Tooth Wear (Abrasion, Attrition, Bruxism and Erosion).
We are all living longer but sometimes our teeth appear to be wearing out faster than we are!
Do you have Tooth Wear? What is 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. Once enamel is gone you cannot get it back.
1. Dental Abrasion and Gum Recession
Tooth abrasion (before and after treatment ).
What is Dental 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 and repair.
2. Dental Attrition and Tooth Grinding (Bruxism)
Signs of dental attrition and treatment.
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 dentin
- 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.
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 Para functioning this increases significantly and teeth will wear.
- Para functioning 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 minimize 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
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!
3. Dental Erosion
Erosion is increasingly evident, affecting all ages and requires additional preventive care.
Dental Erosion (before and after treatment)
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
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 neutralize 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.
- 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.
- A diet of frequent acidic food and drinks will cause tooth wear and tooth sensitivity. The more acidic foods or drinks the worse the tooth wear. Hence orange juice is actually worse than cola.
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 esophageal 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
- Professional wine tasters
- Competitive swimmers in poorly controlled chlorinated pools
What should I do to minimize the risk of dental erosion?
- Eat foods that act as a buffer by neutralizing saliva acidity (eg. dairy products)
- 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 minimizes 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.
- Use a high fluoride toothpaste and a Professional Topical Fluoride Treatment in our office, 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.
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