What is tooth wear?
Tooth wear is very common and certainly can be a complicated situation to diagnose and treat. It has a variety of causes which can be happening all at once in some individuals. Basically tooth wear is the loss of natural tooth structure and is classified into attrition, abrasion, erosion and abfraction. Some wear in an older person is to be expected. It becomes more concerning as a younger person, as it means that by the time you are old, there may not be much tooth structure left. Tooth wear may be rapid or happen so slowly over time that you may not notice it until your teeth are shorter or a new dentist comments on it! Tooth wear is something your dentist will try to identify early, find the cause of and implement prevention strategies to save your tooth structure. Unlike bones, we can’t regenerate new tooth enamel – once it is gone, it is gone. A telltale sign is often tooth sensitivity.
If your tooth wear is moderate to severe, then we may recommend restorative solutions to replace some of the missing tooth structure such as fillings, or crowns as well as the preventative strategies to stop it continuing. Active tooth wear is often accompanied by general tooth sensitivity. If your teeth are suddenly becoming sensitive in general, you should ask your dentist for advice. If this topic has interested you, we will now discuss the various types of tooth wear.
Attrition
Attrition is caused by tooth grinding, clenching and repeated chewing of hard fibrous foods and sometimes a habit of chewing gum for hours at a time. Mild attrition is a normal part of the ageing process, but it can be much worse. You may notice shorter teeth, flattening off of your tooth cusps, fillings that seem to break all the time, crowns that even chip, tooth chipping or cracking, and sensitivity. You may also have thickened reinforcing bone develop slowly around your gums and tooth roots, and/or suffer with a sore jaw joint and surrounding muscles. You may have had one or more root canal treatments because of cracking in your teeth. If you need extractions sometimes your teeth may also be really hard to remove because of all that extra reinforcing bone. You may also have the facial characteristic of quite a wide, square jaw line with large cheek muscles (called masseters). Like when you go to the gym, if muscles are exercised all the time, they get bigger! Treatment for attrition often starts with alerting you to habits you may not know you have and being more mindful of grinding, to protection from grinding such as a night guard or splint (see link). In severe cases, people can obtain relief by regular injection of Botox to relax/weaken the large jaw muscles and prevent being able to bite so hard. We have trusted local experts in Botox we could refer you to if this was something that interested you.
Abrasion
Abrasion is tooth wear caused by the rubbing of something external on your teeth, most commonly your toothbrush. Isn’t it terrible to get punished for brushing your teeth too much? Some people press really hard when they are brushing and wear grooves along the sides of the teeth, usually at the gumline on the outside surfaces and it may be on one or both sides. They usually are the sort of people who love a hard bristled toothbrush, wear out their toothbrushes quickly and they often say their teeth don’t feel clean unless they have really scrubbed them. They may experience sensitivity whilst brushing, with cold or sweet foods, and even if cold air from a cold wind blows into their mouth. If someone has tooth brush abrasion and it is mild and caught early, advising them to change their brush and habit (for example teaching them about electric toothbrushes with a different technique) and suggesting they use a sensitive toothpaste can be enough to improve symptoms. If it is more severe your dentist might advise some conservative tooth coloured fillings to protect the sides of your teeth in combination with changing your habits. Where abrasion can get even worse, is if you also are experiencing erosion.
Erosion
Erosion is tooth wear caused by acid dissolving tooth structure. This acid can be from your stomach if you have reflux, experience heartburn, suffer with severe morning sickness or have an eating disorder such as bulimia. Many people who have reflux are unaware of it and it is called Silent Reflux. Sometimes the first person to alert you to it, could actually be your dentist. The other origin for acid in your mouth is the foods and drinks we consume. There is a long list of foods and beverages that have a pH low enough to cause erosion but these are some of the more common ones we hear about: soft drinks or energy drinks (including diet or sugar free drinks), lemon water, apple cider vinegar, citrus fruits, chewable vitamin C tablets, wine, soda water with or without lime and vinegars. Generally the problem foods or drinks will be something we have nearly every day or even multiple times a day. As a dentist we look for loss of the gloss of the enamel, yellowing of the teeth and dishing or scooping out of enamel, often on the cusp tips of the molars. It has a very characteristic appearance and the location of the lesions can be a clue as to the cause. A classic damaging combination might be to have lemon water every morning and then go and brush your teeth quite hard with a manual brush, causing sensitive worn away areas at the gum line along the sides of your teeth. Your dentist may suggest changing your habits eg ceasing drinking the acidic beverage is ideal, swallowing Vitamin C tablets whole, drinking through a straw and rinsing thoroughly with water after having reflux or drinking something acidic and waiting for at least 30minutes before brushing.
Abfraction
Abfraction is a little more complex to understand but it is thought that people who grind their teeth can cause major flexing of the whole tooth resulting in microfractures of enamel at the gumline of the teeth. These can look a lot like tooth brush abrasion, so diagnosis can be difficult.