A patient came to my dental practice yesterday with a most peculiar symptom. She complained that her teeth stringed when she brushed them. Not every time, but often enough that she was concerned. I took some radiographs and did a quick exam of the upper left quadrant which was the area that she felt the stinging coming from. At first I could see nothing wrong. I looked more closely and I found one tooth that had a tiny perforation on the occlusal surface in the enamel. I could not believe this tiny bit of missing enamel could be the cause of her complaint. It was an incipient ‘pot hole’ in her tooth. Pot holes commonly are seen on posterior teeth starting at a cusp tip. These cusp tips are often the part of the tooth that makes contact with the opposing teeth and over time can experience wear in the enamel. Once the perforation occurs, dentin can become exposed and be sensitive to touch.

I took my explorer and scratched the tiny patch of exposed dentin on her tooth and she felt no pain. I was vexed. What could be causing her complaint? I scratched my head and asked her to pay attention to which tooth was stinging when she brushed and come back and point it out at her next recall. She wasn’t satisfied with this advice. I then took out my dental explorer and scratched the exposed dentin spot again, harder and she almost jumped out of the chair. I had found the problem! She had said she didn’t feel this pain every time she brushed, just sometimes.

At this point I explained that we would fill her pothole with a tiny composite restoration and it could be done without any local anesthetic. I filled this tiny pothole and tested the tooth again and she felt nothing. Problem solved. My patient asked whether how hard she brushed her teeth could be a partial cause of her problem. She explained that she brushed vigorously with an electric tooth brush. I explained that electric tooth brushes only require a gentle pressure on the tooth and that brushing toothpaste with hard repeated pressures could cause increased wear on her teeth.