The Wear Essentials – a Discussion of the Causes of Tooth Wear
Tooth wear is not an uncommon condition. Patients who have it will complain of teeth that have poor appearance and or are sensitive. Sometimes, the patient may not be aware they have tooth wear and the dentist finds it during the routine checkup.
Incidence of tooth wear increases with age and is higher in males.
There are 3 main causes of tooth wear:
- Erosion – dissolution by acids e.g. fizzy drinks
- Attrition – tooth on tooth wear e.g. grinding
- Abrasion – foreign object on tooth wear e.g. overzealous tooth brushing
It is important to understand that the causes rarely occur in isolation; rather they tend to occur in combination e.g. brushing one’s teeth following a fizzy drink is combined erosion and abrasion. Each of the above will be discussed in turn including ways to minimize or prevent the associated tooth wear.
There are 2 sources of acid that cause tooth wear; those that are introduced from outside the body e.g. foods, drinks, chemicals and those that are already present inside the body like stomach acids.
Acidic foods and drinks include citrus fruits, canned tomatoes, fruit juices, sports drinks, vinegar, wine, beer and fizzy drinks.
I wouldn’t expect my patients to stop enjoying these foods and drinks but I do have some helpful tips. Avoid biting into lemons and holding them against the teeth. Use a straw for sports drinks, fruit juices and fizzy drinks and limit them to mealtimes. By no means brush your teeth following an acid load. Wait at least 10 minutes to allow the saliva to buffer the acid back to normal pH to prevent further wear through abrasion.
Stomach acids can cause significant tooth wear in patients who suffer from acid reflux or chronic vomiting conditions such as bulimia, anorexia nervosa and chronic alcoholism. If you suspect you suffer from any of the above please consult your family doctor or dentist.
This is caused by grinding teeth against each other. In patients who do this it most commonly occurs at night during their sleep but can occur during the day. Stress is the most common cause.
Tell-tale signs or symptoms include waking up with sensitive teeth, pain in the jaw joints, facial muscle tenderness and headaches. In addition, people who night grind often tell their dentist that their husband or wife has noticed it.
If you suspect you grind please consult your dentist who can make a simple but very effective bite guard just by taking a mold of your top and bottom teeth. The appliance works very well in reducing or preventing damage to the teeth caused by clenching and grinding habits.
Most commonly occurs with overzealous tooth brushing. Patients will present with wear lesions near the gums of the upper and lower back teeth, which sometimes need to be filled by the dentist. It is more common in the upper arch and in the premolar and first molar areas. Patients may also complain of sensitivity to cold. Other causes of abrasion include habits of using the teeth to cut wires, hold or chew pens, remove bottle tops, hold pins, clips or nails.
In terms of brushing, limit it to twice a day, morning and night. Brush for two minutes and use the time evenly around the mouth. Thirty seconds in each corner allows for 10 seconds of brushing on the cheek side, biting and tongue side surfaces. Use of a soft bristle manual brush or an electric brush which cuts out if too much pressure is applied may also be recommended by your dentist.
Tooth wear can damage teeth, make them appear unsightly and can cause pain and sensitivity. Most causes can be reduced or eliminated. Please see your dentist if you suspect you have tooth wear.