Tooth Wear

(Tooth Surface Loss)

In this section, we will cover:

What is tooth wear?
How is it caused?
How can I prevent it?
How is it diagnosed?
How is it treated?

What is it?

Tooth wear is a condition in which there is loss of tooth tissue not caused by decay or trauma. A small degree of tooth wear is physiological (normal and occurs with age). If a greater than normal amount of tooth tissue is lost, this is known as pathological tooth wear.

There are three main types of tooth wear:

Erosion; this is where tooth tissue is dissolved by chemicals such as acid. It is not caused by bacteria
Attrition; this is mechanical wear caused by tooth-to-tooth contact on the biting surfaces of the teeth
Abrasion; this is physical wear of the teeth due to materials other than the tooth

Another type of tooth wear is "abfraction". This is loss of tooth tissue towards the gumline caused by flexure (bending) of the tooth. It is not universally accepted as a true form of tooth wear so I won't go into any more detail about it here.

How is it caused?

Tooth wear will often present as a combination of one or more of the types described above. Each type of tooth wear is caused in different ways.

Erosion

Erosion is caused by intrinsic or extrinsic acids.

Intrinsic acids are from within the body:

Gastric reflux
Repeated vomiting
- may be due to pregnancy, bulimia, alcoholism
Teeth affected: upper front teeth, surfaces closest to the roof of the mouth

Extrinsic acids are from outside the body:

Citrus fruits
Fizzy drinks
Fruit juice
Vinegar
Teeth affected: tooth surfaces you can see when you smile and biting surfaces of lower back teeth

As the erosion progresses, you may see chipping of the front teeth and "cupping" of the back teeth. "Cupping" is where the dentine wears away faster than the enamel around it so you see dished out lesions on the back teeth.

Attrition

Attrition is caused by grinding forces between the teeth.

Bruxism (grinding and clenching the teeth)
- when sleeping
- when stressed or angry
- when concentrating
"Clicking" the teeth together when listening to music

If these habits continue over years, your front teeth will start to look shorter and jagged, and the biting surfaces of your back teeth will become flatter.

Abrasion

Abrasion is caused by foreign materials rubbing against the tooth.

improper toothbrushing
- too much force
- using a hard-bristled brush
abrasive toothpastes
biting your nails/pens

More recently, charcoal toothpastes have become popularised. There is concern that these toothpastes are too abrasive for the teeth. If used regularly, they may wear the enamel away.

How can I prevent it?

Ways you can prevent tooth wear or stop it from progressing are:

Reduce acidic foods and drinks in your diet
- Have it with your meals instead of as a snack
- Drink through a straw placed at the back of the mouth to limit contact with your teeth
Brush your teeth properly!
- Check your technique with your dentist or hygieniest
- I would recommend an electric toothbrush with a pressure sensor so you know if you're pressing too hard
Stop grinding/clenching your teeth (Bruxism)
This is easy to say but hard to do - especially if you do it at night time as most people do.
- Eliminate/reduce stress
- Use a mouthguard at night time which helps relieve the load on your teeth
Seek medical advice where needed
For some people, it will not be possible to prevent tooth wear without a little help from the friendly GP. For example, if you suffer from gastric reflux, bulimia or alcoholism. It is vital to seek medical attention in these cases for your general wellbeing.

How is it diagnosed?

Tooth wear is diagnosed based on:

clinical appearance of your teeth
diet
medical history
habits including nail biting, teeth grinding

To judge whether the tooth wear is active (still happening) or historical (used to happen but has now stopped), your dentist may decide to monitor your teeth by taking photos or moulds of your teeth.

How is it treated?

Not all tooth wear requires active treatment. Reasons to consider treatment include pain or sensitivity, functional problems or cosmetic concerns.

Stage 1: Prevention
Stage one of management is always prevention. For all patients, it is important to follow preventive advice to stop tooth wear occurring in the first place or to stop it from progressing further.

Stage 2: Restoration
Alongside the preventive advice in stage 1, your dentist may provide either direct or indirect restorations (onlays, crown, veneers) to protect what is left of the tooth.

Stage 3: Maintenance
The final stage, which is lifelong, is maintenance of the restorations and continuing to follow the preventive advice.