What is Tooth Wear?
Tooth Wear is the loss of tooth surface, which is not caused by decay or by an injury. Tooth wear can typically categorize as pathologic or physiologic. As people age there is a certain amount of wear and tear that occurs and is considered normal. Pathologic tooth wear is wear that occurs beyond the scope of what is considered typical. This can have impacts on a person’s function and chewing ability, esthetic concerns, and can become painful if tooth wear exposes the nerve.
There are three categories of Tooth Wear:
Attrition occurs when tooth wear results from other teeth, including the destruction of tooth structure due to clenching/grinding and bruxism.
Attrition is the mechanical wearing down of the biting and chewing surfaces of teeth.
The tooth to tooth contact during chewing grinds down the surfaces.
The back teeth become flatter, and the front teeth become shorter.
Severe attrition of the front teeth will have a disfiguring effect on the face. It may infrequently cause sensitivity to sweet, hot and cold food and drinks.
What is Bruxism?
Bruxism is the involuntary grinding and clenching of teeth. It can take place during waking hours, but occurs more commonly while people are asleep.
The causes of Bruxism are considered to be stress, anxiety and was thought by some to be caused by the abnormal positioning of jaws and of teeth (malocclusion). We now know that some people have a neurologic component to the causes, therefore that management becomes important because we know we can’t stop bruxism in some people.
The effects of bruxism can be remedied and made more comfortable by the use of a nightguard if tooth wear is caught early but often requires restorations if the tooth wear becomes more significant.
Abrasion is the wearing away of tooth surface caused by friction. This happens when teeth are brushed too vigorously in sweeping horizontal strokes.
The use of a hard toothbrush can also cause the problem.
It is often evident on the outer surfaces of the back teeth.
A wedge or V shaped indentation of the tooth will be seen at the gum margin.
What is tooth erosion?
Erosion is the wearing away of tooth surface by an acid, which dissolves the enamel and the dentin. Erosion is a common cause of Tooth Wear and is usually preventable.
The two sources of acid in the mouth are dietary and gastric
Foods which have a high acid content can cause the enamel and dentine to be eroded. The acid dissolves the calcium in the tooth. Drinks with a high acid content are: All soft drinks. That includes the carbonated, diet and sports varieties, as well as sparkling mineral water. Citrus can also have a damging effect such as “lemon suckers”.
How does acid from the stomach damage the teeth?
The acid produced in the stomach during the digestive process is sufficiently powerful to dissolve any food, including bone and teeth. When the contents of the stomach are regurgitated the acid comes into contact with the teeth.
Any condition, such as bulimia, that causes repetitive regurgitation or vomiting will result in the erosion of teeth.
The dentist if often the first to notice the problem. The back surfaces of the front teeth are the first to be affected.
In cases of gastric reflux or chronic regurgitation, bulimia, if severe enough a condition known as Barrett’s esophageal cancer and pre cancer can result. About 10% of those affected by GERD can develop symptoms of this and 1% can eventually develop the cancerous form.
How is tooth wear repaired?
Once tooth wear has resulted in the outer enamel to wear away, the softer inside part of the tooth, dentin, begins to wear away at a faster rate. Dentin is about 6 times softer than enamel so the rate of wear typically speeds up in amount and rate over time.
The loss of the enamel and the resulting sensitivity of the exposed dentin can be attended to in the following ways:
Small areas of erosion can be desensitised by your dentist.
Larger areas of exposed dentine can be repaired by bonding a tooth colored filling material to the tooth or a replacement crown can be fitted over the entire tooth, where the erosion has led to a large breakdown of tooth structure, thus reconstructing the lost tooth structure. Often times crown lengthening procedures are necessary in addition to crowns because as the tooth is worn away, it continues to erupt, pulling the gums and bone with it. If not corrected, inadequate tooth remains to restore correctly and esthetics are compromised.
Orange Park general dentist and Prosthodontist, Matthew Nawrocki DMD, MS is dedicated not only to the treatment of the residents of Orange Park and surrounding communities but also to the oral health education of everyone within reach. We encourage you to visit our past blog posts for more information or contact us any time for a consultation!