Expert: Steven C. Scherr, D.D.S. - 10/20/2006

Question
Dr. Scherr:
I have been having some pain , on and off, in one tooth, in the upper front part of my mouth for the past several weeks.
My dentist checked it a couple of times over the past few months, made a few tests for sensitivity, and indicated that there was no problem.
This morning, the pain has re-occurred.
I used Sensadyne toothpaste but, it did not help.
Assuming that my dentist is correct, can fatigue or stress or lack of sleep or whatever, cause such a reaction.
And do you have a suggestion as to temporary or permanent remedies.
Hope you can help.
Nicholas M.

Answer
Nicholas,

There are several possibilities.  Each tooth has an inner nerve that has a limited capacity to heal.  A little bit of this healing capacity is used up each time we eat, drink hot/cold fluids, have a filling placed, etc.  When a nerve is beginning to approach its healing limit, the struggle to heal can produce sensitivity.  If one grinds or clenches their teeth, day or night, this may exasperate this process.

Nerve testing is an inexact science at best.  It may take months, or even years, for a tooth nerve to reach the point where testing indicates a problem.  If the pain tends to be present primarily in the morning, it could be that grinding or clenching the teeth overnight is contributing to the problem.  Most people, or their bedpartners, would not usually be aware of this.

Sensodyne toothpaste has little impact unless it is used on an every day basis over weeks and months.  One of two uses at the time the tooth becomes sensitive is not likely to have any impact.

I'd suggest you talk to your dentist about possible causes for the tooth pain.  If you both feel that night clenching or grinding may be a factor, a plastic night guard appliance could be made to protect the teeth during the sleep hours.

Should the pain persist or worsen, it may indicate that the healing capacity has been exceeded.  Should this occur, root canal therapy would be needed to removed the damaged nerve.

Nicholas, I wish you well.

Steve