Tooth Wear : Erosion is Not The Only Problem

“What is Tooth wear?”  Put simply, a definition of tooth wear is the wearing away of enamel and dentin surfaces by a process other than decay.  The damage can be chemical (acidic) or physical (from brushing too hard or grinding).

There are three types of tooth wear:

  • Dental erosion. More on this page
  • Abrasion
  • Attrition

These may occur alone or in any combination.  So you should be aware that the teeth can wear down from other sources than just acids in the diet. The condition is a gradual process that initially affects the outer enamel but can progress to cause considerable damage.
the three causes of tooth wear, erosion , abrasion and attrition

Dental Abrasion: ‘Over-Brushing’ Your Teeth?

Abrasion is the process whereby the dental tissues are physically worn away by something other than the opposing teeth biting on them (which is known as abrasion- below).  Most commonly this is caused by over-aggressive brushing – note this can also cause gum recession.  This will cause characteristic notches on the enamel just above the gum line. This loss of enamel can lead to symptoms sensitivity with heat/cold and when brushing the areas affected.

Abrasion can also be caused by toothpicks, pipe smoking, musical instruments and dentures.

Abfraction is a process where surface wear is caused at the gum line. This is thought to be caused by bending forces on the teeth due to grinding and clenching

Abrasion and erosion may cause damage in combination: If your teeth are softened by acidic drinks or food and you brush immediately afterwards, any damage will be compounded.

Tooth abrasion treatment depends on the degree of surface loss. Options range from white fillings to repair lost tissue (in most cases this is enough) to root canal and crowns where the loss is severe (ie through to the pulp- this is less common).

 

How to Prevent Tooth Abrasion

Your dentist will guide you and may mention some of these points:

How you brush has the major bearing on how likely you are cause tooth abrasion

  • Do not use excessive force while brushing.  Use gentle, circular motions as opposed to strong sideways brushing.  See our guide to proper tooth-brushing. Some of the better electric toothbrushes have pressure sensors to prevent over-brushing.
  • Use a soft- bristled toothbrush with a small head.
  • Be careful with the canines and premolars in particular (those at the corner of your mouth) – As people tend to brush here both when cleaning the back and front teeth – You may be inadvertently over cleaning here.
  • Avoid abrasive toothpastes such as many ‘whitening’ versions.
  • Careful use of toothpicks.
  • Stop any habits that are wearing at your teeth, e.g. nail-biting or chewing pens.
  • Wait 30 minutes, after taking an acidic drink or food, before brushing.

 

Dental Attrition: Grinding Down Your Teeth?

Tooth attrition is wear caused by their biting together. As you can see in the picture at the top of the page, this causes the symptom of an overall flatter, shorter tooth appearance – due to loss of tooth structure. Common in children.  Before this there may be chipping away of the edges – most noticeable on the front teeth.

Some degree of this type of damage is inevitable over your lifetime.  Various factors will increase the likelihood of reaching damaging levels of attrition:

  • Grinding and clenching (habits known as bruxism) is the major cause. This obviously greatly increases the contact time and forces between the biting surfaces, thus accelerating the rate of damage.
  • Loss of some teeth with increased pressure and attritional forces on those that remain.

 

"Tooth-wear"

Tooth wear – shortening and flatter appearance –  in this case as a result of mainly erosion and attrition

How to Prevent Dental Attrition

  • If you are grinding or clenching at night your dentist can make a night-guard to be placed as the first line in tooth attrition treatment. This plastic shield will prevent your teeth from contacting and damaging each other as you grind.  See our teeth grinding article for much more advice on this common problem.
  • If you lose several teeth, in particular large back molars, these need to be replaced.  This will act to take the load off your remaining natural dentition.  Options for replacing missing teeth include dentures, bridges and implants.

If you have damage from tooth wear, see the dental erosion article for advice on what treatment and management options are available.

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