Decay is not the only cause of tooth destruction. Increasingly dentists are spending time restoring teeth that have lost their enamel due to erosion (damage from acid), attrition (tooth against tooth, nail biting, etc) and abrasion (e.g. vigorous tooth brushing). The increase in our average life span and the fact more teeth are being retained for longer means teeth are being exposed to these effects more than ever before.
Acid erosion has been largely linked to the high consumption of soft drinks, both fruit juices and carbonated drinks. However, erosion is also seen in patients with symptoms of gastric reflux (heartburn) and in patients with eating disorders such as anorexia and bulimia. This is due to the highly acidic stomach contents coming into contact with the enamel of the teeth.
Nocturnal tooth grinding is very common and might be exacerbated by stress and anxiety. It is the tooth to tooth contact that leads to the loss of tooth tissue. It can also lead to tooth mobility, tooth fracture and jaw joint pain.
Often it is a combination of factors which leads to severe tooth wear. When we discover tooth wear in a patient’s mouth we will always try to ascertain the exact cause of the loss of the enamel. It is very important to find the cause, so as to try to eliminate it or reduce its effect. This should be done before treatment is begun so that we can get the best long term result with the restorations that are placed. If the cause is acid erosion, we will look at your diet and advise the reduction, or sometimes the complete elimination of, carbonated drinks, fruit juices or other acid foods (pickles etc). We may question you about digestive problems and eating patterns (eating a heavy meal shortly before bedtime increases the likelihood of stomach contents being regurgitated into the mouth while asleep – you will not even be aware you have done this!) We will look for evidence in the pattern of your tooth wear that would suggest you are grinding your teeth. People are often unaware they are doing this, although sometimes partners have told them that they are kept awake with the noise of their gnashing teeth!!
Tooth brush abrasion tends to be noted at the neck of the teeth and is caused by using too hard a brush with too vigorous a scrubbing action, possibly in the presence of acid. Proper tooth brushing instruction from our hygienist, along with an awareness of any sources of acid can eliminate this problem. Any small cavities created can usually be restored with tooth-coloured restorations.
Minor erosion or attrition can usually also be restored with small tooth-coloured restorations. However, when the wear is significantly worse we might build up teeth with large tooth-coloured fillings which reconstruct the tooth shape. Significant erosion may require teeth to be crowned.
So, the 21st century dentist has a lot at his/her disposal to restore tooth wear. But ideally we would rather prevent you needing our help.
To Reduce Tooth Wear
Watch your intake of carbonated drinks/fruit juices. Have them with a meal, this reduces the acid affect. Don’t sip drinks over a prolonged period as this increases exposure time of the enamel to the acid.
Drink with a straw, as this can bypasses the teeth, and don’t swish these drinks around your mouth.
Don’t ignore heartburn. Get your doctor’s advice if persistent. Medication may be required.
Don’t brush your teeth for at least 60 minutes after an acidic drink. Let your saliva do it’s natural job and neutralise the acid first. Otherwise, you will just scrub the acid into your teeth and exacerbate the acid attack.
Eating cheese or milk products after acidic foods helps counteract their effects. Chewing gum will stimulate saliva flow and neutralise acid also.
We may recommend you wear a splint at night if we suspect you are grinding. Wearing this may prevent the need for extensive restorative dental work.
Using an electric toothbrush may be less abrasive than a manual tooth brush.
Visit your dentist regularly – especially if you have been warned of early signs of tooth wear.