“Doc, I think I have a cavity. Every time I drink some soda, my tooth hurts.”

Experience tells me it’s certainly possible, so I’ll naturally take a look – but quite often, I already know that what is causing the discomfort is an entirely different issue. Patients are often surprised when I explain that while I understand this area hurts, it’s not a cavity.

Hot, cold, air, or sweets – the triggers can be different for different people – but the effect is the same: dental pain. For some, it can be mild or tingly. For still others, it can be excruciating and intense. And yet, this can occur without decay.

So what’s going on? Often, it has to do with changes to the tooth enamel. This protective outer layer of your tooth is both the hardest substance in your body and it acts as an insulator to the inner and more sensitive dentin layer, as well as the pulp. Hard as it is, enamel is still subject to changes that can have consequences for your comfort and tooth function.

So what causes enamel to become damaged or thinned?

In a word – life. But here are a few practices or habits that tend to accelerate changes:

— Dietary factors such as acidic drinks (sodas, fruit juices, wine) and foods
— Teeth clenching and grinding
— Dehydration of teeth caused by a dry mouth condition (medications or insufficient water intake)
— Digestive problems such as acid reflux
— Damaging habits (using your teeth in ways you shouldn’t, such as opening things with them)
— Improper brushing (overly aggressive or excessively abrasive)

The result of thinned enamel – also referred to as enamel erosion – is sensitivity. Gum recession can also produce a similar result because this exposes the root surface, which is not covered by enamel. Nevertheless, the result is comparable. The teeth hurt.

Yet another popular activity – tooth whitening – can lead to sensitivity due to the cleansing activity of peroxides that are used to remove stain and debris within and between the complexes of enamel rods (the basic unit of tooth enamel). It also removes something called smear plugs (debris in the dentin tubules), and this increases the conductivity of fluid that exists in the tooth’s inner layer, the dentin. When the fluid backs up – once again, you experience pain.

In many cases, desensitizing toothpastes can help. The active ingredient is typically potassium nitrate. It usually takes several weeks of continued use to experience relief. If this does not resolve your symptoms, your dentist may be able to administer a desensitizer that provides instant relief. Any persistent pain should be evaluated by a dental professional in order to prevent more serious and expensive problems.