Tooth Wear of Permanent Teeth

1. What is Tooth Wear?

• Tooth Wear is the loss of tooth surface, which is not caused by decay or by an injury.
  Abnormal Tooth Wear can affect the enamel, dentine and the nerves and blood vessels of the tooth.
• There are three categories of Tooth Wear:

• Attrition
• Abrasion
• Erosion

‍

Attrition:

 2. How teeth can be worn down by other teeth.

• 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.
• This type of Tooth Wear takes place in all mouths, and is part of the normal ageing process.
• 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.

3. 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 the abnormal positioning of jaws and of teeth (malocclusion).
• The effects of bruxism can be remedied and made more comfortable, by the use of a nightguard.
• It is made of a soft plastic material and worn when you are asleep.
• An acrylic bite plate will also have a similar effect.

4. What is the treatment for severe attrition?

• The damage to teeth caused by attrition is best repaired with replacement crowns or onlays.

• They restore the size of the shortened and flattened teeth.
• The bite and chewing relationship (occlusion) between the upper and lower teeth will be restored.
• Any sensitivity to hot and cold is eliminated by covering the previously exposed dentine.
• The aesthetics of the teeth, mouth and face can be improved dramatically.

‍

Abrasion:

5. How teeth can be worn away by brushing.

• 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.

6. How is abrasion repaired?

• Toothbrush abrasion can be repaired by bonding a tooth colored filling over the abraded area of the tooth.

‍

Erosion:

7. What is tooth erosion?

• Erosion is the wearing away of tooth surface by an acid, which dissolves the enamel and the dentine.

• Erosion is a common cause of Tooth Wear and is usually preventable.
• The two sources of acid in the mouth are dietary and gastric.

8. How can acid in food and drink affect teeth?

• Foods which have a high acid content, can cause the enamel and dentine to be eroded. The acid dissolves the calcium in the tooth. Foods with a high acid content are:

• All soft drinks. That includes the carbonated, diet and sports varieties, as well as sparkling mineral water.
• Soft drinks are a major cause of tooth erosion. The degree of erosion is directly related to the frequency and amount of soft drinks consumed.
• Citrus fruits: oranges, lemons and grapefruit.
• Fruit juices.
• Pickles and vinegar.
• Yoghurt.

9. 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 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.
• The erosion is seen as a light yellow patch on the tooth. This indicates that the enamel has been dissolved and the sensitive dentine under the enamel has been exposed.
• This exposure of the dentine, will result in pain from sweet, hot and cold food and drinks.
• If the erosion penetrates deeper and reaches the nerves and blood vessels, the pain can become severe.

10. Which conditions will cause acidic Tooth Wear?

• This very damaging type of Tooth Wear is caused by the regurgitation or vomiting of acidic stomach contents. It is evident in the following conditions:

• Acid Reflux or heartburn.
• Anorexia and Bulimia.
• Hiatus Hernia.
• The excessive consumption of alcohol.
• Morning sickness in early pregnancy.
• Chronic indigestion.
• Over eating.

11. How can tooth erosion be prevented?

• Dietary factors and good oral hygiene

• Try to reduce the excessive consumption of acidic foods and drinks to more moderate levels.
• The frequency of intake should also be cut down.
• Include these foods and drinks as part of the regular meals. This will dilute the acidity of the food in the mouth.
• It will also limit the time for the damaging acid to remain in contact with the teeth.
• Oranges and lemons must not be sucked.
• Sugarless chewing gum is recommended to neutralize the acid by increasing the salivary flow.
• Toothbrushing after meals with a fluoride toothpaste should become a regular daily habit.

• Gastric Factors

• Gastric causes of acidic erosion are mainly features of psychological and general health problems.
• The dentist has a part to play in their early diagnosis, and the subsequent repair of the damage to the teeth.

12. How is erosive Tooth Wear repaired?

• The loss of the enamel and the resulting sensitivity of the exposed dentine, can be attended to in the following ways:

• Small areas of erosion can be desensitized by your dentist.
• Larger areas of exposed dentine can be repaired by bonding a tooth colored filling material to the tooth.
• A replacement crown can be fitted over the entire tooth, where the erosion has led to a large breakdown of tooth structure.
• A root canal treatment will be necessary before the fitting of a replacement crown, if the nerves and blood vessels have been affected.