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Toothwear

Do you have Tooth Wear?

Traditionally tooth decay and gum disease have been the main risks to teeth but increasingly perfect teeth are wearing down or dissolving away.

Tooth wear is the irreversible loss of tooth surface. The resulting structural loss can harm appearance, impair function and cause sensitivity. The damage can also become costly and complex to repair.

We look forward to helping – early diagnosis, monitoring and prevention is most ideal but when wear has progressed with our extensive training and experience you can be confident we can help!

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There are three main types of tooth wear: abrasion, attrition and erosion.

It is sometimes difficult to determine the type of tooth wear present because different types frequently occur together.

Samples of tooth wear presenting at Evesham Dental Health Team affecting all ages (Before and After Treatment)

10yr old boy
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40yr old lady
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65yr old gentleman
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Abrasion

  • Grooves, notches, cracking and chipping of teeth will appear
  • Frequently recession of gum tissue and notching of the tooth root
  • The pattern of the wear will match the causative factor or habit
  • Teeth may be painless or sensitive depending on the rate of wear
  • Most frequently abrasion is associated with overzealous tooth brushing and abrasive toothpastes

What causes dental abrasion?

Abrasion is the loss of tooth structure by mechanical forces from a foreign element rubbing or scraping rather than tooth to tooth contact.

When abrasion is caused by a particular habit such as biting pencils the pattern of notching or chipping will correspond to the habit. If possible it would be best to stop the habit or when this is not possible, please discuss with our team about protective measures.

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At EDHT we frequently see abrasion with certain toothpastes and toothbrushes. How abrasive is your toothpaste:

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Attrition

See also Headaches & Bite Problems

We are all living longer but sometimes our teeth appear to be wearing out faster than we are!

How will I know if I have dental attrition?

The signs of dental attrition might include:

  • Flattening of back teeth, the natural cusps wear flat
  • Shortening of front teeth with flat angular edges
  • Wear facets that match perfectly with a corresponding facet in the opposing arch of teeth
  • Yellowing of the tops of teeth as enamel wears through to underlying softer dentine
  • Increasing tooth wear especially combined with Erosion and Abrasion
  • Chipping and cracking of teeth and restorations
  • Teeth may be painless or sensitive
  • A white line may appear in the cheek or indentations on the sides of the tongue adjacent to the biting surfaces. Extra bone may form around teeth such as adjacent to lower premolars, called tori

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What causes dental attrition?

Attrition is the wearing down of teeth and/or restorations due to tooth to tooth contact. It occurs when opposing teeth contact for long periods of time and with higher pressures than normal. Squeezing the teeth together is called clenching. Grinding the teeth together is called bruxing. Since these acts are not part of normal function (chewing and swallowing) they are called parafunction.Our teeth should normally only meet together for a few minutes in every 24hrs, but if we are parafunctioning this increases significantly and teeth will wear.

Parafunctioning may occur during sleep and so many patients are totally unaware. Others notice that they clench when tense or when doing certain activities. Parafunction is often painless and as tooth wear progresses very gradually it is easily overlooked. Some patients may experience cold and touch sensitivity, like an electric shock when the neck of the tooth is touched by a finger nail. This is because the neck of the tooth flexes and cracks with excessive forces which together with erosion and abrasion can create a wedge like lesion called an abfraction cavity.

What should I do to minimise the risk of dental attrition / parafunction?

  • Sometimes the tooth wear is adaptive and will have stopped automatically. It is wise to ask the dental team to take clinical photographs and impressions for study models enabling future comparison.
  • Avoid excessive use of chewing gum
  • If you are aware of consciously clenching your teeth together, try to reduce this habit
  • Identify whether, when and why any parafunction is occurring. This could be due to tension, bite discrepancies, habits or neurological traits. The dental team will be able to guide you to an appropriate diagnosis and management. Depending on the cause the management might involve counselling, exercises, medication, splint therapy and/or protection, equilibration, restoration or orthodontic /orthognathic surgery.
  • Because all tooth wear is likely to be multifactorial also follow preventive action for erosion and abrasion

Erosion

Erosion is increasingly evident, affecting all ages and requires additional preventive care

The signs of dental erosion may include:

  • teeth appearing yellow (due to darker dentine showing through thinning outer enamel)
  • teeth appearing glazed and smooth (due to the tooth surface being worn away)
  • front teeth edges becoming square, transparent and chipping, eventually becoming shorter
  • fillings sitting higher than the surrounding tooth surface
  • chewing surfaces of back teeth showing smooth, concave craters
  • teeth becoming sensitive to hot, cold or sweet food and drinks

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What causes dental erosion?

The cause of dental erosion is acid attack. Sources of acid in the mouth are dietary, gastric or occupational.

Every time acid touches the surface of your teeth the enamel becomes softer and loses some of its mineral content. Your saliva will slowly neutralise the acid in your mouth and restore it to its natural balance. However, if the acid attack happens too frequently, the teeth do not have a chance to repair themselves and tiny particles of enamel can be washed or worn away. Minerals dissolve from the tooth surface and like a cliff face with a tide moving in and out, eventually collapses lost forever.

Dietary foods and drinks containing acid are the most common causes of erosion. Examples include fruit, pickles, fizzy drinks, energy and sports drinks, wine, squashes and fruit juices. Many of these foods and drinks also contain natural or added sugar which can in addition cause tooth decay.

A diet of frequent acidic food and drinks will cause tooth wear. The type of acid, calcium chelating properties, temperature and exposure time are factors that determine the amount of erosion that occurs.The lower the pH of a product, the more acidic it is but products such as citrus fruits appear worse as they bind (chelate) more calcium from the tooth. Hence orange juice is actually worse than cola.

Any food or drink with a pH lower than 5 may cause tooth wear and tooth sensitivity.

The pH of some common foods and drinks are indicated below:

  • Milk pH 6.9
  • Flavoured milk pH 6.7
  • Tap water pH 6.0
  • Cheddar cheese pH 5.9
  • Coffee pH 5.0
  • Beer pH 4.5
  • Orange juice pH 3.5
  • Apple juice pH 3.4
  • Grapefruit pH 3.3
  • Pickles pH 3.2
  • Sports energy drinks pH 3.0
  • Common soft drink pH 2.7
  • Cola pH 2.5
  • Red wine pH 2.5
  • Lemon juice pH 2.2
  • Vinegar pH 2.0

Other factors that contribute to erosive tooth wear include:

  • a dry mouth, which increases the risk of damage from acid attack
  • frothing or swishing acidic drinks around the mouth increases the risk of acid erosion
  • erosion often coexists with dental abrasion. Abrasion is most often caused by brushing teeth too hard and exacerbates erosion if the tooth surface is already softened by acid.
  • grinding of the teeth can worsen erosion.

Which gastric conditions contribute to erosion?

  • Vomiting (eg morning sickness, bulimia and excessive alcohol)
  • Acid reflux (eg gastro oesophageal reflux disease, hiatus hernia, heartburn)
  • A number of medications such as vitamin C, aspirin and some iron preparations are also acidic and may contribute towards acid erosion

Which occupations might risk erosion?

  • Industrial processes risk exposure to acids but hopefully adequately protected nowadays
  • Professional wine tasters (if only I was so lucky)
  • Competitive swimmers in poorly controlled chlorinated pools (again less likely nowadays)

What should I do to minimise the risk of dental erosion?

  • Eat a well balanced diet, and reduce the amount of acidic and sugary foods and drinks. Try to limit snacking so that acidic foods and drinks are at mealtimes only.
  • Eat foods that act as a buffer by neutralising saliva pH more quickly (eg. dairy products contain a protein called casein which protects teeth from acid).
  • Avoid holding or ‘swishing’ acidic drinks around the mouth as this increases the likelihood of tooth decay and tooth wear. Use a straw whenever possible as this minimises exposure of the drink to your teeth.
  • Do not brush immediately after eating or drinking acidic drinks as tooth enamel will be softened at this time. Leave at least an hour before brushing eg after wine in the evening and brush before breakfast fruit juices.
  • Apply a remineralising paste eg GI Tooth Mouse or GI MI Paste after meals and before bed. Apply with a finger and leave this on the teeth without rinsing.
  • Use a high fluoride toothpaste eg Duraphat to make your enamel more resistant to erosion
  • Drink plenty of water frequently throughout the day, especially if exercising and avoid caffeinated beverages, as caffeine causes dehydration.
  • Have treatment for any underlying medical condition. Perhaps use a neutralizing agent such as antacid tablets

Remember

Maintaining your body’s fluid levels by drinking water frequently is the best way to prevent a dry mouth, quench thirst and protect teeth from dental erosion.

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