Rethinking Dentine Hypersensitivity: A Trigeminal Perspective
Some patients report that certain textures, such as cotton wool, wooden instruments or even dry fabrics can trigger a distinct “tooth shiver” sensation, sometimes without direct contact with the tooth surface.
Tooth sensitivity commonly occurs following hot or cold stimuli. However, some patients will report unusual triggers for tooth sensitivity. As such, practitioners must consider atypical causes of dental pain to avoid unnecessary or over treatment.
The science in a spotlight
While these experiences may seem unusual, they still relate to the same underlying pathways involved in dentine hypersensitivity. Tooth sensitivity is often explained using the Hydrodynamic Theory, which focuses on the movement of fluid inside the dentinal tubules. The concept suggests that this movement is caused by thermal or physical changes, or osmotic stimuli. Where it comes into contact with exposed tubules, this movement stimulates a baroreceptor and neural discharge. The fluid tends to flow away from the dentine-pulp complex in response to cooling, drying, evaporation or hypertonic chemical stimuli. Heat causes the reverse direction of movement[i].
However, the Hydrodynamic Theory is being challenged. Emerging research suggests that odontoblasts may contribute to the pathogenesis of dentine hypersensitivity[ii]. Dental pulp nerve fibres are often entangled with odontoblasts. This might allow the transmission of signals to adjacent nerve endings via chemical mediators. Pain mediators may also communicate between odontoblasts and trigeminal neurons, further supporting alternative mechanisms for dentine sensitivity.
The trigeminal nerve is the largest cranial nerve and it is responsible for communicating sensations in the mouth, teeth and face, with the brain. The trigeminal nerve integrates sensory input from the teeth, face and surrounding tissues. Variations in how these signals are processed may contribute to heightened or unusual sensitivity responses in some patients[iii].
Referred pain
The trigeminal nerve may also contribute to broader or referred sensations across the face and surrounding tissues. Because it integrates sensory input from the teeth, skin and oral structures, stimulation in one area may be interpreted in another. This helps to explain why some patients experience sensitivity beyond the immediate tooth surface.
This may also provide insight into reports of unexpected triggers, including textures or non-contact sensations, which do not align with traditional models of dentine hypersensitivity and may reflect broader mechanisms of central sensitisation[v]. Variations in sensory processing within trigeminal pathways may influence how these signals are perceived, particularly in individuals with exposed dentine or lower sensory thresholds.
While distinct from dentine hypersensitivity, conditions such as trigeminal neuralgia demonstrate how minor stimuli can, in some cases, trigger disproportionate sensory responses, including everyday activities such as shaving, exposure to cold weather, or light touch[vi,vii,viii]. Together, this highlights the central role of trigeminal pathways in how sensory input is interpreted across the oral and facial region.
Application in the dental practice
Consequently, a comprehensive dental assessment is critical. This identifies potential causes of sensitivity, prior to the delivery of any treatment, avoiding unnecessary dental interventions.
To help patients manage symptoms and alleviate the pain experienced, recommend BioMin® toothpaste. This uses bioactive glass technology to gradually release calcium, phosphate and fluoride ions for up to 12 hours, sealing and stabilising the tooth surface. By limiting fluid movement within the tubules, BioMin® addresses the underlying cause of sensitivity at its source, rather than simply masking symptoms. This approach addresses the inherent biological trigger of dentine hypersensitivity, rather than acting only after the sensitivity response has already been initiated.
Dentine sensitivity sits within a complex neurological and biological system. Patients’ explanations of triggers or their perceived pain levels and location may not be telling the full – or the right – story. For dental professionals, understanding all the potential causes and performing a comprehensive clinical investigation into symptoms is crucial for an accurate diagnosis and genuinely helpful treatment strategy. This includes recognising that some sensitivity responses may be influenced by broader sensory processing, not just direct stimulation of the tooth surface.
The science is clear. The solution is simple.
2026 Supply Update
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