Sometimes its the day to day small things that start to have a big impact on us. This applies to our aims and desires in life, but also to our teeth and the health of our mouth. Often people know about tooth decay as a cause of holes in teeth or even as a cause of tooth loss. Sometimes people aren't aware of the processes that can lead to tooth loss through daily wear. Dentists call this non-carious tooth surface loss, which is a jargony way of saying holes not caused by decay. The types are erosion, attrition, abrasion and abfraction.
Erosion
Erosion is caused by acidic things that come into contact with out teeth. Every time you have something acidic in your food or drink, or if acids from your stomach come into your mouth, the outer enamel layer is softened. This is because some of the mineral dissolves out of the tooth. If this happens occasionally, your saliva will slowly cancel out the acidity and rebalance the tooth, but if it happens too often, the rebalance does not happen and over tiny all of the tiny mineral losses start to wear the tooth down.
It shows up as hollows in the teeth or a general flattening and shortening of the teeth. Sometimes the teeth look yellower as the deeper dentine is exposed (which is darker than enamel) and this can be very sensitive to hot cold sweet and acids.
Erosion is the big hitter in terms of tooth substance loss that is not related to tooth decay. It is related to some medical conditions like bulimia, gastro oesophageal reflux disease, hernia and alcohol dependency. Where this is the case then your dentist might work with you and your medical team to prevent the deterioration of your teeth while your medical team help you to manage your problem.
In most cases though, erosion is often related to foods and drinks. Many foods in our modern diet have a low pH or are acidic. Pickles and pickled foods (think of the kimchi trend), citrus fruits like lemon, grapefruit and orange, and sour sweets are common ones. Mostly though drinks play a huge role in this condition. Fizzy drinks, pops and carbonated drinks can cause erosion. Even the ‘diet' brands', sports drinks and fizzy water are still harmful. Most alcohol including wine, cider, 'alcopops' and ‘designer drinks' play a part too.
Abrasion, attrition and abfraction
So what about those other causes? Well I can hit on these together, because usually they are all made worse by erosion, so often the management stays the same.
Abrasion is damage at the gum line of the tooth from brushing too hard in an acid environment or with an abrasive toothpaste. Sometimes the gum line gets pushed up too.
Used with the right pressure toothbrushes should not groove the tooth but if used with a lot of pressure they can do and especially if the toothpaste used is "abrasive". It is very hard to tell, as some toothpastes may seem gritty in texture but not be abrasive to the tooth, while smooth textured toothpastes might be very abrasive.
Often whitening toothpastes are more abrasive. If in doubt you should check with your dentist. I often ask my patients what toothpaste they use, partly to check if they use one that might be causing this problem. It feels or looks like a line or groove at the gum line and eventually can cause a dish shape. The pictures here show a more severe case and a milder one.
Attrition and abfraction occur because of the flexing and rubbing of the teeth during biting. With attrition the damage occurs at the tooth biting edge from grinding teeth together and abfraction is a v shaped chipping at the neck of the tooth which is caused by repetitive flexing forces through the side of the tooth. Both happen to people who have a condition where they rub their teeth together habitually called bruxism. The damage depends on the condition, how the teeth meet and also the acids in the environment. The edges of the teeth may chip or flatten and over time the teeth get shorter.
What can be done?
The main take home message from these conditions is that they get worse over time, so what might seem like a very small problem now will turn into a big problem later. Mild versions of the condition often need very little intervention from your dentist, but some small lifestyle and habit changes. A dentist might suggest a mouthguard or tooth splint if they think this will prevent the condition worsening, sometimes may put fluoride on your teeth to make them more resilient or prescribe a high fluoride toothpaste or suggest repairing some teeth often with white composite filling.
Lifestyle changes that can help
Plain water is the best drink for your teeth with milk as a close second.
If water is not possible have acidic food and drinks just at mealtimes. This will reduce the number of acid attacks on your teeth allowing your saliva to rebalance your mouth.
Try to drink quickly without holding the drink in your mouth or swishing it around. Sometimes using a straw might help to send the drink to the back of your mouth instead of it touching your teeth.
Cheese, milk and sugar free gum after acids can help to rebalance your mouth.
Wait for at least one hour after acids before brushing your teeth, to give your saliva time to rebalance your mouth. This will stop you from brushing acid into your teeth.
Brush your teeth last thing at night and at least one other time during the day, with fluoride toothpaste. Use a small-headed brush with medium bristles. I often ask my patients to avoid soft brushes as they hold more toothpaste which can contribute to abrasion.
Learn how to use your toothbrush really well. It is not embarrassing to become an adult and not know quite how to use your toothbrush properly. It happens because often we are not shown properly, but dentists and hygienists are always happy to help with this and bringing your tooth cleaning kit to a check up can help them to give you confidence and improve.
Use high fluoride toothpastes if you are prescribed them by your dentist, but if not use the right amount. Anyone over three years old should use a toothpaste containing 1350-1500parts per million fluoride and that information is on the packet. Children under three should have a toothpaste of at least 1000ppm and should have an adult brush their teeth until they are 8 years old.
Spit out after brushing and do not rinse, so that the fluoride stays on your teeth longer.
Treatments from the dentist are only necessary where the wear is giving sensitivity or getting so severe that it is going to affect how you chew or the health of the teeth. This might involve building up your teeth, adult braces to move teeth to a better position, splints or crowns in very severe cases. All treatments are planned on a case by case basis and are completely bespoke to individual need and want.
Making small daily changes can stop this from happening to you or stop it from getting worse. If you would like more information about tooth wear or if you think you would like an assessment at the clinic for tooth wear, please contact me directly.
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