The most common natural inciting agents which are responsible for causing pain are hot and cold foods as well as liquids. Consumables with a rich concentration of sugar in it such as toffee and chocolate also can cause pain when munched upon-especially so when teeth are having cavities.
A mechanical stimulus e.g passing a finger nail around the neck of a tooth can induce pain. It is left entirely to the pain threshold of a patient who eventually decides to pay a visit to a dental clinic trying to seek a line of treatment that restores his dental health.
It follows that with intact or undeteriorated enamel tucked around the tooth mostly around its incisal or occlusal surfaces as well as cervical margins the chances of intense pain arising out of what has already been mentioned so far will be minimized if not remote.
It is therefore vital that the entity of the tooth be maintained and preserved. To those who believe that they are performing a great cleansing act by vigorously brushing their teeth in the same way they employ a polishing brush to shine their shoes fail to realize that such an aggressive battering with the bristles applied horizontally to the long axis of teeth erodes the enamel gradually exposing the sensitive portion of the tooth, the dentine. With the thickness of enamel wearing out sensitivity becomes a common complaint of these patients.
In a random survey of 25 patients who visited the Dental clinic, 14 of them used the ‘assault technique’. Hitting the enamel forcefully without even trying to surmise the cause of semi-lunar concavities on the facial surface of their front teeth they had continued in the same vein until the day their dentist educated them about the genesis of their cavities. None of the 14 patients ever bothered to look themselves in the mirror when they brushed their teeth.
Even the remaining 11 patients were not free of blemishes. Only 5 out of these had, after more than three visits to a dental clinic started brushing correctly. While 6 out of this lot used the mixed rotational and horizontal method, suffice to say that unless there is a honest effort made by those committed to safeguarding the integrity of their enamel around their teeth sooner than later, sensitivity is bound to surface.
A question that is often asked by a patient: “What happens if I take very hot coffee and immediately afterwards bite into an ice cream cone?” When one eats ice cream pain and sensitivity occurs in the lower anterior teeth. The crowns of these teeth are comparatively small which would imply that contact with any cold food or drink produces a greater fall in temperature than would occur in larger teeth. The distance from the outer surface of enamel to the pulp is less that in the other teeth.
Hence for a given cold stimulus the thermal gradient is greater in lower teeth. With this the temperature across the tooth structure from outside to inside falls faster. The thermal gradient is the difference between the outside temperature and the inside temperature divided by the distance between.
Pain occurs when the ice cream is bitten and continues for a shorter time afterwards, outlasting the stimulus for a few seconds because the dentine has been cooled and requires this short time to return to its normal temperature. As the person continues to eat ice cream the pain becomes less. This is because temperature of the tooth gradually approaches that of the ice cream, so that the thermal gradient decreases.
In a similar way pain may occur from drinking hot liquids. This is even more likely if a person drinks hot coffee soon after taking a cold dessert. The dentine becomes colder than normal. Application of heat to the outer surface therefore produces a larger temperature gradient through the tooth. The rapid swing in temperature causes pain.
The simple solution of the problem is to avoid such severe temperature changes. This would prevent the occurrence of the shifts of thermal gradient and contribute toward maintaining the health of the pulp, which harbours blood vessels and nerve fibrils.
A man goes shopping and sees a Thermos flask. He asks a sales assistant what it does. “It keeps hot things hot and cold things cold,” replies the assistant. He buys one and takes it to work the next day. “Look at this,” he says to his workmate. “It’s a Thermos flask. It keeps hot things hot and cold things cold”. “What have you got in it?” asks his friend. “Two cups of coffee and a choc ice,” comes the reply.
The best bet is to enjoy your ice-cream if you have intact enamel. Allow about 15 to 30 minutes to elapse after one has munched an ice-cream. Let the temperature come back to normal before indulging in a drink that is scalding.
One could choose to have either hot or cold item first. What is essential is the definitive time allowance between two food items which are at extreme temperatures. It is for the patient to choose and follow the instruction of his dentist and maintain the intactness of enamel around the surfaces of his teeth.