Sensitive Teeth Resolved
Dr. Nick has personally hypothesized and published about two of the four possibilities relating to sensitive teeth. Basically, hypersensitive teeth exist when the clinician has ruled out other basic dental, restorative or periodontal maladies; in other words, it is diagnosed via a process of exclusion. If dental hypersensitivity truly is the culprit, there are essentially four possibilities:
-Dentinal Hypersensitivity or DH. Exposed dentin on the top/occlusal of the tooth from wear or erosive issues; dull pain, trigeminal c-fiber neurological etiology.
-Cervical Dentinal Hypersensitivity or CDH. Exposed dentin on the cervical/gumline aspect of the tooth from occlusal/traumatic or iatrogenic reasons; sharp pain, trigeminal a-delta fiber neurological etiology.
-Frictional Dental Hypersensitivity or FDH. Cold hypersensitivity from bite/occlusal excursive aberrant interferences; sharp pain, of trigeminal and autonomic sympathetic neurological origins. Basically, sensitivity from the occlusion or bite.
-Sympathetic Dental Hypersensitivity or SDH. Cold hypersensitivity arising from the cervical spine whereby 3rd order autonomic sympathetic nerve fibers reach all the way to the pulp tissues within the dentition and are hyperactive, causing excessive vascular vasoconstriction. This hypoxia leads to a decreased threshold whereby cold is perceived. Ramped up sympathetic tone anywhere from damage along the spinal T1 - L2 vertebrae are etiologic.
DH and CDH account for approximately 50-60% of cases of HT, FDH approximately 20-30%, and SDH for approximately 10%. Curing DH and CDH involves clogging the exposed microscopic dentinal tubules using lasers and ozone gas. Dr. Nick uses both of these technologies on a daily basis within his practice. The implementation is fast, painless and simple and the cost is minimal. Typically, patients with HT are initially treated with lasers and ozone. If there is a reduced response to a before and after ice water swish, the DH or CDH was the diagnosis and the patient is cured. If they remain hypersensitive to cold water or air after laser/ozone implementation, the next step is to address the occlusion via the usage of T-Scan digital occlusal technology. Using the computerized bite data, Dr. Nick can find tiny aberrations within the dynamic bite whereby miniscule bite adjustments on either the teeth and/or dental work almost instantly resolve as demonstrated by a change in the ice-water swish; before bite adjustment vs. after bite adjustment. MANY patients have FDH due to a bite issue! Sadly, very few dental professionals are even aware of this possibility!
Dr. Nick first published about FDH in 2014 in a textbook chapter, followed by the formal pilot study published by himself and his associates in 2017:
If DH/CDH and FDH have been eliminated as being causative, SDH remains. Sadly, there is no direct cure for SDH. Many orofacial pain and TMJ/D patients possess this endotype (cause). One can only diagnose this via local anesthetic neck nerve blocks; but, it is a step in the right direction and greatly appreciated by patients to discover that excessive autonomic sympathetic tone is the reason for their HT, and can be a clue to help them resolve their chronic pain issues. SDH was first presented in 2024 by Dr. Nick and associates. Both FDH and SDH are unknown to most dental professionals and represent Dr. Nick's passion for improving dental medicine and patient care!
SDH publications:
2024: https://adtt.scholasticahq.com/article/121303-greater-auricular-nerve-block-reduces-dental-hypersensitivity-to-intraoral-cold-water-swish-challenge-a-retrospective-study
2025: https://adtt.scholasticahq.com/article/142572
DH/CDH
FDH
SDH
