Short Answer: Probably not. Tooth sensitivity can be caused by many things besides cavities. Cavities need to be really deep to cause any symptoms at all.
Long Answer: In my office, when a patient comes in to see me with a complaint, about 9 out of 10 times that complaint is, “my teeth are sensitive”. In many cases, their assumption is that they have a cavity. It’s important to know that about 90% of the time, those sensitive teeth have nothing to do with cavities at all. The culprit is usually something that has sensitized teeth to biting pressure, cold, hot drinks or sweets. Below are the most common causes of tooth sensitivity (besides cavities) and some things to try to troubleshoot the problem.
Typical causes (besides cavities):
1. Sinus infection – Above your top back teeth is an air space which connects to your nose. That air space is called a sinus and it can fill up with fluids, especially when you have a cold or allergies. When this happens, it can directly impact the sensation felt by your teeth and you might describe it as an “ache” which is hard to pinpoint as coming from one specific tooth. Symptoms that would indicate your sinus is the likely culprit for your tooth sensitivity include pain that changes as your head position changes (if you tilt your head to the side, does it hurt more or less?), pain during a time you have a sinus infection, allergies or just a cold/flu.
2. Wear (on the tops or sides of your teeth) – You may be grinding your teeth at night and are unaware of it. Before you confidently profess, “I don’t grind my teeth!”, I would ask how you know that? You are not aware of nearly anything you do when asleep, and grinding your teeth during the night is extremely common. That grinding wears away protective enamel that keeps your teeth from being sensitive much like you might strip a house of its insulation.
Similar to wear on the tops of your teeth, you can also have excessive wear along the sides of your teeth as well. This can occur when you brush your teeth too hard or with a brush that isn’t soft. You would be surprised how much tooth you can wear away even with a soft brush. Need convincing? Remember that the Grand Canyon was formed by just water! If you use “whitening” toothpaste, the problem gets compounded because whitening toothpaste doesn’t actually whiten your teeth chemically, it simply removes stains more aggressively by using rough sandpaper-like material in the toothpaste. This makes them appear whiter, but that sandpaper-like material also strips away more insulation around your teeth.
If the biting surfaces of your teeth have too much wear, you might even feel a little “zap” on one tooth when you bite on it with a specific piece of food. Your next bite may have no pain at all and then five bites later…”zap!”. This is usually caused by a food particle pressing on just the right spot where you have excessive wear and where the tooth is more sensitive.
3. Foods and Acids – There are many foods/drinks that sensitize teeth because they are rather acidic. Acids actually strip away a microscopic film of protection around teeth that makes them more sensitive (examples: soda water, lemon juice, apples, pineapple, citrus, tomatoes, sauerkraut, etc.). If the acids are particularly strong, they can literally melt small craters on the tops and sides of your teeth and we call that “erosion”. This can sometimes occur if you have GERD (heartburn) as the acids from your stomach literally come back up into you mouth (usually at night) and then sit on your teeth. There are other causes of erosion, but untreated heart burn is a common cause.
4. Tooth Grinding– We already discussed how tooth grinding can wear away your tooth and cause problems, but in this case I am referring to pain caused by the actual pressure of your teeth clenching and grinding together for hours at a time at night. Again, you are not likely to be aware of this problem just as you are generally unaware if you snore or talk in your sleep. If you do grind your teeth, that pressure can cause the nerves around your teeth to get sensitized and hurt during the day. Imagine you are a couch potato and I somehow convince you to run a half marathon in the morning. The next day your muscles will be very sore and even if you just walk to the kitchen, you will feel pain with every step. The same thing can happen with teeth.
5. Referred Pain – Sometimes we feel pain in our teeth even when the source of the problem is not actually our teeth. Pain from a sinus problem is one example we already discussed. There are many other causes like an issue with your jaw joint (TMD), teeth that are erupting like adult teeth in children or even wisdom teeth in adults, a cold sore, gum infections and even some diseases can create a situation where you feel pain in your teeth when the teeth are perfectly fine.
Signs you might have a cavity:
- Severe pain – Usually the sensitivity caused by the five causes above is not severe. On a scale of 1 to 10, most people would describe the pain as a 2 or 3 out of 10 and sometimes as high as five. Pain caused by a cavity typically feels much worse like a 9 or 10 on that scale. Tooth pain might keep you from sleeping at night.
- Constant and lingering pain – Tooth pain generally does NOT start when you drink something cold and then disappear. A tooth problem will hurt and continue to hurt for a long time, perhaps for days or longer. If you feel pain when you drink something cold and the pain disappears immediately after you swallow, it is unlikely to be caused by a cavity and more likely from one of the causes in the list above.
- Spontaneous pain – A problem caused by a cavity usually isn’t triggered by cold or sweets. The pain usually happens spontaneously.
- Swelling – If you see swelling around a particular tooth, a bubble that “pops” right next to a tooth or see pus coming from specific area, this is more likely to be related to a specific tooth problem.
- Focused pain – If you feel an “ache all over”, something else is likely going on besides a cavity. Pain caused by cavities typically cause one specific tooth to hurt, not a group of them. If you can tap on just one tooth and feel a problem, then that is more likely a cavity or tooth-related issue.
You might have one of these issues above and it does not necessary mean you have a deep cavity. There may be other explanations, but when I see patients that do have a deep cavity, they usually present with one or more of the symptoms listed above.
Hopefully I have made it clear that when you have sensitive teeth, there are usually many good explanations besides a cavity. The most effective advice I give to patients when I have ruled out cavities as a cause of their sensitivity is:
- Discontinue use of any whitening products (rinses, toothpastes, bleach gels, etc).
- Buy sensitivity toothpaste (ANY toothpaste that has 5% Potassium Nitrate). No need to buy any specific brands, they are all identical.
- Brush gently with the softest toothbrush you can find or use a good quality electric toothbrush, which I think is better than a manual brush anyways.
Remember that if you feel pain when you drink something cold and the pain disappears immediately after you swallow, it is unlikely to be caused by a cavity.
Lastly, if in doubt, see your dentist for peace of mind and confirmation.
Please leave a comment if you have further questions or feedback.