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How can tooth enamel feel pain when drilled by a dentist?

How can tooth enamel feel pain when drilled by a dentist?


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Enamel has no nerves, so theoretically a tooth should not feel any pain when a dentist bores into it. Yet still we use anesthetics…

Maybe it's dentin's fault? It apparently has some tubes filled with liquid and the tooth's nerves can feel this liquid's movement. So, maybe, the closer the dentist gets to dentin (especially if he/she touches it), the more pain is felt? By the way of vibrations from the boring tool?


Yes you are right. It is the dentin. Enamel has got no nerves. So when the dentist use his/her instrument, initially there is no pain (if the enamel is intact). The next layer is dentin. As you said, dentin has got dentinal tubules containing dentinal fluid. Whenever there is any stimulus which has not yet reached the pulp, but may have reached the dentin, eg of stimulus in the form of pressure, temperature change, sweet food, sour food etc, cause the fluid to move or get displaced. The displacement of dentinal fluid stimulates nerve endings in the pulp and hence generates a pain/ sensitivity response to your brain.

Reference

Reference

There are three main theories of dentine hypersensitivity: Direct Innervation (DI) Theory Odontoblast Receptor (OR) Theory Fluid Movement/Hydrodynamic Theory

The Hydrodynamic or Fluid Movement theory is one of the main theories in dentistry to explain the mechanism by which a tooth perceives the sensation of pain. It is currently the most widely accepted theory used to explain tooth sensitivity.

Reference

Now the drilling causes heat generation, even though little, due to the coolant, plus pressure and hence causes the fluid to displace and hence pain. This pain usually ends after the treatment.

Hence anaesthesia is required. Hope I have answered your question :)


Often times a tooth that’s been treated with a root canal already has a crown or deep filling on it. A crown is one of the very last things you can do to save a tooth and help hold it together. Once a tooth has a root canal it is brittle because the blood supply to the tooth has been filled in. It’s still possible to bite down and crack the root or an existing crack under the crown may grow down the root. This may cause pain when biting down on the crown in certain ways. Sometimes the pain will come and go. Sometimes the tooth can get re-infected around the crack. More recently, I’ve seen many cases of cracked roots. Even my wife just had this happen on an upper molar -check out our Facebook to see her experience -https://www.facebook.com/MadSmileSolutions/. Often times we’ll have the endodontist (root canal specialist) use their microscopes and evaluate if it can be re-treated but if no, the best option, unfortunately, is to remove the tooth and place a dental implant.

A dental implant is a man-made tooth root. It later is topped off with a special connector (abutment) and crown. This is typically done in phases after diagnostic x-rays are taken. The dental implant looks like a screw placed into the bone of your jaw. Once your bone or a bone graft integrates with the threads of the screw, it is stable and ready for the “tooth” to be attached. The total cost to replace a tooth with an implant is $3500-$6000+ depending on what type of x-rays and implant is needed or if you require a bone graft.

“Do Dental Implants Hurt?”

I hear this question every day! Most of my patients say it is less painful than getting a filling. Many patients notice pressure as the implant is being placed but no pain. Typically, we can place an implant in a short appointment and people return to their day comfortably.

“Is a Dental Implant My Only Option?”

Often a dental implant is the best option for replacing a failed root canal tooth. However, there are 2 other options. A partial denture, which is fake teeth that snap on to your other teeth and come in and out or a fixed bridge, which is a fake tooth suspended between two crowns cemented on the neighboring teeth. A third option, might be to do nothing, however, long term consequences of a missing tooth are shifting of surrounding teeth and loss of bone. These can create long term, bigger problems contributing to gum disease, crooked teeth and tooth loss.

For my wife, she was on and off again complaining of tooth pain from a crown and root canal done years earlier. We had numerous times taken a standard x-ray only to not see anything conclusive. When we finally took the CT 3D x-ray we could see the root had gotten re-infected. We met with the endodontist and he agreed it was able to be retreated andthe best plan was an implant.


Words in This Story

dental cavityn. a small hole formed in a tooth by decay

enameln. the very hard outer layer of a tooth

drilln. a tool used for making holes in hard substances

injectionn. the act or process of forcing a liquid medicine or drug into someone or something by using a special needle

filling ­– n. material that is used to fill something : example: a filling for a tooth

calciumn. a substance that is found in most plants and animals and that is especially important in people for strong healthy teeth and bones

phosphaten. chemistry : a salt or compound that has phosphorus in it and that is used especially in products (called fertilizers) that help plants grow

fluoriden. a chemical that is sometimes added to drinking water and toothpaste to help keep teeth healthy


Why Your Dentist Recommends Tooth Shaving

Your dentist usually has a good reason for everything that they do. In this case, teeth shaving is a necessary step that your dentist must take before placing braces in your mouth if your teeth are too crowded.

The extra space between your teeth allows for the teeth to align from the braces properly. Without teeth shaving, your teeth wouldn’t become straight from the braces. Instead, your teeth would end up crowding together and turning in awkward positions. It just wouldn’t work out.

Furthermore, teeth shaving is sometimes a necessity for adults since their pallets and jaws have already finished developing, which means the dentist cannot make adjustments to them.Usually, a dentist would adjust the structure of the teeth by attempting to change the hard pallet and soft pallet. As mentioned earlier, that is not really an option for adults.

Teeth shaving is still an option though.

Also, do not worry about the small gaps between your teeth. Your orthodontist will adjust the wires in your braces so that all the gaps will close. The gaps are so small that most people won’t even be able to notice them. You will likely notice them and want them closed though. They tend to get lots of food stuck in them.

Other Reasons for Teeth Shaving

There is more than just one reason that your dentist will recommend teeth shaving. It’s usually done for cosmetic purposes though. Some of those other purposes include the following:

Cosmetic Re-contouring

Cosmetic re-contouring is shaving your teeth to make them appear straighter. It doesn’t involve braces or anything like that. Re-contouring is usually done for the front two teeth as those are the most visible.

In fact, this is the most frequent reason that people get their teeth shaved. It’s a relatively simple process and is a painless procedure (as all teeth shaving procedures are).

Replacing Teeth

If you have a broken or missing tooth, then your dentist may need to shave the adjacent teeth to ensure that the replacement tooth fits properly. This is not too common of a reason to have your teeth shaved, but it does happen occasionally.

Again, do not worry when you hear “teeth shaving,” it’s a perfectly normal part of getting a replacement tooth. It is especially common for the pointed teeth due to the closeness of the teeth.

Reshaping Teeth to Ensure that a Denture Fits

Teeth shaving, in this case,is usually done before placing any kind of dental hardware in the mouth. It’s done so that the hardware can easily fit onto the teeth. It’s often done by shaving a notch into the teeth. Sometimes it might be done if hardware needs to be placed between the teeth.

This just depends on what your dentist needs to place in your mouth.

Why Teeth Shaving is Good

Teeth shaving may not only be used for tooth straightening, but it can also be used to adjust the shape of your teeth. This is particularly common for people that have odd shaped teeth.

For instance, if you have uneven teeth, then your dentist can shave the top of your teeth and make them level again.

Final Thoughts

Overall, there is nothing to fear when a dentist says they will shave your teeth despite how scary the phrase sounds. Teeth shaving is not even a painful process since there are literally no nerves for the dentist to disturb.

It is simply necessary for dental care if you want straight teeth. It is also necessary if you want to correct awkwardly shaped teeth.

Medically Fact-Checked & Written by Our Dental Editorial Team

You can read more about our editorial guidelines by clicking this link and learn more about the Emergency Dentists USA editorial team here.

Author, Dentist


Pain in tooth that was shaved down for bite adjustment.

I had a permanent crown put on one of my lower molars (#30) in December, and my dentist shaved down the healthy opposing upper molar to fix the bite (the crown was way too high when it was first put in, and apparently shaving down only the crown couldn't get the bite to where it needed to be). While my dentist was shaving the healthy tooth I could feel some sensitivity, but she insisted that she only took off a bit of enamel and that it should cause me no lasting problems.

It has been 2+ months and there is still significant pain in that tooth when I'm eating. Sometimes it's so bad that I can't chew on that side of my mouth. Certain foods, such as fresh pineapple, cause so much pain that I simply avoid them now. The other day I had a bout of stomach flu and I vomited several times, and the stomach acid seems to have made the situation even worse. I can barely manage to eat even soft foods now. I have been using Sensodyne toothpaste along with a prescription fluoride toothpaste, but it doesn't seem to be enough.

I'm asking for advice here because I am seriously questioning the competence of my dentist. I'm hoping to get some reassurance that this situation can be resolved with something as simple as a filling. I'd really like to avoid a crown & root canal treatment on a tooth that was perfectly healthy to begin with. I'm also faced with the decision of going back to the same dentist to get the work covered for free (but taking the risk that she'll make the situation even worse), or going to someone else and eating the copay.

I had a permanent crown put on one of my lower molars (#30) in December, and my dentist shaved down the healthy opposing upper molar to fix the bite (the crown was way too high when it was first put in, and apparently shaving down only the crown couldn't get the bite to where it needed to be). While my dentist was shaving the healthy tooth I could feel some sensitivity, but she insisted that she only took off a bit of enamel and that it should cause me no lasting problems.

It has been 2+ months and there is still significant pain in that tooth when I'm eating. Sometimes it's so bad that I can't chew on that side of my mouth. Certain foods, such as fresh pineapple, cause so much pain that I simply avoid them now. The other day I had a bout of stomach flu and I vomited several times, and the stomach acid seems to have made the situation even worse. I can barely manage to eat even soft foods now. I have been using Sensodyne toothpaste along with a prescription fluoride toothpaste, but it doesn't seem to be enough.

I'm asking for advice here because I am seriously questioning the competence of my dentist. I'm hoping to get some reassurance that this situation can be resolved with something as simple as a filling. I'd really like to avoid a crown & root canal treatment on a tooth that was perfectly healthy to begin with. I'm also faced with the decision of going back to the same dentist to get the work covered for free (but taking the risk that she'll make the situation even worse), or going to someone else and eating the copay.

It is nearly always a bad idea to reduce the chewing surface of a natural tooth because a crown really needs adjustment. Sometimes we do it when very little adjustment is needed, or where the opposing tooth is supererupted. It is hard to imagine your dentist reduced so much as to cause the pain you are talking about. Perhaps the tooth has a fracture.


Your Mouth Is Dry

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Saliva protects you from bacteria and a dry mouth can exacerbate any problems you're having with your teeth, since it allows bacteria to grow the bacteria has a perfect environment to thrive in. Dry mouth can be caused by certain medications and can make it hard to spit, talk, or speak.

The Rx: According to the National Institute on Aging, you should avoid cigarettes, alcohol, and caffeine because they can make your dry mouth worse. Practice regular brushing and flossing and try to keep your mouth salivated by sipping water or sucking on sugar-free hard candy. Visit your dentist immediately so he or can find the source of your tooth pain. Your dentist can also prescribe medications to counteract your dry mouth and keep your teeth healthy.


How do you prevent enamel loss?

To prevent enamel loss and keep teeth healthy, be sure to brush, floss, and rinse with a fluoride and antiseptic mouthwash daily. See your dentist every 6 months for regular checkups and cleaning. You can also try the following:

  • Exclude highly acidic foods and drinks from your diet such as carbonated sodas, lemons, and other citrus fruits and juices. When you have something with acid, have it at mealtimes to make it easier on your enamel. You can also switch to things like low-acid orange juice. Rinse your mouth right away with clear water after eating acidic foods or drinking acidic drinks.
  • Use a straw when you drink acidic drinks. The straw pushes the liquid to the back of your mouth, avoiding your teeth.
  • Finish a meal with a glass of milk or a piece of cheese. This will cancel out acids.
  • Monitor snacks. Snacking throughout the day increases the chance of tooth decay. The mouth is acidic for a few hours after eating foods high in sugar and starches. Avoid snacking unless you're able to rinse your mouth and brush teeth.
  • Chew sugar-free gum between meals. Chewing gum boosts saliva production up to 10 times the normal flow. Saliva helps strengthen teeth with important minerals. Be sure to select sugar-free gum with xylitol, which is shown to reduce acids in beverages and foods.
  • Drink more water throughout the day if you have low saliva volume or dry mouth.
  • Use fluoride toothpaste. Fluoride strengthens teeth, so make sure fluoride is listed as an ingredient in your toothpaste.
  • Use a soft toothbrush. Try not to brush too hard. And wait at least an hour to brush after you've had acidic foods or drinks. They soften the enamel and make it more prone to damage from your toothbrush.
  • Ask your dentist if sealants may help you prevent enamel erosion and tooth decay.
  • Get treatment for conditions like bulimia, alcoholism, or GERD.

BOOST YOUR JAWBONE

Some patients don’t have enough bone in which to anchor a dental implant. While bone from elsewhere in the body can be used, this involves surgery.

Now scientists have devised ways to grow bone using chips of synthetic bone made from materials such as calcium carbonate.

These chips are mixed with plasma — the liquid part of the blood — which helps bone cells grow, explains Wayne Halfpenny, a consultant oral and maxillofacial surgeon at BMI The King’s Oak and Cavell Hospital, London.

‘This mixture is packed into the damaged area and forms a scaffolding for bone cells to grow into and form new bone.’

However, it can take up to six months before the bone is thick enough to anchor an implant.

Available: Limited availability already.

CRAB SHELL GEL ENDS CAVITIES

A gel made up of tiny pieces of silver, fluoride and chitosan — a material found in crab shells — has been shown to slow and even stop tooth decay.

Brazilian researchers found that just seven days after the gel was used on children’s teeth, 81 per cent of the cavities had stopped expanding.

After 12 months, 67 per cent of the treated cavities were still the same size, according to the study at the University of Pernambuco.

All three ingredients in the gel have anti-bacterial effects.


Painful pulp

Teeth have three layers, only one of which &mdash the innermost layer of the tooth &mdash can hurt. That innermost layer of the tooth is called the pulp and contains both blood vessels and nerves. Pain is the only sensation to which the nerves in the pulp respond, Manz said. Whereas people with tooth sensitivity may complain, for example, of tooth pain triggered by heat or cold, the nerves in the pulp don't sense temperature, Manz said. Rather they feel pain, which may be associated with, say, drinking a very cold milkshake.

Dentin, the middle layer, is alive but without nerves however, dentin contains fluid that moves around as the teeth move, and the pulp can feel the movement of that fluid. The third, outermost layer is the tooth's hard white enamel, which is not living and so cannot feel anything.


Conclusion

Taking care of your mouth can be easy!

Teeth experience daily wear and tear and may at some require remineralization. Luckily, you can easily accomplish this at home with remedies like baking soda, vitamin D, probiotics, and mineralizing toothpastes containing fluoride and hydroxyapatite.

Have a look at the table below for a summary of things you can do to remineralize your teeth.