There are tests to determine which route the inflammation may go to diagnose the type of pulpitis, either reversible or irreversible. You may use a pulp tester or, once again, use the cold test. Unlike dentin hypersensitivity, if the cold test sensitivity lasts longer than 10 seconds, it is likely irreversible pulpitis. A tooth with Irreversible pulpitis will never fully heal at this stage, regardless of the pain level you are experiencing. The only way to permanently treat irreversible pulpitis and save the tooth is to have a root canal treatment done, and the sooner, the better. The longer the infection festers, the more likely the chances of a root canal failure. And again, for those afraid of the thought of a root canal, once you are numb, a root canal is just a boring appointment and shouldn’t be bad at all.

What is Reversible Pulpitis?

Reversible Pulpitis is when inflammation in your tooth can possibly settle and heal.

If a cold test sensitivity lasts less than 10 seconds and longer than 3 to 4 seconds, it is possibly reversible pulpitis. I call it “possibly reversible” because reversible pulpitis always has the possibility to progress into irreversible pulpitis, which ultimately means the tooth needs a root canal treatment or extraction to fix it. Luckily, I have found an excellent technique for my patients to minimize the chances of reversible pulpitis progressing into irreversible pulpitis. I have even used this technique on myself.

What is a Remedy to Pulpitis?

If pulpitis has become irreversible there is no simple remedy. The tooth will need dental treatment to correct pulpitis. If pulpitis is still possible reversible the remedy is to take Ibuprofen to reduce the inflammation.

I tell my patients to take 400mg Ibuprofen, or whatever the label tells you to on the over-the-counter bottle, three times a day for three to four days. Ibuprofen, in this case, isn’t for the pain, though it helps with that too. Ibuprofen is an anti-inflammatory and can reduce inflammation just enough so that your tooth can optimally heal itself. If Ibuprofen is hard on your stomach, you have two options to run by your doctor. He could also prescribe a steroidal anti-inflammatory, like Medrol, in its place, or you can take omeprazole before taking ibuprofen. Omeprazole can calm the stomach before taking Ibuprofen. Omeprazole is an over-the-counter drug, and its brand name is Prilosec OTC.

Dental pulp inflammation or pulpitis.
Ice test times. Dentin hypersensitivity cold duration is about 3 Seconds. Reversible pulpitis is about 4 to 10 seconds. Irreversible pulpitis is more than 10 seconds. 
Ibuprofen nonsteroidal anti-inflammatory

Causes & Remedies of Cold Sensitivity

Now let's get into many primary causes that will induce either Dentin Hypersensitivity or Pulpitis.

How Does Tooth Decay Cause Cold Sensitivity?

The first cause of these two routes is tooth decay. A cavity can cause pulpitis or dentin hypersensitivity. If the cavity is small, it will likely cause dentin hypersensitivity as it exposes the underlying levels. To fix the cavity, it will at least need a filling. If the decay is deep, it can set off pulpitis, whether it is reversible or irreversible pulpitis. If a cavity is causing pulpitis, it will likely need a root canal at some point. However, sometimes it will only require a filling or crown. Either way, the sooner the cavity is treated, the better.

How Does Gum Recession Cause Cold Sensitivity?

Gum recession is the next cause or trigger of cold sensitivity. I have a video more about gum recession. If your gums recede, the root portion becomes exposed and will cause hypersensitivity as well. To make matters worse, the roots of your teeth wear down faster than the enamel, which creates notches in the tooth roots. These notches expose more of those little tubules connected to your nerves, causing pain. If gum recession is causing hypersensitivity, you can try an anti-sensitivity toothpaste. Click here for my favorite anti-sensitivity toothpaste. Also, as a remedy, you can have a bonding or filling done over the sensitive spot. Fillings work to reduce cold sensitivity most of the time but aren’t 100 percent effective. If the pain is extreme or you just can’t take the pain, and you have tried everything else, then a root canal is the sure way to eliminate the pain as a last resort. Also, with gum recession, make sure you stop what is causing the recession, like brushing too hard, teeth grinding, or gum disease.

How Do Worn-down Teeth Cause Cold Sensitivity?

Moving on, like gum recession, worn-down or flattened teeth can also cause hypersensitivity due to the thinning or elimination of the enamel layer. The common causes of this dentin exposure will happen from teeth grinding, brushing too hard, too many acidic foods like sucking on lemons, too much soda, bulimia, and acid reflux, to name a few common causes of worn down enamel. Again, the remedies with worn-down teeth are just like gum recession, filling on the sensitive spot, anti-sensitivity toothpaste, or root canals as a last resort.

How Do Cracked Teeth Cause Cold Sensitivity?

Cracked teeth can cause a variety of symptoms, and too many to cover in this article. A cracked tooth can cause dentin hypersensitivity, pulpitis, or other issues, so we won’t go over them here. Cracked teeth can be frustrating for patients and dentists to find a remedy. They depend on where and how severe the fracture is. If you suspect a fractured tooth, read my article or watch my video on the subject for more information. For this article, just know that a cracked tooth can cause cold pain through dentin hypersensitivity or pulpitis.

How Does Tooth Trauma Cause Cold Sensitivity?

Tooth trauma, like hitting the tooth hard, as we alluded to earlier, can cause pulpitis. I recommend the ibuprofen anti-inflammatory remedy to my patients with tooth trauma unless the pain is very persistent or too severe. Then, we usually monitor the pain and signs of infection until they go away or progress into irreversible pulpitis and only perform a root canal if needed in the future.

How Do Fillings and Crowns Cause Cold Sensitivity?

Dental work like crowns and fillings can cause either pulpitis or dentin hypersensitivity. There can also be other causes of pain due to dental work, but those typically don’t provoke cold sensitivity. If this happened to my patient, I would recommend the Ibuprofen anti-inflammatory protocol. This situation happened to me as a patient. After a filling, my tooth was sensitive, and I took ibuprofen, and everything healed. Unfortunately, any time you work on a tooth, there is a possibility of hypersensitivity, but a good dentist will do all to minimize that possibility. I will go over this more in another video and article. If the pain persists with my patient after Ibuprofen, I would simply redo the filling. One of these two options resolves the issue for more than 95% of patients with cold sensitivity due to a filling. A tiny percentage will need a root canal, and most will never even develop cold sensitivity.

How Does Teeth Whitening Cause Cold Sensitivity?

Teeth whitening can also cause temporary dentin hypersensitivity. However, it usually will subside a short time after whitening has been stopped. In addition, anti-sensitivity toothpaste will help reduce whitening sensitivity.

How Do Acidic Foods Cause Cold Sensitivity?

Excessive acidic foods like sucking on lemons will expose the underlying tooth to hypersensitivity. If you eat a lot of acidic foods, avoid brushing right after as this will wear your enamel thin. Even if you don’t wear your enamel thin, it can still cause cold sensitivity. Anti-sensitivity toothpaste works well here. Also, avoiding acidic foods will help to stop this from progressing.
Tooth decay that causes Irreversible pulpitis and cold-sensitive teeth.
Worn-down enamel that causes cold-sensitive teeth.
Sucking on lemons
Craze lines or small cracks in teeth.

Conclusion

This article is part of a more extensive series of oral pain so that you can match up the symptoms we talked about here and read my articles on possible diagnoses and treatments for more clarity. That way, you can further narrow down and find the cause of your pain and cold-sensitive teeth to hopefully find a remedy and see a dentist that can provide you with an official diagnosis and treatment. If you are in Southern California, my dental office is linked below.

You can find my favorite toothbrush, floss, toothpaste, and other dental products here. Everyone should watch my daily tooth care routine video I have posted now, and I will show you why it is the best way to brush, floss, and more.
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