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North Americans are lucky. Throughout all facets of healthcare and that includes oral care, we tend to take it all for granted. I recently returned from the Middle East countries where I was visiting with some friends at their dental convention. Two of my passions are reading and writing and being a pharmacist, there is a never ending list of questions that the general public will seek you out at any type of gathering.

I found there was great interest in sedative dentistry being the latest “in-word” for those patients labeled as “difficult to freeze”. This has resulted in a new discipline at many universities in North America where an accredited post graduate program appropriately called Dental Anesthesia is hot ( no pun intended) as the continuing education course one should take.

One question from a culture that has coffee stands similar to how we have hot dog or sausage vendors and where people stop to buy a snap of strong coffee and toss it down as though it was a shot of vodka all seemed strange to our customs.

Two questions were at the top of the list:

• Why are my teeth sensitive when I have a hot drink?
• Why are my teeth sensitive when I inhale air or have a cold drink?

Some time the questions were aimed at both situations.
Pharmacists do not diagnose and therefore a consultation with their dentist was my first advice. However this much I knew. Sensitivity to temperature – usually heat but also cold – is a classic symptom of the pulp of the tooth being inflamed.

Here are some possible causes if your tooth is sensitive to cold:

• There is evidence of deep decay. The problem can usually (but not always) be fixed with a restoration such as a filling or maybe a crown. Once the pain in response to cold has progressed to being sensitive to heat, you will have a tooth infection and endodontic therapy (root canal treatment) is required to save the tooth.
• If you recently had a new filling or crown treatment, and there is irritation directly after, this is normal and nothing to be concerned about as long as it comes immediately after the dental treatment and it gradually gets better. However if you had the treatment a week or more ago and your tooth is now beginning to react to the cold, or if the sensitivity gets worse over time, it is possible that your tooth already had some latent undiagnosed condition. Now, with the added irritation of being worked on, the condition is aggravated and requires further treatment.

Exposed roots. If your gum has receded or if the enamel or cementum of your tooth has worn to where the sensitive part of the tooth is exposed, it can make your tooth experience pain from cold. A filling or protective coating can keep your tooth from becoming too irritated. If this is the case, your tooth will also be sensitive to air. Any special toothpaste for sensitive teeth can help with this type of problem.

You can do a bit of diagnosis by checking these symptoms.

• If the cause (deep decay, exposed root) can be determined, address that cause. Remove the decay and fill the tooth, or cover the exposed root.
• When the tooth is irritated, does it hurt only briefly or does the pain linger? If the pain lingers for more than a couple of seconds (which is the time required for the tooth to warm up) it also indicates an irreversible pulpitis, and endodontic treatment will be required.

Sensitivity to heat.

Sensitivity to hot on a tooth is a classic symptom of an exposed nerve. The empty space in the center of your tooth that once held a healthy nerve is now exposed and repair may or may not be reversible. This means the tooth is only partially vital and a root canal procedure may be indicated. Dead tissue carries an odor. One of the components of decaying flesh is methane gas. When heat is applied to the tooth, the gas expands putting pressure on the large nerve outside the tooth that connects all your teeth. You need to have a root canal on this tooth in order for these symptoms to disappear.

Dentinal sensitivity. occurs when the dentin (middle layer) of a tooth is exposed. Normally, the dentin is covered by enamel above the gum line and by cementum below the gum line. Dentin is made up of tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth’s pulp (the center of the tooth). When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches. This causes sensitivity.

Comments to localanesthetics@yahoo.ca M.Sc. PharmD. CCPE Please visit WWW.AnestheticNews.com