Tooth sensitivity or “dentin hypersensitivity,” refers to pain or discomfort in one or more teeth as a response to certain stimuli, such as hot or cold temperatures. The pain experienced is usually sharp, sudden and shooting. The condition normally occurs when the layer of the tooth underneath the enamel (called the dentin – a porous tissue in the teeth) or the layer covering the root (called cementum) is exposed along the gum line. The exposed areas respond to hot and cold, and sometimes to very sweet and spicy foods, and trigger pain. The condition may either be temporary or a chronic problem and it can affect one tooth, several teeth, or all the teeth together. Even though the condition occurs due to different causes, in most cases this can be easily treated or prevented by incorporating serious changes in the patient’s oral hygiene regimen. Developing good oral habits and scheduling regular dental visits help people deal with the condition in a better manner. Treatment will depend on the specific factors causing the sensitivity. Billing and coding different dental conditions and procedures can be quite challenging. Dental billing service providers knowledgeable in the dental codes and related guidelines can easily manage the coding and claim submission processes for dentists.
Causes and Symptoms
As mentioned above, tooth sensitiveness occurs when the dentin, a porous tissue in the teeth, becomes exposed. The dentin has microscopic channels – called tubules – which are pathways to the nerve. When dentinal tubules are exposed due to receding gum tissue or enamel loss, nerves are more easily triggered by certain stimuli causing tooth sensitivity. In certain cases, other factors like overzealous brushing, tooth decay (cavities), gum diseases, exposed tooth root, worn tooth enamel and fractured teeth can leave the dentin of the tooth exposed, causing sensitivity. People with sensitive teeth may experience pain or discomfort as a response to certain triggers. The pain may be experienced at the roots of the affected teeth. Symptoms associated with the condition may come and go over time for no obvious reason and may range from mild to intense. Common triggers include – hot / sweet/acidic foods and beverages, cold water (especially during routine dental cleanings), brushing or flossing teeth and alcohol-based mouth rinses. Diagnosis of tooth sensitivity may begin with a dental examination wherein the dentists look out for potential problems like loose fillings, or recessed gums that could be causing the sensitivity. Often times, mild cases of tooth sensitivity can be treated with over-the-counter dental treatments.
Dental billing involves using the specific CDT codes to report various dental conditions on the dental claims that providers submit to health insurers. In addition to billing and coding, dental insurance verification and pre-authorization services are crucial to verify the patient’s coverage.
Dealing with Sensitive Teeth – Top Procedures and Remedies
The problem of sensitive teeth never completely disappears as it can be caused by a number of problems. Symptoms associated with the condition may be less prominent or even seem to go away for a while. However, unless the actual reasons for sensitive teeth are diagnosed and treated properly, the problem may continue. For instance, if the sensitivity is due to a cavity, a restoration can be placed. On the other hand, if it is a gum disease that causes sensitiveness, the dental professional can perform a thorough cleaning of the area.
There are certain dental office procedures that a dentist may recommend for tooth sensitiveness. Proper diagnosis of the reason for the sensitivity is essential in treating the problem. If the reason for the sensitivity is correctly addressed, the treatment outcome will be successful. Below discussed are some of the effective in-office treatment procedures and general care tips that dentists usually recommend for relief from sensitive teeth –
In-office Treatment Procedures for Sensitive Teeth
- Surgical Gum Graft – Regarded as a type of dental surgery, gum graft is generally performed when gum recession occurs – when the tooth loses a certain amount of gum tissue, exposing more of the tooth at the root. This may cause increased sensitivity, especially when eating or drinking hot or cold foods. Gum graft is relatively a simple and quick procedure wherein the periodontist first removes a piece of tissue from the roof of the mouth or from nearby healthy gum tissue. This tissue is attached to the area where the gums have worn away. This in turn can protect exposed roots and reduce sensitivity. There are different types of gum grafts available, and the type of surgery recommended by the dentist depend on the extent and severity of damage, and a person’s individual needs. CDT codes for gum graft procedure include –
- D4270-Pedicle soft tissue graft
- D4273 – Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft
- D4275 Soft tissue allograft
- D4276 Combined connective tissue and double pedicle graft, per tooth
- D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical sites)-each additional contiguous tooth, implant or edentulous tooth position in same graft site
- D4285 Non‐Autogenous connective tissue graft procedure (including recipient surgical site and donor material) – each additional contiguous tooth, implant or edentulous tooth position in same graft site
- Root Canal – If the sensitive teeth cause severe pain, dentists may recommend a root canal procedure. This is done to repair and save a badly damaged or infected tooth instead of removing it. It involves the removal of the soft center of the tooth – the pulp – which is made up of nerves, connective tissue, and blood vessels that help the tooth grow. Removing injured or infected pulp is the best way to preserve the structure of the tooth. CDT codes for root canal procedure include –
- D3331 Treatment of root canal obstruction; non-surgical access
- D3346 Retreatment of previous root canal therapy – anterior
- D3347 Retreatment of previous root canal therapy – bicuspid
- D3348 Retreatment of previous root canal therapy – molar
- Use Fluoride Varnish and Coatings-. The dentist may apply fluoride varnish to the sensitive areas of the teeth to strengthen tooth enamel and reduce pain. The fluoride varnish fills tiny holes in the tooth enamel that could expose the teeth to temperature change and other irritants. In addition, other bonding agents and plastic sealant coatings may be applied to strengthen enamel and dentin (a bony tissue beneath the enamel). Fluoride foam or gel can be placed into a mouth tray and patients are asked to sit with this in their mouth (for 3-5 minutes). This provides the teeth with a high concentration of fluoride to strengthen the area.
- Desensitizing Toothpaste – Desensitizing toothpastes contain ingredients that temporarily fill the holes within the tooth enamel and dentin. This in turn reduces the amount of exposure the teeth’s sensitive nerves will receive and thus reduce the amount of pain. As there are several brands of toothpastes available over-the-counter, the dentist may recommend one particular brand that works best for sensitive teeth. The patient may be advised to put a thin layer of the desensitizing toothpaste on the exposed tooth roots before going to bed.
- Desensitizing or Bonding Agents – Bonding or desensitizing agents are substances used to nullify the sensitivity of teeth. Exposed tooth root surfaces can be treated by applying bonding resin to the sensitive root surfaces. This will seal the dentin and provide a barrier to sensitivity. A local anesthetic may be needed for performing this procedure. However, these bonding agents cannot be used if the person is suffering from an increased sensitivity due to reasons such as tooth decay, infections, and plaque. In most cases, these agents only bring in the desired results if the patient is suffering from tooth sensitivity due to bleaching activity. Therefore, it is important to check with the dentist about bonding options for reducing sensitivity in teeth.
Home Remedies or Treatments for Sensitive Teeth
Apart from the above-mentioned in-office dental procedures; there are home remedies that are effective for sensitive teeth. Some of the common home remedies that dentists may recommend include –
- Use a Soft-bristled Toothbrush – Changing your toothbrush on a regular basis is one important home remedy that helps reduce tooth sensitivity. Brushing the teeth with stiff bristled brushes can make the tooth condition worse as these bristles are hard on enamel, leading to more microscopic holes and eventually more sensitivity. In addition, they can also worsen gum recession, leading to exposed dentin and sensitive nerves. To avoid these problems, it is important to brush the teeth twice a day with a soft-bristled tooth brush and fluoride toothpaste and floss daily. Brushing gently can help preserve the tooth surface and maintain gum integrity.
- Make a Salt Water Mouthwash – Salt is a natural and organic anti-bacterial solution that is safe when used in the mouth and it offers numerous benefits when mixed with water. Salt water balances the pH level inside the mouth, creating an alkaline environment that reduces bacterial growth and plaque in the process. Prepare a salt water rinse by mixing two teaspoons of salt with a cup of warm water. Use this twice a day (once in the morning and at night) until sensitivity improves.
- Avoid Problematic Foods and Beverages – Acidic food items and beverages (such as coffee, sodas, and pickles) can increase tooth sensitivity. Avoiding or minimal consumption of these food items can completely reduce sensitivity. Also, it is best to avoid foods and liquids that are extremely hot or frozen, as these can cause tooth discomfort and aggravate sensitivity.
- Use a Mouthguard at Night – In certain cases, tooth sensitivity is caused by grinding teeth at night (called bruxism). To resolve this problem, the dentist can take molds of the teeth and make a custom mouthguard the patient can wear during sleep. This guard protects against pressure and prevents damage to teeth that can be caused by nighttime grinding.
- Use Garlic – Garlic contains valuable compounds that help maintain good oral health. Allicin is one such compound in garlic that reduces bacterial growth and soothes pain and is a natural remedy for sensitive teeth. Garlic can be sliced and applied directly to the affected teeth, or a paste can be made by combining a clove of garlic with a few drops of water and half a teaspoon of salt, which is left on the teeth for ten minutes before rinsing it off.
- Relieve Pain with Clove – Cloves and clove oil are anti-inflammatory, germicidal, and analgesic and can therefore reduce inflammation, bacteria overgrowth, and pain. When used as an extract that is swished in the mouth, clove can have a numbing effect that relieves tooth sensitivity.
There are several causes that lead to sensitive teeth. Therefore, it is important to identify in advance the actual cause so that the condition can be treated successfully. Maintaining good oral hygiene and attending regular dental checkups can help prevent, slow, or stop tooth sensitiveness. Taking good care of the teeth by brushing three times a day helps to get rid of bacteria and plaque formation in the teeth.