Toothache caused by cold: possible causes and treatment options

Tooth sensitivity to cold can occur when the dentine or the tooth’s nerve is exposed to cold stimuli. It is most commonly caused by dentine sensitivity, tooth decay, gum recession, cracks in the teeth, leaky fillings or inflammation of the dental nerve. The diagnosis is made during a dental examination, and treatment depends on the identified cause.

Sensitivity to cold occurs when cold stimuli reach the dentine or dental pulp through areas where the tooth’s natural protection has been compromised. Depending on the cause of the exposure of these structures, the pain may be brief and mild, or it may indicate a dental problem requiring treatment.

• Cold stimuli reach the dentine or the tooth’s nerve;  
• the pain may be brief and sharp or persistent;
• general sensitivity does not have the same causes as pain localised to a single tooth;
• the correct diagnosis depends on the duration of the pain, its location and associated symptoms. 
   

To determine the cause of sensitivity to cold, the dentist will discuss the patient’s symptoms and any habits that might be contributing to the problem, such as their diet or how they look after their teeth. This is followed by a clinical examination and, if necessary, further investigations to rule out similar dental conditions.

The most common causes of tooth sensitivity to cold are:

• dentin sensitivity;
• tooth decay;
• gum recession;
• tooth cracks;
• old or compromised fillings;
• inflammation of the dental pulp.

Dentin sensitivity

Dentin is the tissue located immediately beneath the enamel and can react to various stimuli, such as exposure to cold. It becomes exposed when the enamel thins or becomes damaged, which can be caused by aggressive brushing or gum recession.

Consequently, stimuli reach the nerve endings inside the tooth more easily, leading to dentine sensitivity, which is often manifested as a brief, sharp pain upon contact with cold food or drink.

Tooth decay  

Tooth decay is one of the most common health problems worldwide. If left untreated, caries spreads and affects the deeper layers of the teeth, with the dentine being the first to be affected. Symptoms include, but are not limited to: sensitivity to cold, hot or sweet foods; pain at night; and increased sensitivity when chewing.

Regular visits to the dentist, as well as good oral hygiene – including brushing and flossing – are the best ways to protect your teeth against tooth decay. 

Gingival recession

A common cause of this is aggressive brushing or using an incorrect brushing technique. Pressure applied to the gums can lead to them receding and the root being exposed, thereby causing tooth sensitivity to cold stimuli.

Another major cause is periodontal disease. Inflammation caused by bacteria affects the gums, leading to recession and exposure of the tooth root.

Tooth cracks

Tooth cracks are fine fissures that appear in the enamel or within the internal structure of the tooth. They are not always visible and may cause mild symptoms that come and go.

Signs that may indicate a dental crack include:

• sensitivity to cold or heat;
• pain or discomfort when biting;
• sensitivity after eating hard foods;
• intermittent pain that is difficult to pinpoint;
• a feeling that the tooth is ‘troublesome’, for no obvious reason.

In the early stages, the crack may be confined to the enamel and cause only mild discomfort. If it extends deeper, it can affect the tooth’s nerve and lead to complications requiring more complex treatment. Therefore, any sensitivity or pain that occurs repeatedly when chewing should be assessed by a dentist.

Old fillings or poorly fitted dental work

Although fillings and dental restorations are effective solutions for restoring damaged teeth, they are not permanent and may need replacing over time, particularly when they allow bacteria to enter or no longer fit properly.

Signs that may indicate the need to replace a filling or dental restoration:

A visit to the dentist allows the restoration to be assessed and the optimal time for its replacement to be determined, before any complications arise.

Inflammation of the dental pulp (tooth nerve)

The dental pulp is the tissue located inside the tooth, which contains blood vessels and nerve fibres. When it becomes irritated, pulp inflammation occurs. 

In many cases, sensitivity to cold is not a dental emergency. However, when the pain becomes severe, persists after the stimulus has been removed, or is accompanied by other symptoms, it may indicate damage to the dental nerve or the presence of an infection and requires consultation as soon as possible.

• the pain lasts for more than a few seconds;  
• it occurs spontaneously, without a cold stimulus;  
• the pain worsens at night;  
• there is swelling or tenderness when biting;  
• you develop a fever or feel unwell;  
• the pain is localised to a single tooth.  

If the pain is limited to a single tooth, it is more likely to be caused by a localised problem, such as a cavity, a crack in the tooth, a leaking filling or inflammation of the dental pulp. 

Generalised sensitivity affecting several teeth is more commonly associated with exposed dentine or gum recession. In both cases, a dental examination is necessary to establish a diagnosis.

The measures below may temporarily relieve discomfort, but they are no substitute for a dental check-up. If the pain persists or recurs frequently, it is important to identify the cause and treat it appropriately.

• avoid very cold drinks and foods;  
• avoid chewing on the affected side;
• avoid putting extra pressure on the affected tooth (chewing gum, sweets or any hard food);
• use toothpaste for sensitive teeth;  
• do not attempt any DIY treatments on the tooth;  
• avoid aggressive brushing.

If the sensitivity persists or affects your daily activities, book a dental appointment to identify the cause and choose the appropriate treatment. 

• How valid and applicable are current diagnostic criteria and assessment methods for dentine hypersensitivity? – Gernhardt CR.
• Root Canal Explained, American Association of Endodontists
• Crack Lines: The Precursors of Tooth Fractures – Their Diagnosis and Treatment –
• Abou-Rass, Marwan Published in: Quintessence International
• Managing dentine hypersensitivity – Robin Orchardson BDS, PhD, David G. Gillam BDS