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What are the causes of excessive tooth wear and what are the prevention and treatment options?
There are often multiple causes for this excessive wear:
- Attrition - is the loss of dental structure through tooth-to-tooth friction, as is the case of bruxism. The patient grinds his/her teeth and rubs them together, unaware of doing so, often while sleeping and during daytime stress and focus periods.
- Abrasion - when the loss of dental tissue is caused by friction between the tooth and certain objects interposed between the teeth, such as a smoking pipe, needles, pencils, sunflower seeds, nail biting or the biting of other objects, excessive brushing with abrasive toothpastes or applying a high pressure while brushing.
- Erosion - the enamel and the dentin are demineralized by the acids from carbonated soft drinks, through an excessive consumption of citrus fruits or gastric reflux. Starting from a 5.2 pH, the enamel starts to dissolve. Most carbonated soft drinks have a pH under 2, with a harmful effect on the teeth, proportional with the consumption frequency and time in the mouth.
Tooth wear is a normal process, which occurs during decades, due to chewing hard foods, carbonated drinks, brushing friction. However, the quantity of lost dental structure is normally very small, as the enamel is very hard and prevents such loss. This is why we see more abraded teeth in old people.
However, unfortunately, excessive tooth wear is more and more frequent in young people, affecting their look, mastication, and causing bite (occlusion) changes, which affect the temporomandibular joint and cause pain in the ear region, limit mouth opening, and cause muscle spasms. The loss of tooth enamel exposes the dentin underneath to the exterior; being softer, the dentin is lost at a higher rate. The teeth become short, with uneven, anfractuous edges, aesthetically unappealing and with multiple functional issues. Early stage dental abrasion is asymptomatic, and patients find out about this problem during a dental checkup. When tooth wear is excessive, teeth may become sensitive and unaesthetic and the patient requests treatment for this problem.
Preventing tooth wear is very important, in order to limit and stop future loss of dental tissue:
- the consumption of carbonated drinks is reduced;
- the gastroesophageal reflux is treated through medication;
- a correct brushing is performed, with medium hardness toothbrushes and less abrasive toothpastes;
- habits related to biting of hard objects: pencil, pen, nails, needles etc. are corrected;
- a mouthguard is used during the night, for people who grind their teeth while sleeping;
- the dental areas affected by decalcification are remineralized with fluorinated gels;
- the dentin areas exposed to the exterior are protected by covering them with obturations or veneers;
The more advanced the stage of tooth wear, the more difficult and costly the treatment will be. A simple obturation is no longer sufficient for restoring the affected tooth.
Sometimes, surgical crown lengthening is required, in order to increase the tooth area located above the gum, in order for it to provide retention for a prosthetic crown.
The orthodontic treatment repositions the teeth in order to obtain a favorable position for the prosthetic treatment.
The loss of dental substance is usually slow and causes the compensating eruption of the opposite teeth, so the space required for the restoration of the tooth is eliminated. The restoration of the entire arcade or both arcades is necessary, with the heightening of the occlusion and recovery of the normal size of the teeth.