Toothwear

Tooth wear is the loss of the outer tooth surface as a result of chemical or mechanical activity in the mouth (as opposed to tooth decay and gum disease which are caused by the action of bacteria in the mouth)

Tooth wear has three main causes, although in the vast majority of patients these occur in combination:

❉ Erosion
This refers to the progressive loss of tooth substance by chemical or acid dissolution. Enamel forms the outer structure of the tooth and is much harder than dentine (the middle part of a tooth). It is relatively resistant to erosion; however once the outer enamel layer has been perforated, dentine can be quickly worn away, causing “cup shaped” cavities or grooves.

Healthier living has led to a great increase in the consumption of fruit. Many fruits contain large quantities of natural acids; some fruits are particularly acidic, e.g. lemons and grapefruit. The most common cause of erosion is too frequent or inappropriate use of carbonated drinks (including sparkling water) and fruit juices with high levels of acidity. This habit appears to be particularly common amongst teenagers and young adults. Pregnant women suffering from severe morning sickness, or people suffering from from gastrooesophageal reflux disease (GORD) or hiatus hernia may show signs of dental erosion. It is also a problem in individuals who suffer or from certain eating disorders (e.g., anorexia, bulimia).

In addition, erosion is high in older patients, associated with a reduced salivary flow rate in the mouth- as a consequence of age or as a side effect of commonly administered medications.

❉ Abrasion
This is commonly seen alongside erosion. It is tooth wear caused by excessive rubbing away of enamel and dentine. Examples include vigorous tooth brushing, using too much toothpaste, and porcelain crowns rubbing against natural teeth, or adopting a coarse diet. It is due to the harmful effects of the combination of erosion and abrasion that we advise you to wait at least an hour before brushing your teeth; if an acidic substance such as orange juice has come into contact with the teeth, this softened outer layer of the tooth can be easily removed by toothbrushing. Waiting an hour allows saliva to act, buffering the mouth and encouraging this soften outer layer to remineralise (and harden).

❉ Attrition
This is caused by the contact between the teeth over and above normal use. Unfortunately, it is becoming increasingly common, with more individuals finding they grind or clench their teeth, linked to stressful lifestyles. In combination with erosion and abrasion, quite severe damage to teeth may result. Fibrous foods (which are an extremely important constituent of a healthy diet) can be quite abrasive, and when consumed alongside acidic drinks like orange juice, biting surfaces of the teeth may be rapidly worn away.

We are seeing a paradigm shift. People are living longer, people are retaining teeth longer and diets are changing. So teeth are being challenged in a host of new ways.

Just as an example, modern lifestyles have created diets which contain higher levels of acidic foods and drinks such as fruit juices and sparkling drinks. Sports drinks have also become increasingly popular and contain high levels of acidic content.

Diets rich in hard seeds and nuts are more common.

Eating disorders, gastroosephageal conditions and stressful lifestyles can also increase tooth wear through stomach acid regurgitation and tooth grinding.

Increased levels of tooth wear is seen in those ingesting higher than normal levels of alcohol and particularly in those taking social drugs.

Everyone experiences some tooth wear simply due to normal use of the teeth (what we refer to as “physiological”). However, the level of wear can become rather more significant (what we refer to as “pathological”), and as a result teeth can become short and unattractive as well as feeling sharp, rough or sensitive. Even speaking or chewing can become a problem and some people also experience jaw and muscle discomfort.