In contrast to tooth decay and gum disease, an increasingly common problem is teeth which simply wear down or dissolve away to varying extents as time passes. There are 3 different forms of accelerated tooth substance loss. Each with different underlying cause and treatment.

 Attrition

This is the mechanical wearing down of the chewing surfaces of teeth initiated by excessive tooth to tooth contact such as in bruxism. Attrition causes teeth to lose their form / shape and become flat and unsightly and sensitive to sweets & hot and cold drinks.

Characteristic Features are usually, development of a facet (flat surface with circumscribed and well defined border). Opposing tooth facets will match perfectly in occlusion.

Treatment for Attrition

To investigate possibility of Bruxism  as it can cause severe damage to teeth, fillings and any crown and bridge work. If bruxism exists, then either a soft or hard night guard should be made depending on the clinical situation.

If damages to the teeth are present, to restore and repair them with non-invasive techniques and materials, which will correct the bite, prevent tooth sensitivity and improve the function as well as the aesthetics of the teeth.

Erosion

This is loss of tooth structure (enamel and dentine) dissolved through acid erosion caused by acidic foods and drinks in our diets, or in patients with conditions like bulimia or acid-reflux.

When tooth enamel is exposed to acids, it softens and loses some of its mineral content. Saliva will help neutralise acidity, restore the mouth’s natural balance and slowly harden the tooth enamel. Nevertheless, since the tooth’s recovery process is slow, if the acid attack happens frequently, the tooth will not have a chance to repair itself.

Over time, this acidic softening – especially if combined with abrasion (a general wearing of the surface by constant rubbing), for example, from toothpaste during tooth brushing – can cause significant wear, resulting in reduced thickness of enamel which can lead to a change in the texture, shape and appearance of teeth, which may also mean they become sensitive.

Early signs of acid erosion include;

  • Sensitivity
  • Discolouration
  • Rounded Teeth

The later stages of acid erosion can include;

  • Front teeth may appear slightly transparent near their biting edges
  • Advanced Discolouration
  • Severe Sensitivity
  • Small dents may appear on the chewing surface of the teeth

Treatment of Erosion

The most important rules in the management and treatment of erosion are:

  • To initially treat the pain
  • Treat the cause of this condition ( dietary Advice, Diet Control)
  • Preventative strategies to prevent the worsening of erosion lesions
  • Monitor the progression of tooth wear with study casts and photographs
  • To Provide provisional or temporary treatment until the erosion is controlled and stabilized
  • To utilize non-invasive restorative treatments , such as dental bonding
 Abrasion

Abrasion is the wearing down of tooth surface by incorrect brushing technique and perhaps through the use of a hard brush. This kind of tooth wear causes the gums to recede and exposes the dentine on the root surfaces of teeth which is unsightly as its yellow in colour and can make the teeth more sensitive to air.

Treatment of Abrasion

Change of oral hygiene habit (such as avoiding overzealous brushing, use of soft bristle toothbrush) is important to prevent further progression. Existing abrasion cavities can be restored by dental fillings, composite and glass ionomer are both commonly used materials for such cavities.

For severe abrasion which involves pulp of the tooth, root canal treatment and crowns may be needed.

With tooth wear, it’s very important that the cause of the tooth wear is correctly identified. For example, if the patient suffers from gastric induced Erosion but this is incorrectly identified as Attrition, then the use of night guard treatment can cause more damage to the teeth by holding gastric acids on the tooth surface for a longer time.

Also some patients suffer from more than one type of tooth wear. Their tooth wear may be caused by a combination of factors. Simply treating one type of wear and ignoring the other types at work, will not stop the damage to the patient’s teeth.