Tooth wear

By Dr Rosalind Ho BDS S’PORE , MFGDP (UK)

Our teeth do not last forever. However, with today’s awareness, the longevity of teeth may be prolonged if patient are aware of teeth being worn down with age, habits and lifestyle.

One of the most common lesions in the mouth is tooth wear. This is a situation where the teeth are worn down and usually detected during a dental check-up. Patients may or may not be aware of them. Sometimes pain or sensitivity lead them to seek the dentist’ s consultation.

What are the types of toothwear?

Attrition-This is caused by tooth to tooth contact resulting in loss of dental tissue starting with the incisal or occlusal surfaces of the teeth. It is physiological and usually seen as part of aging. It is accelerated by

·       night grinding which is a nocturnal habit (patient may not be aware)

·       constantly chewing hard food

·       poor alignment of teeth resulting in some teeth bearing more force of mastication

·       loss of back or posterior teeth resulting in uneven distribution of biting load

Abrasion– Progressive loss of hard tooth substance usually the enamel and cementum as well caused by interactions with mechanical objects for example pens and toothbrushes etc other than tooth to tooth contact. It can also occur between teeth or proximal surfaces. Common causes;

·       Wrong tooth brushing technique as in wrong direction

·       vigorous brushing

·       Excessive and vigorous use of interdental picks between teeth

·       Abrasive toothpaste used

·       Use of mechanical objects such as biting hairgrips, nail biters, pipe smokers (in which case the presentation is a notch

The choice of the appropriate toothbrush and correct brushing are important. Gentle interdental cleaning and flossing also advised.

***Abrasion cavities may be filled with strong composite resin materials that are tooth colored.

Interproximal cavities are more challenging to fill.

Abfraction– Term is used to describe abrasion that occurs at the necks of the teeth (cervical areas) near the gums and is typically ‘V’ shaped compared to the flat surfaces of attrition. It is caused by occlusal stress resulting in teeth ‘flexing’ at the necks.

. Present as wedge shaped lesions with sharp angles

. Related to biting, chewing, clenching and night grinding.

 .    Often diagnosed as abrasions

Night grinders and those who clenches their teeth should have a night guard fitted to reduce further wear and it may also prevent fracture of teeth and restorations.

Erosion- The loss of tooth substances not due to bacteria but chemical process. Acids are commonly involved in the dissolution of tooth substances.

·       Often affecting the inner surfaces of the teeth ( incisal and palatal)

·       Seen as a scooped out depression with smooth polished surfaces

·       In severe cases, the erosion reaches the dentine resulting in sensitivity to thermal changes

Extrinsic causes

·       Habitual consumption of highly acidic low PH carbonated drinks, sports drinks and concentrated fruit juices

·        Acidic foods such as pickles, vinegar

Intrinsic causes

·       Involves hydrochloric acids from the stomach

·       Regurgitation

·       Reflux

·       Vomitting

Implications of toothwear

·       Overtime, teeth may be badly worn down to the extent that they become sensitive.

·       In severe cases, the teeth may ache and this may become irreversible due to pulp damage.

·       Teeth fracture have been known to occur if the worn tooth becomes weak.

·       Caries can set in these cavities

·       Likelihood of root canal treatment if pain is irreversible. Crown will be required.

·       Esthetically unpleasing

·       Cost considerations

Treatment of tooth tissue loss

1.       Identify causes eg diets, habits, brushing techniques

2.       Relieve sensitivity for mild cases eg fluoride, desensitizing toothpastes, varnishes etc

3.       Protect remaining substances by bonding (tooth colored fillings), adjust occlusion carefully, crowns for severe cases where there is a possibility of fracture

4.       Spints and night guard to reduce further wear

5.       Patient education to remove causative factors

6.       Monitoring of case

Teeth needs maintenance and prevention to prevent unnecessary wear and discomfort. It will also prevent expensive rehabilitation. A regular check up is of paramount importance.