Worn Teeth

What is Tooth Wear

Tooth wear occurs for a variety of reasons and is defined as the non carious (decay) loss of tooth tissue. The process of removal is often gradual and it takes time for the effects to be noticed. Many patients complain of the effects when they start to notice symptoms or when the treatment has become very difficult.

There are four types of tooth wear: abrasion, attrition, abfraction and erosion. It is sometimes difficult to determine the type of tooth wear present because different types often occur together.

Abrasion

Abrasion is wear of teeth by a rubbing action and can have several causes such as heavy handed or inappropriate toothbrushing, habits such as holding wire or pins between the teeth. These worn areas can be prevented from worsening by using a better tooth brushing technique and / or an electric tooth brush can help.

Treatment

If they become too unsightly white filling material can be used to fill the worn areas, however, this will not make the tooth strong again, only fill the gaps. Unfortunately, the fillings do not stick so well to these worn areas and can repeatedly fall out. Again, prevention is better than the cure.

Erosion

Dental erosion is where tooth tissue dissolves away due to acid attack from diet or sometimes from within e.g. stomach acid.

What does dental erosion look like?

The first signs of dental erosion include:
• teeth become sensitive especially to cold
• teeth become shiny or lose texture
• teeth appearing to become shorter with chipping of the edges
• fillings especially amalgam may become raised up with troughs around
• the top surface of the teeth may have dished out craters in the surface

The Causes

The cause of dental erosion is acid dissolving the tooth tissue.

Many drinks including soft drinks, energy drinks, sports drinks, alcohol and fruit juices contain acids. Most of these drinks also have a high sugar content that can cause the teeth to decay.

A diet high in acidic food and drinks can cause tooth wear. The lower the pH of a product, the more acidic it is. Any food or drink with a pH lower than five may cause tooth wear and tooth sensitivity.

Treatment

The main complaint is usually sensitivity which can often be managed. If the teeth become so worn that fillings or crowns are required for improved aesthetics, treatment will be very extensive and expensive. Worn teeth can be the hardest cases to treat, prevention is better than the cure.

Attrition

Attrition is the loss of tooth structure as a result of tooth to tooth contact, such as grinding of teeth.

• The back teeth become flatter, and the front teeth become shorter.
• This type of Tooth Wear to some degree takes place in all mouths, and is part of the normal ageing process.
• A severe form of tooth grinding is called Bruxism (see below). Here tooth loss can be rapid.
• More often it takes a long time for the wear to occur.

Bruxism is the involuntary grinding and clenching of teeth.

• Most commonly it occurs during sleep although some people can grind when the are concentrating on something awake.
• Stress is probably the biggest cause of grinding in adults, however, sometimes it can be due to irregularities in the bite.
• The fabrication of splints for wear at night can help with prevention of further tooth wear and also with the symptoms.
• These can be either soft (like a gum shield) or hard, more permanent designs.

Abfraction

Abfraction can be defined as the loss of tooth structure from flexural forces – often clenching. The teeth have a tendency to flex under pressure and this causes tension on one side of the tooth and compression on the other side of the tooth thereby causing V and C shaped impressions on the sides under tension and compression respectively. This theory is controversial and is yet to be fully proven in research.

Treatment

Treatment is almost impossible, it is possible to place white fillings in the “V’s”, however, the material does not stick well and whilst you carry on clenching the likelihood is that the filling will be “flexed” out. The best preventative option is usually the provision of a night time splint.