What is tooth-wear?

Tooth wear occurs naturally with the onslaught of every day life. Repeated chewing, eating, drinking and brushing affect the teeth slowly over many years. More correctly, this should be called ‘ tooth- ageing’ and ‘tooth wear’ should be used to describe an abnormal acceleration of this process. It is sometimes also called “tooth surface loss” and there are three main mechanisms by which this can occur:

• Erosion (acid)
• Abrasion
• Attrition (or bruxism/grinding)

These can occur alone, or in combination and since they represent irreversible damage to your teeth, the key (like so many other dental issues) is prevention.

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What are the problems with tooth wear?

Tooth wear is often very simple to treat- if it’s spotted early- but it can become very complex further down the track. Significant changes to your teeth and mouth may have taken place over the years.

The main problems we see from tooth wear include:

Short teeth- not often noticeable till later on- small incremental losses from grinding can add up until one day you wake up and notice… “Hey, why are my teeth so short?”

Short teeth can lead to:

Facial changes– the teeth and jaws support the skin that overlies it, so shorter teeth not only affects your smile but also your youthful appearance. Younger people tend to show more teeth when smiling and show more teeth below their lip at rest. If enough tooth height is lost, additional wrinkles start to form and the corners of your mouth will turn down, leading to a stronger marionette line. These are all issues that contribute to you looking older than your years.

Yellowing of teeth– enamel is nice and white, or at least ‘light-In-colour’ for the most part, but the second layer of teeth is dentine, which is very yellow in colour. Erosion, attrition and abrasion can cause thinning of the enamel; this leads to, either the unsightly exposure of the yellow dentine underneath or, of the root surface. Aesthetically, this is an issue at the front of the mouth, and whilst less noticeable at the back, exposure of dentine or root surface often leads to:

Sensitivity– to cold, hot, sweet, even chewing, since the dentine is connected to the nerve unlike enamel which does not contain nerve endings. Sensitivity, even the slightest temperature change, can range from something quite mild to severe discomfort.

Aesthetic changes– all forms of tooth wear can affect the health and vitality of your smile.

Premature Ageing– a condition we all want to avoid.

Worn and damaged teeth– people who grind are much more likely to chip and fracture teeth, and damage existing fillings and restorations.

Plaque and food traps– toothbrush abrasion can be mild or severe; in the latter case it may make cleaning more difficult and cause food and plaque to collect around the gum margins

What is erosion?

When you expose your teeth to strong chemicals (usually acids) frequently over a period of time the enamel will begin to dissolve. Bacteria are not involved, as in dental decay or gum disease, it is chemical attack and dissolution of your teeth that is the result. Erosion or acid erosion as it is commonly known, is becoming an increasing problematic and can be incredibly damaging.

These chemicals can come from different sources:

1. Your diet (by far the most common)
2. Your stomach (as in vomiting and reflux) – common in patients with GORD, hiatus hernia, alcoholism and eating disorders such as bulimia.
3. Your environment

What is dietary erosion/ acid erosion?

Acidic foods and drinks are those with a low pH. Consuming these products too often will soon start to take its toll on your teeth. Examples include:

• Carbonated drinks- (contain carbonic acid)
• Citrus fruits- (contain citric acid) such as lemons, oranges etc.
• Other fruits and fruit juices
• Vinegars and pickles- (contain acetic acid)

Sodas, pops, fruit juices, fizzy drinks, and diet versions of cola, lemonade etc. are all erosive and so the amount that you drink should be kept to a minimum, or at least consumed in moderation. Sports drinks and iced teas are also erosive and often packed with sugar.

Identifying the early signs of acid erosion or acid wear is crucial so that changes can be made to prevent its progression. Leave it too long and not only does the rate of damage increase exponentially, but the complexity and cost of fixing it does too.

By reading this article, you are making yourself aware of the risks and you can take a few steps to minimise intake and thus the damaging effects. Next, get yourself checked by a quality dentist such as Dr Jamie to see if you are susceptible to erosion and to check what damage has already occurred. Dr Jamie will take photos inside your mouth and explain the areas you need to take care of, what, if anything, has been affected by erosion, and the treatment options available (should you need them).

As with sugar, consuming these liquids through a straw can (to some degree), protect the teeth. Also keeping these drinks away from bedtime- when your saliva flow (your natural protection) slows- will also help to minimize damage. If you have a lack of saliva also known as ‘dry mouth’ or your saliva has less buffering capacity then, as with all dental problems, you will be more susceptible and the effects more pronounced.

In the same way that sugar near bedtime does the most damage in terms of decay, so does acid, in terms of erosion…so stay away from acidic food and drinks just before you go to sleep- it is really important!

Children with ‘sippy’ cups or feeding cups that contain juice can mean the liquid contact time with their teeth is considerable and therefore significant damage can occur.

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What are the signs of acid erosion or acid wear?

Acid wear is the early stage- before acid erosion- it makes teeth appear smoother and more shiny. As the erosion progresses, more yellow dentine shines though, creating yellower teeth.

This largely affects the top surfaces of your molar or back teeth in the bottom jaw. This is because fillings don’t wear with acid. This can lead to fillings becoming proud or little dips or divots appear in the tooth; this is where the dentine has worn more quickly. It can also affect the fronts of your teeth especially if drinks are consumed in bottles rather than cups since this changes the pattern of flow of the beverage across your teeth.

Wear on the backs of the front teeth tends to suggest some form of regurgitation erosion rather than dietary erosion. Repeated exposure to acid from the stomach, largely hydrochloric acid will erode the teeth in this area in a classic pattern.

If you frequently drink and eat acidic food then you are at risk of dietary erosion and steps should be taken to prevent acid wear.

How does the dentist diagnose acid wear?

Dr Jamie will look for the characteristic appearances described above. He will be looking for the different presentations from the different types of tooth wear: erosion, attrition and abrasion.

He will also consider your diet and lifestyle in order to establish the cause. Questions relating to diet, alcohol, sickness, stomach issues, clenching, grinding etc will need answers. He’ll talk you through the various ways to prevent further progression of the problem, and if it’s required the treatment options needed to restore your teeth.

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What is toothbrush abrasion?

Toothbrush abrasion comes from using our trusted friend- the toothbrush- in a way that causes damage beyond the simple ‘plaque removal and fluoride massaging tool’ it was designed to be. Used incorrectly, this innocuous object can be the source of a number of damaging consequences.

Toothbrush abrasion comes from brushing:

• Too long
• Too hard
• With too much pressure
• With the wrong technique- most often this is due to a long fast horizontal scrubbing motion
• With an inappropriate toothbrush
• With a combination of all of the above (most common!)

Toothbrush abrasion is something I see every single day and it’s becoming more and more of a problem. Most people have the idea that when it comes to cleaning- the more and the harder the better- this is simply not true!! A bathroom sink…maybe… but not your mouth. Your gums and teeth are very susceptible to wear, so what’s the desired outcome for tooth brushing? It’s to remove any plaque that is present (in combination with brushing or interdental cleaning) and that’s it!

As with other types of wear, these actions are irreversible; your gum and tooth structure will not grow back.

Given that you usually brush twice a day, how easy it should it be to prevent this problem and brush correctly? Truly you should just learn to do it right now!

Practice your technique consciously for a few weeks until it becomes a habit and then you should never need to think or worry about it again. The trouble is, though, we’re time poor and find it too easy to go into autopilot- over time this state of affairs compounds and damages our precious teeth and gums.

Not only is toothbrush abrasion unattractive – you may have heard the unfortunate term: ‘long in the tooth’, but it also exposes the yellow root surface and creates varying degrees of sensitivity from mild to extreme.

What should I do to prevent toothbrush abrasion?

Here are Dr Jamie’s top tips:

1. Brush only twice a day- morning and night
2. Brush for about 2 minutes- not more, not less
3. Work in a system around your mouth
4. If using an electric toothbrush spend 1-2 seconds on each tooth- no need to actually brush- let the electric brush do all the work. Spending longer than this can create tooth wear.
5. If using a manual toothbrush, use small circles and mini vibrations then flicking away from the gum.
6. Use a soft or medium soft toothbrush
7. Do not scrub
8. Remember hard doesn’t equal clean.
9. Watch yourself brush in the mirror- do not walk around brushing- it will slow you down. Look in the mirror; it will make you think about your actions.
10. Work systematically around the mouth
11. Get a dental check up every 6 months- we can take photos to monitor wear and remind you if you are slipping into bad habits and causing damage.

What does toothbrush abrasion look like?

Toothbrush abrasion is pretty easy to spot. In a healthy situation the gum covers the entire root, the moment the gum begins to recede then toothbrush abrasion can be suspected.

A dentist check up is needed to rule out gum disease as a possible cause. If toothbrush erosion is the cause, then eventually more of the root surface will become exposed. Remember, the enamel is very wear resistant, but the root surface is basically dentine and therefore much softer: it will begin to notch over time and give a scooped out appearance at the base where the tooth and gum meet.

Unlike gum recession, which is associated with gum disease, the gums themselves tend to be very healthy- that is firm and pink, no redness, bleeding, swelling or other signs of gingivitis. Also, since it is the most prominent part of the tooth which takes the brunt of the force, the gum in-between is not affected. The teeth most commonly affected are the premolars and first molars, followed by the canines.

Is the tooth wear ‘active’ or ‘inactive’?

This is a really important question and one of the reasons why it is good to stick with the same dentist; they are able to monitor your condition and advise if things are progressing. Changing dentists often leads to having more ‘dental’ work carried out, together with the ensuing costs. Photographs can help keep an eye on things and demonstrate if the problem is worsening.

Tooth wear treatment

Advice and prevention is critical at every stage, and for that you need to see a dentist. Caught early, this may be all that ‘s necessary. Since tooth wear is actually a very slow process. However, left to its own devices and without making the appropriate positive changes, it will progress and treatment will become more extensive and expensive.

If the teeth have an unattractive appearance from toothbrush abrasion, then tooth coloured bondings may be placed to improve the appearance, or gum surgery can be undertaken to bring the gum back down thus covering the tooth. This may also be needed for sensitivity reasons or because the wear is considerable and progressing.

Other options for sensitivity include dentist fluoride applications or desensitising procedures. A first line defence may simply be sensitive toothpastes such as Sensodyne or Colgate Sensitive Pro-relief. Some dentist-only products such as tooth mousse may also be needed. In certain circumstances where the sensitivity is extreme (irreversible pulpitis has been diagnosed), root canal treatment may be needed.

If tooth wear has affected the fronts of your teeth, composite or porcelain veneers may be needed to improve the appearance. If tooth wear has affected the molar teeth and the height of your teeth and your smile has been compromised, it may be necessary to have a full mouth approach to rehabilitation involving crowns, onlays or other more long-term restorations.

If you are grinding or have a bruxing habit, then an occlusal splint or night splint will be needed to protect your teeth.

Summary box:

TreatmentsComposite fillings | Crowns | Veneers | Desensitising procedures | Prevention | Grind guard
CostSee treatment page for details

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