Tooth sensitivity is one of the most common reasons for consultation among adults. 20 to 30% of the adult population suffers from it at one time or another. Yet this apparently simple complaint conceals several very different clinical realities, each requiring tailored management.
A desensitizing toothpaste recommended at the pharmacy may relieve certain situations, but it can also mask a more serious problem. My position at Dental Swiss Clinics in Montreux is that sensitivity always deserves a precise diagnosis before any lasting management.
Diagnosis Before Treatment
When faced with a patient complaining of sensitivity, the first step is to understand precisely what is happening. The nature of the stimulus that triggers the pain, the character of that pain, its duration, and its context guide the diagnosis.
Pain with cold, reversible quickly
This is the most common situation. It typically corresponds to mylolyse or more broadly to dentin hypersensitivity related to dentin exposure. The pain is sharp but brief; it disappears as soon as the cold stimulus stops. It is provoked, never spontaneous.
Pain with heat and cold, with gingival signs
When sensitivity is associated with red, bleeding, or receded gums, the origin is often periodontal. Gingival recession exposes root surfaces, which are naturally more fragile than enamel. These areas become sensitive to thermal variations. The challenge is to treat the periodontal cause before treating the sensitivity symptom.
Spontaneous, throbbing, diffuse pain, especially at night
This description completely changes the diagnosis. Pain that appears without stimulus, that throbs, that radiates, and that wakes you at night points toward pulpitis. The pulp is affected, often irreversibly. Treatment is no longer desensitization; it is endodontic management or an extraction evaluation depending on the prognosis.
This three-step clinical framework allows for quick orientation toward the right therapeutic strategy.
The Main Causes in My Practice
Two causes largely dominate consultations for sensitivity.
Gingival recession with dentin exposure
This is the most common cause, often generalized. The gums gradually recede, exposing the dental necks and sometimes the root surfaces. The exposed dentin directly transmits stimuli to the pulp, creating the sensation of sensitivity. The causes of recession are multiple: overly aggressive brushing, periodontal disease, bruxism, sometimes a combination.
Mylolyse (non-carious cervical lesions)
Wedge-shaped lesions at the junction between enamel and root, often called mylolyse, also expose dentin. They result from a combination of mechanical factors (brushing), chemical factors (acid erosion), and occlusal factors (flexural forces on the tooth). They cause very localized sensitivity, typically to cold.
Other causes (bruxism with wear, incipient cavities, tooth cracks, post-whitening effects) exist but are less common in daily practice.
My Therapeutic Approach Based on Origin
Treatment depends directly on the identified cause. There is no single answer to tooth sensitivity.
When the origin is periodontal
Treatment begins with the cause. Management of the periodontal problem, strict adherence to an adapted hygiene protocol. I readily recommend saltwater rinses (natural soothing effect) and frequent gingival brushing or massage to stimulate the tissues.
Once the periodontal problem is stabilized, the use of fluoride becomes useful. Fluoride varnish applied at the office, fluoride gel for home application, fluoride toothpaste at an appropriate concentration. Weekly application of gel such as Elmex gelée is often recommended for maintenance.
When the origin is mylolyse
I start with fluoride toothpaste, used daily. In the vast majority of cases, this approach is sufficient to significantly reduce sensitivity within a few weeks. Studies document efficacy within 60 seconds after application for certain stannous fluoride formulations.
If the lesion is too pronounced or the toothpaste is not enough, a composite restoration fills the defect, seals the dentinal tubules, and eliminates sensitivity durably.
When the origin is pulpal
If the diagnosis points toward pulpitis, desensitization is no longer the right strategy. Endodontic treatment becomes necessary, sometimes extraction depending on the situation. In these cases, early management matters, to avoid progression to a dental abscess.
Why a Desensitizing Toothpaste Is Not Always Enough
A desensitizing toothpaste can indeed reduce sensitivity, but three precautions are necessary.
One, it can mask a diagnosis
Relieving a symptom without understanding its cause is not a good medical strategy. Sensitivity that decreases with toothpaste does not mean the underlying problem is resolved. Untreated periodontal disease will continue to progress; a deep cavity will continue to evolve toward the pulp.
Two, the effect requires continuous use
Desensitizing toothpastes work by progressive occlusion of dentinal tubules. As soon as you stop using them, sensitivity reappears. It is not a curative treatment; it is a palliative that requires regular use.
Three, certain causes do not respond to toothpastes
Pulpitis is not treated with toothpaste. Neither is a tooth crack. If sensitivity persists despite several weeks of regular use, a thorough diagnosis is necessary.
What Matters to Prevent Sensitivity
A few simple actions significantly reduce the risk of developing tooth sensitivity.
Proper brushing
Soft-bristled brush, moderate pressure, vertical or rotational movements, never horizontal. Overly aggressive brushing is one of the main causes of gingival recession and therefore future sensitivity.
Effective interdental cleaning
Dental floss or interdental brushes depending on the morphology of the spaces. This cleaning prevents gingivitis that can evolve into periodontal disease, which itself generates sensitivity.
Regular follow-up at the office
Scaling tailored to your situation allows early identification of signs of recession, bruxism, or other risk factors, before sensitivity sets in.
Beware of acidic habits
Frequent acidic beverages (sodas, citrus juices, white wine), untreated gastroesophageal reflux, can accelerate enamel erosion and expose dentin.
Frequently Asked Questions
Is a desensitizing toothpaste sufficient?
It can help in certain situations, particularly in cases of dentin hypersensitivity related to moderate recession. But it does not treat the underlying cause. A precise diagnosis is always preferable to prolonged self-medication.
Why does sensitivity appear more often with age?
Because gingival recessions become more common over the years. The accumulation of years of brushing, possible periodontal conditions, the natural evolution of gingival tissues—all of this gradually exposes root surfaces.
Can sensitivity disappear spontaneously?
Yes in some cases, particularly after a transient period related to whitening or recent treatment. No if it is related to permanent recession or an underlying pathology that is not treated.
When should you consult for tooth sensitivity?
If sensitivity persists for more than two to three weeks, if it is accompanied by spontaneous pain, if it wakes you at night, or if you notice a visible change in your gums. In all these cases, a consultation allows for the right diagnosis and avoids complications.
Is fluoride the only solution?
No. Fluoride is very effective for dentin hypersensitivity and mylolyse. Other approaches exist depending on the cause (periodontal treatment, composite restoration, endodontic treatment if pulpitis). The choice depends on the diagnosis.
For an evaluation of your situation, contact Dental Swiss Clinics in Montreux: Monday from 8 AM to 8 PM, Tuesday to Friday from 8 AM to 6 PM.