Tooth Wear

tooth wearTooth wear is the term used to describe the progressive loss of a tooth’s surface due to actions other than those which cause tooth decay or dental trauma. Tooth wear increases with age. The prevalence of any tooth wear (where dentine is exposed on at least one tooth surface) among the dentate (possessing natural teeth) population reported during the 2000–2002 National Surveys was

 

17.4% for 12-year-olds,

29.7% for 15-year olds,

38.1% for 16–24 year-olds,

76.2% for 35–44 year-olds

93.0% for 65+ year olds.

For all age groups, males had a higher prevalence of tooth wear than females.

The amount of tooth wear seen currently is considerably greater than in the past due to the fact that more people are now retaining their natural teeth into old age. Tooth wear is caused by three phenomena: erosion, attrition and abrasion.

Erosion is the progressive loss of tooth substance by chemical or acid dissolution, and no bacteria are involved. Erosion of tooth surfaces is mostly the results of too frequent or inappropriate use of carbonated drinks (including sparkling water) and fruit juices with high levels of acidity. This habit would appear to be particularly common amongst teenagers and young adults.

Erosion is also a problem in individuals who suffer from gastrooesophageal reflux disease (GORD) or from certain eating disorders (e.g., anorexia, bulimia). In addition, risk of erosion is high in individuals with a low “unstimulated” salivary flow rate.

Attrition is the progressive loss of hard tooth substances caused by mastication or grinding between opposing teeth. The extent of attrition will depend upon the use to which an individual puts their teeth. For example, it will increase in people who habitually clench or grind their teeth (a condition known as bruxism), e.g., during sleep. It will also tend to be more pronounced in people who eat a particularly fibrous diet.

Abrasion is the progressive loss of hard tooth substances caused by mechanical actions other than mastication or tooth-to tooth  contacts. Abrasion is commonly associated with incorrect toothbrushing technique, giving rise to notching at the junction of the crown and root of teeth. It will also be seen in individuals who use their teeth as a tool (e.g., to remove bottle tops, to hold pins, clips or nails).

The long-term use of tongue jewellery also causes tooth abrasion, when the jewellery is hitting against the teeth.

Prevention

Sugar drinksImage courtesy of Iamnee at FreeDigitalPhotos.netReducing the frequency of drinking carbonated drinks and fruit juices with high levels of acidity is the key to preventing erosion of the teeth. Toothbrushing should be avoided immediately after consuming acidic drinks and foods for a period of time (at least 20 minutes), as the acid softens the enamel making it susceptible to damage from brushing. Attrition is a slow-progressing condition and many people will only be made aware of the damage to their teeth on visiting the dentist. In the case of bruxism, treatment may require the wearing of a bite guard during sleep.

Abrasion can be reduced by adopting a correct toothbrushing technique (see Recommended Toothbrushing Technique). In particular, the toothbrush should be held using a pen-grip and vigorous horizontal scrubbing actions with a hard toothbrush should be avoided. Teeth should not be used as a tool to grip or hold items. Long-term use of tongue jewellery should be avoided. Toothpastes vary in their level of abrasiveness; whilst abrasives help to remove tooth stain they may also contribute to tooth wear. Those concerned about tooth wear could seek a less abrasive fluoride toothpaste. Fluoride toothpastes also help to combat tooth wear, specifically erosive tooth wear, as the availability of fluoride promotes the formation of a calcium flouride layer (CaF 2).