Sensitive teeth: when is it time to see a dentist?

Most sensitive teeth do not need an urgent appointment — but some do, and the difference is easy to learn. Use one rule above all others: count how long the pain lasts after the trigger has gone. A couple of seconds is ordinary sensitivity, and trying a desensitising toothpaste for two to four weeks first is reasonable. Thirty seconds or more, pain that arrives on its own, pain in one single tooth, or pain on biting means the nerve or the tissue around the root is involved, and that belongs in a dental chair within days. Swelling of the face or gum, fever, or trouble opening the mouth or swallowing is a same-day matter. In Germany you need no referral to see a dentist — you can book directly.

Take a sip of cold water, then count. Under about five seconds is the classic signature of exposed dentine — uncomfortable, but not urgent. Thirty seconds or more suggests the nerve inside the tooth is inflamed, and inflamed nerves do not settle down again on their own.

Sensitivity from receding gums or worn tooth necks usually affects several teeth, often symmetrically. A single tooth that hurts far more than its neighbours has a specific local reason — decay under a filling, a crack, a failing restoration — and specific reasons need looking at.

Bleeding gums, a swollen patch, a bad taste, a chip you can feel with your tongue. Sensitivity plus a second finding is a different situation from sensitivity alone.

Waiting makes sense if all of the following are true: the pain is short and sharp, it is triggered by cold, air or sweetness rather than appearing spontaneously, it affects more than one tooth, nothing is swollen or bleeding, and nothing hurts when you chew.

In that window, use a toothpaste for sensitive teeth twice a day, switch to a soft brush, stop scrubbing horizontally at the gum line, and keep acidic drinks to mealtimes. Give it the full two to four weeks — these products build their effect gradually and are routinely written off after four days. One condition is attached: it only counts as watchful waiting if you are actually watching. Four weeks with no improvement is itself the finding, and it is time to book.

Any one of these is enough on its own.

• The pain outlasts the trigger. Cold sets it off and the ache continues afterwards.
• One tooth is clearly the culprit. You can point to it without hesitation.
• Heat now hurts more than cold. That switch often marks the point where a nerve moves from irritated to inflamed.
• It hurts to bite, or a sharp jolt arrives when you release a bite on something hard — typical of a crack or of inflammation at the root tip.
• Pain wakes you at night, or is worse lying down.
• A filling feels rough, chipped or has an edge you can catch with a fingernail — see A filling has fallen out: what to do now.
• The gum beside the tooth bleeds every time you brush, or has visibly receded.
• You are taking painkillers to get through the day. They hide the signal, not the cause.

A few days really is enough of a window here. The point is not that these are emergencies; it is that all of them become harder and more expensive to treat if left for months — a tooth that could have been saved with a filling in March may need a root canal treatment (Wurzelbehandlung) by September.

• Swelling of the gum, cheek or under the jaw
• Fever together with dental pain
• Difficulty opening your mouth, swallowing or breathing — go to a hospital emergency department, not a dental practice
• Severe, constant pain that painkillers do not touch
• A tooth that has been knocked, is loose, or has broken with bleeding
• Pain spreading across a whole side of the face, ear or temple

Swelling with fever is the combination to respect: an infection that has left the tooth and entered the surrounding tissue needs treating quickly, and how quickly matters more than who does it.

Out of hours. Evenings, weekends and public holidays are covered by the dental out-of-hours service (zahnärztlicher Notdienst), organised by the regional dental association and rotating between practices. The duty practice for your area is listed online and can also be found through the nationwide patient service number 116 117. It treats what cannot wait — pain, swelling, bleeding, injury — and stabilises the situation; the definitive treatment follows at your own practice.

Knowing the sequence takes much of the tension out of it, particularly if the last dentist you saw was in another country.

We start by asking you to describe the pain: what sets it off, how long it lasts, whether it has changed. That conversation narrows the field more than any device does. Then a visual examination and usually a small X-ray, because decay between two teeth and under an old filling is invisible to the eye. We test with a controlled cold stimulus, tap gently to check the tissue around the root, and often ask you to bite on a small wedge to look for a crack.

For plain sensitivity, the appointment often ends with fluoride varnish, advice on brushing and a review in a few weeks. Where a cause is found — a leaking filling, a worn notch, decay, gum inflammation — we explain what the statutory health insurance (gesetzliche Krankenversicherung, GKV) covers and what it does not, and put it in writing before we start. Nothing is treated in the same appointment without your agreement.

This is the obstacle that keeps more people out of the dental chair than the pain itself.

You do not need a referral. You go directly to a dentist of your choice, with no need to register in advance, and you can change practice whenever you want.

Bring your health insurance card (Gesundheitskarte, eGK). For statutory patients that card is all the paperwork a routine appointment needs. With private health insurance (private Krankenversicherung, PKV) you are billed directly and claim the amount back from your insurer. If the card has not arrived because you have only just moved, bring the confirmation from your insurer.

Say the urgency out loud. Practices keep slots free for acute cases, and they go to the people who describe their symptoms clearly. “Pain lasting several minutes after cold, since Tuesday, one tooth on the lower left” gets a different appointment from “sensitive teeth”.

You can be treated in English. Half of dentistry is the description, and describing a symptom in a language you are still learning is genuinely hard. Our team works in English as well as German, Russian, Turkish, Ukrainian, Arabic, Kurdish and French — English-Speaking Dentist in NRW sets out how the system works for newcomers. Being able to say “it is sharp, then it stops” rather than pointing vaguely at your face changes what we can do for you. Our hours also make it possible to come before or after work: Monday to Friday 07:30–19:30 and Saturday 08:00–18:00, at Morianstraße 10 in Wuppertal-Elberfeld.

Pregnancy. Do not postpone a dental examination because you are pregnant. Untreated inflammation is the greater risk, and treatment is entirely possible during pregnancy — the second trimester is generally the most comfortable time for anything planned. Say that you are pregnant when you book.

Children. Children rarely describe sensitivity in adult terms. Watch for chewing on one side, avoiding cold drinks, or refusing particular foods. Newly erupted permanent teeth are often briefly sensitive as the surface matures — but a child avoiding one specific tooth should be seen.

Dental anxiety. If fear is the reason you are reading rather than booking, book the consultation without treatment. Being examined and told plainly what is going on is usually less frightening than the version your imagination has built, and it commits you to nothing. Sedation and laughing gas (Lachgas) are available where they make the difference between attending and staying away.

Sensitivity after recent dental work. Teeth are commonly sensitive for two to four weeks after a filling, a cleaning or gum treatment. Improving week by week is expected; getting worse is not, and warrants a call.