Chilling Truths: Unveiling the Secrets of Tooth Sensitivity and Cost-Saving Dental Care

[00:00:18] Eon Engelbrecht E-Radio-SA: Welcome to another “Save Your Money, Save Your Teeth”, the go-to podcast where curiosity meets dentistry, straight from the experts. I am Eon Engelbrecht, and every week I’ll be chatting with Doctor Clifford Yudelman, taking a nice deep dive into the world of dental care from a consumer’s perspective. Whether you’re looking to brighten that smile or protect your wallet, we’ve got you covered with practical advice and the latest insights. So, stick around as we uncover the secrets to maintaining both your dental health and your finances. Doctor Yudelman, welcome once again. Are you well?

[00:00:56] Dr Clifford Yudelman OptiSmile: Ah, thanks. Yes. I’m good. Thanks. Eon.  I hope you didn’t get blown away by all this wind that we’ve been having. And speaking of wind, sjoe, if you have sensitive teeth, you know, when you when you breathe in, it can really make them even worse. And that’s what we’re going to be speaking about today.

[00:01:14] Eon Engelbrecht E-Radio-SA: Anything cold, hey, really works on the teeth if, if they’re sensitive. Doctor Yudelman, what causes tooth sensitivity and recession at the gum line?

[00:01:25] Dr Clifford Yudelman OptiSmile: So, gum line recession is caused when you have exposed root surfaces, and your roots don’t have any enamel. The enamel finishes at or just under the gum line. So, one of the things that we see, that’s most common, that we see at OptiSmile is when a patient has had orthodontic treatment and the orthodontist has moved the teeth outwards, and there’s no bone at the gum line, and then the gum will recede. That type of recession is due to the bulge of the root or lack of bone, that can also happen naturally with ageing. It’s fairly self-limiting. Once it’s once it’s receded, it stops, but then that root surface that’s exposed is more prone to acid attack from eating, you know, from drinking hot water with lemons. We’ve spoken before about dietary factors in previous episodes that can cause erosion. And then there are also abrasions, which are from brushing too hard or using a very hard toothbrush or a whitening toothpaste or charcoal toothpaste, something that’s very abrasive. The last one is those little V-shaped grooves that people will have.

[00:02:49] Dr Clifford Yudelman OptiSmile: The dentist might tell you that you’ve been brushing too hard on one particular tooth, and that tooth could be a tooth that’s more further in, and then a tooth that’s further out doesn’t have anything of the sort. The dentist might not be correct in saying it’s from brushing too hard, because it would be impossible to brush the tooth that’s in harder than the tooth that’s sticking out. And the correct terms for that is abfraction. And that’s very common these days, especially since Covid. A lot of people have been under stress, clenching and grinding. So, it’s hard to understand how if you clench or grind, you would think it would only affect the top of your teeth, but in fact, your teeth jiggle around a little, and they bend a very, very tiny amount at the gum line. And that causes a loss of tooth structure, sort of a stress fracture that compounds at the gum line and the acid and the abrasion from tooth brushing. They all work together to cause exposed root surfaces.

[00:03:51] Eon Engelbrecht E-Radio-SA: Wow. Okay. Can you explain the relationship between enamel erosion and increased sensitivity on the crowns of teeth?

[00:04:01] Dr Clifford Yudelman OptiSmile: Yes. So basically, when you’ve got already got a pre-existing gum line recession from what I just spoke about, and then if you eat a lot of acidic things like vinegar or you drink hot water and lemon or you drink carbonated water, things that we’ve discussed before, that starts melting away the enamel, and it also opens up the dentinal tubules or the dentine, because at the neck of the tooth, when there’s no more enamel and you’ve got exposed root surface, there’s a direct connection at the root, to your actual nerve in your teeth. And that’s why when you breathe in air or get cold water on the teeth, it can be it can be a lot more sensitive, you know, preventing this type of stuff by using a soft bristle toothbrush, and if you are drinking something acidic, like a lemonade, you know, on the odd occasion you’re using a straw. But I think it’s best to try and avoid most of those acidic things.

[00:05:02] Eon Engelbrecht E-Radio-SA: And what are the most common symptoms that patients with sensitive teeth experience, and how do these symptoms typically vary between individuals?

[00:05:14] Dr Clifford Yudelman OptiSmile: So the sensitivity that we’re talking today, is sensitivity from gum line recession and erosions, etc. as I’ve been saying, and one has to be careful not to confuse that type of sensitivity with a fractured tooth or a cavity or a broken filling or something which can start quite suddenly after you bite something hard, or you’ve got a cavity that’s getting closer and closer to the nerve. The type of sensitivity we’re speaking about is, you know, when you breathe in like that or, or if the dentist blows cold air on your teeth and sometimes even hot, or if you put your fingernail at the gum line and you scratch on it and it feels like a very nervy kind of pain, that’s very different to a cavity. And it’s usually reversible. And it does change from person to person, but it’s usually very sharp and it goes away very quickly as opposed to a cavity that’s got cold sensitivity. When we spoke about root canals last week, we spoke about if you get something cold on a tooth and it lingers for 20 or 30 seconds, that means it’s got irreversible pulpitis. And that’s more to do with the nerve. So, this type of sensitivity at the gum line or from recession like this is quite different, but it can actually affect people. So, the people we see with recession and gum line problems, many of them have never, ever had a filling in their life. Having this type of problem can cause a lot of issues for people, even though they’ve never had a cavity. And that’s why desensitising toothpaste are very popular because we do see a lot of people taking in too much acid.

[00:07:01] Eon Engelbrecht E-Radio-SA: So those toothpastes, would that be Sensodyne, that kind of stuff?

[00:07:06] Dr Clifford Yudelman OptiSmile: Ja, so Sensodyne is very cleverly named. It is one of the oldest ones for tooth sensitivity. But most of the sensitivity type toothpastes all work more or less the same. They always coming out with some new formula. I would keep away from the sensitive tooth toothpaste that also claims to give you healthier gums and whiter teeth. I would stick with a specific one. The one that I liked for a long time was Colgate Sensitive. I just tell people to try the different ones on the market and find which one they feel works best. But to be honest, most people, if they stop what’s causing the sensitivity in the first place, even a normal toothpaste will work. You don’t have to use a desensitising toothpaste for the rest of your life, but getting a diagnosis with your dentist is very important because if you’re clenching and grinding, then using a bite plate at night or preventing the clenching and grinding in the first place using a soft toothbrush, there are professional grade desensitises we use something from Ultradent. If we get a person come in where they, they maybe went on a safari and they were drinking a lot of gin and tonics at sunset, which sounds like a lovely idea. And they don’t normally drink a lot of gin and tonics, the tonic, and can cause a severe, you know, sensitivity, reaction. And even if people go for a wine tasting and they swishing a lot of, you know, more immature white wines that are very acidic or maybe went out for some Asian food and there was a lot of vinegar and spice there, maybe a Tai meal. And they come in and their teeth are super sensitive. We’ve got stuff that we can paint onto the tooth, very much like a Sensodyne. We blow a bit of air on it. We painted it 1 or 2 more times, and it works very well. Um, it’s not completely permanent. Normally I don’t even charge because it takes a few seconds, but it sorts that problem out.

[00:09:14] Eon Engelbrecht E-Radio-SA: Doctor, are there particular lifestyle or dietary habits that exacerbate tooth sensitivity and if so, what preventative measures can people take?

[00:09:25] Dr Clifford Yudelman OptiSmile: So, I think we’ve covered most of those. You know, the desensitising toothpaste. Definitely getting a checkup. If you haven’t had a checkup with your dentist in six months or a year, actually looking in the mirror and pulling your lips out of the way and having a good close look at what your teeth look like takes some time. Get a bright light. Have a look in your mouth if anything doesn’t look right there behind your teeth. You could have tartar that needs cleaning—definitely avoiding very acidic (foods). If you Google acidic foods and tooth sensitivity, you’ll find a chart. Just go to images, and you’ll find a chart of all the different things that will cause sensitivity. And you might find that you’re eating a lot of those. Just yesterday, I had a teenager that had a lot of sensitivity. And she loves, um, tinned pineapple. She opens up a tin of pineapple when she comes home from school, and she might pick a little piece of pineapple every, you know, half an hour or hour. And she might spend the whole afternoon eating one tin of pineapple or we have patients that are addicted to naartjies when they’re in season. And, you know, they might not eat a whole nartjie all in one go. They have a little segment here and a little segment there. And I’ve found that people in the wine business that are always tasting wines, and also chefs that are tasting food all the time, they tend to have very sensitive teeth. So yeah, adjusting your diet, soft toothbrush, all of those things can all help.

[00:10:58] Eon Engelbrecht E-Radio-SA: Doctor, what are the first steps that someone should take at home when they notice sensitivity in their teeth?

[00:11:06] Dr Clifford Yudelman OptiSmile: So, if the sensitivity is to cold and to do with what we’ve just been talking about the first thing you can do is just using. I would avoid any strong dental mouthwashes that have alcohol. If you do want to rinse your mouth, if your gums do feel a bit inflamed, you can rinse with a little bit of warm salt water to reduce any inflammation in your gums and go out and get a desensitising toothpaste. You can rub desensitising toothpaste on any particular teeth that feel more sensitive than any others. And, uh, you can even dab a little bit on and leave it on. You can do that a few times a day. Um, have a look for a very gentle toothbrush. , avoid, as I said earlier, avoiding acidic foods. And if you haven’t had a checkup in a while, it may be a sign that you need to go to the dentist. So don’t stay home and just wish it goes away. Pick up the phone and call your local dentist or get some help.

[00:12:14] Eon Engelbrecht E-Radio-SA: Doctor Yudelman, could you discuss the professional treatments available for severe cases of tooth sensitivity? And also, how effective are these methods?

[00:12:26] Dr Clifford Yudelman OptiSmile: Okay, so that’s a great question because when you do go to the dentist, you’ll probably get a lot of the type of advice that I’ve been talking about here. And the one thing is if you have those add fractions, those very deep V-shaped grooves in your teeth, there are ways to restore those professionally. We restore them under a microscope. We often will need to numb the patient. We use a machine called a “Wand” that we use for numbing, and also, to do them properly, the dentist would need to place a little piece of retraction cord, which is like a very, very fine piece of cotton or string, just to gently push the gum out of the way. We do see patients who’ve had these abfractions restored, and the dentist hasn’t used retraction cord or hasn’t used magnification, and they can cause what’s called an overhang, and or the filling is not well bonded at the gum line. And although the filling is still intact, acidic foods and cold air can get underneath the filling. And it could even make it worse. I did mention earlier about professional brush-on, we can paint on some desensitisers. Things like fluoride gels and varnishes are popular. A lot of dentists or hygienists would do that. I don’t like to do bonding on all of those recessions and abfractions. They don’t tend to stay on indefinitely, and they do need to be checked regularly, because if you’re still clenching and grinding, they can leak or pop-out and the materials are getting better and better, but they need to be done very meticulously. You know, we’ve treated a lot of patients with those types of treatments, but it’s not always the first line of defence. If you see a dentist, you know, in line with our theme, save Your Money, Save Your Teeth.

[00:14:27] Dr Clifford Yudelman OptiSmile: If you’ve been going to the dentist over the years, and you maybe haven’t been for a couple of years, and you go in and the dentist is very alarmed because you have 8 or 10 of these recessions, and you know that you’ve had them for a long, long time. And maybe a change in your diet just recently has caused them to be sensitive. And the dentist says, “Ooh, we have to do 8 or 10 fillings”. And it’s, you know, R500 a pop or R1000 a pop, and we’re going to do them all in one visit, and it’s going to take us half an hour. I would get a second opinion. You don’t always have to restore those. So, the other thing that we that we need to talk about is, is in older patients that have a dry mouth and they’ve maybe had recession for a long time. And now the oral hygiene is poor. Perhaps plaque is building up on an area that was just merely one of these recessions or abrasions. You can start getting what’s called root cavities. And that’s a different now, different story root cavities. We will do a podcast, , based on treatments for, for much older patients. Um, I’m 63. I don’t consider myself geriatric yet. I think when I’m 65, that’s I think that’s the cutoff these days. But these days, you’re looking more we’re talking about people in the 80s and 90s. Yeah. And if someone’s got arthritis or can’t, you know, can’t clean their teeth properly, then those types of issues, you know, you get root cavities, and that’s where extra fluoride and things like that can help.

[00:16:00] Eon Engelbrecht E-Radio-SA: Dr Yudelman these over-the-counter products that you get, are they as effective as treatments provided by a dentist?

[00:16:08] Dr Clifford Yudelman OptiSmile: So yes and no. If you’re going to just use an over-the-counter desensitising toothpaste and you’re going to keep drinking hot water with lemons or carbonated beverages, or suck on lollipops every night, or do some of the things that we’ve spoken about today or in some of our earlier podcasts, then I would say, no, you’re going to just keep buying more and more expensive toothpaste. One has to treat the cause of the not treat. One has to find out what the actual cause is and, rather, prevent it. So that’s in keeping with Save Your Money, Save Your Teeth. To be honest, I use a very cheap Colgate, the very plain Colgate toothpaste, the one that says Great Regular flavour, the blue and red one that’s always on sale and you get big tube. It’s got hardly any ingredients in it. When I go to a restaurant, and I have water, I generally just drink tap water or still water, and I make sure I don’t have a little slice of lemon in my water because I would dread having sensitive teeth.   I think it would be a terrible thing to have the sensitivity that I see some of our patients have. You know, the stuff that we paint on or if someone does have a deep abfraction, those things work really well. Look, there’s desensitising toothpaste, the chemistry and some of the things they have in there to block off the little tubules do work well. But if you keep hitting your teeth with acid or a hard toothbrush, you know you’re still going to cause more problems.

[00:17:48] Eon Engelbrecht E-Radio-SA: And then finally, looking towards the future, are there any new developments or technologies in dentistry that could be improve the management of tooth sensitivity?

[00:18:02] Dr Clifford Yudelman OptiSmile: So yes, I Think there’s always new developments coming along. Tooth sensitivity is a big money maker for the toothpaste companies, so I don’t think they’re going to fund anything that’s going to bring about a permanent, you know, change to, to your teeth because then they’re going to stop selling toothpaste. We will be doing an episode on something called injection moulded composite bonding, which is where we take a 3D scan of your teeth, and we do a 3D design of what the ideal tooth shape should be, and we make a silicone mould. Then, we put that over your tooth, and we can squirt new enamel onto it and harden it. That’s quite a complicated subject, but that’s only been something that’s been available for about three and a half years. It also works amazingly well when a lot of tooth substance has been abraded or eroded. And we use it exclusively at OptiSmile. We, we very rarely do crowns or veneers in cases like that, because a crown or a veneer, you have to still drill down more tooth. But with something like this, we often don’t need to drill anything at all. And in most cases, we don’t even have to numb the teeth to build your tooth back up to its former glory. So yeah, there’s a lot of those types of developments coming along with 3D scanning and 3D printing and so on.

[00:19:34] Eon Engelbrecht E-Radio-SA: And that wraps up today’s episode of “Save Your Money, Save Your Teeth”. Doctor Yudelman, once again, a big thank you to you for sharing your expertise with us.

[00:19:44] Dr Clifford Yudelman OptiSmile: Thank you very much. And thanks for having me on again. And be sure everyone to tune in next week when we talk about some of the myths and realities about wisdom teeth. So, I’ll speak to you next week. Eon. Thank you, thank you.

[00:20:01] Eon Engelbrecht E-Radio-SA: Looking forward to that. And also big thanks to our listeners. Remember, while we strive to provide valuable insights, always consult with your own dental professional. And uh, that would be for advice tailored to your personal health. Also, don’t forget to subscribe for more enlightening discussions and then join us again next week as we continue to explore the fascinating intersection of dental, health and financial savvy. Until then, keep smiling and taking great care of your teeth.

[00:20:59] Eon Engelbrecht E-Radio-SA: Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Doctor Clifford Yudelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting https://optimile.co.za for articles that illuminate the path to optimal oral health. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book directly online at OptiSmile.co.za. OptiSmile, where global expertise meets local care.