For Dental Professionals

Sensitivity / Decay

🦷 Tooth Sensitivity and Dental Caries: Clinical Assessment, Disease Progression, and Management

Use this hub to navigate the clinical evaluation of tooth sensitivity and dental caries, from symptom assessment and lesion detection to risk assessment, disease progression, management, and follow-up.

Composite showing the caries continuum from a healthy tooth through an early enamel lesion, early dentin caries, deep dentin caries, and pulpal involvement, alongside non-carious conditions including erosion, attrition, and a cracked tooth. — Tooth sensitivity should be viewed as a clinical presentation rather than a diagnosis. While caries progresses through a biological continuum from enamel demineralisation to pulpal involvement, non-carious conditions such as erosion, attrition, and cracked teeth may produce similar symptoms. Accurate diagnosis depends on integrating the patient's history, clinical examination, lesion assessment, and appropriate testing.

Tooth sensitivity is a common clinical presentation with a broad differential diagnosis. It may arise from exposed dentine, early or advanced dental caries, restorative procedures, periodontal disease, pulpal inflammation, structural defects, or other non-carious conditions. Accurate diagnosis depends on integrating the patient's history, clinical examination, lesion assessment, special tests, and radiographic findings.

This hub is organised around the clinical assessment of the sensitive tooth, guiding clinicians from symptom recognition through lesion assessment, disease progression, differential diagnosis, and management rather than presenting isolated diagnoses. Begin with the presentation that best matches your patient, then follow the linked articles for detailed interpretation and management.

At a Glance

Where is the sensitivity coming from?

Sensitivity has multiple possible causes.

Is there caries?

Sensitivity does not always mean dental caries.

Is the lesion active?

Activity assessment guides management.

How advanced is the disease?

Progression helps determine pulpal risk.

Could this be something else?

Alternative diagnoses must be considered.

Clinical Question	Key Point
Where is the sensitivity coming from?	Sensitivity has multiple possible causes.
Is there caries?	Sensitivity does not always mean dental caries.
Is the lesion active?	Activity assessment guides management.
How advanced is the disease?	Progression helps determine pulpal risk.
Could this be something else?	Alternative diagnoses must be considered.

Patient presents

History

Clinical examination

Sensitivity pattern recognition

Lesion detection

Lesion activity and pulpal risk assessment

Diagnostic synthesis

Management

Review

Outcome

The following framework mirrors the clinical reasoning process used when evaluating a patient with tooth sensitivity. Begin by characterising the presenting symptom, then assess the underlying lesion, determine disease progression, and consider alternative diagnoses before planning management.