Teeth wear involves loss of tooth structure (enamel and dentine). In my clinical experience teeth wear is closely linked to age, and it can become a serious issue as it impacts upon appearance, self-confidence, comfort and eating.
There are multiple causes of wear and in most cases they work simultaneously. The two major causes are:
- Erosion: tooth loss from exposure to acidic substances. These acids can either be from the body itself e.g. reflux or vomiting, or from food/drink intake such as acidic fruits and soft drinks.
- Tooth on tooth wear as a result of clenching or grinding
The appearance of worn teeth depends on the cause:
- Teeth which are worn due to erosion often appear like they have lost their shine, have flattened or concave surfaces and have cupping of the biting surfaces.
- Teeth which are worn due to clenching and grinding are often short, with sharp defined edges and when the patient closes together the teeth fit together like a jigsaw puzzle.
Enamel acts like a protective thermal seal around the nerve and when it is lost sensitivity often results. Hence, worn teeth are often sensitive to cold foods and drinks, and also to cold air. Sensitive teeth are best managed with use of de-sensitizing toothpastes such as Sensodyne or Colgate Sensitive, and your dentist can apply professional pastes to assist with comfort.
Long term consequences include:
- TMJ (jaw joint) pain
- Dental nerve issues
- Change in appearance of face- lower half of the face gets shorter
- Impaired eating
- Impaired speech
- Generalised sensitivity
- Poor appearance
Treatment for patients with wear must always start with management of the causative factors, such as wearing a nightguard or medication and diet adjustments to control reflux. Reflux is a very common problem in the ageing population and many people do not even know that they have it. Reflux silently lowers the acid levels of your saliva and as a result breaks down the enamel causing wear. Your dentist will refer you to your GP for management.
Your dentist will also complete a diet questionnaire and saliva testing to determine if certain foods or drinks are contributing to the teeth wear- foods to minimize include those with citric acids e.g. lemons, limes, oranges. Drinks which are highly acidic include soft drinks and sports drinks.
Once a management plan is determined we can look at building the teeth back up so that both the appearance and eating are improved. To do this we always plan using 3D software to simulate the treatment and then we have the patient wear a mock-up for up to 4 weeks so we can ensure that they are happy with the proposed changes. A mixture of white composite filling material and porcelain is used to reconstruct the smile.