Teeth Wear: Worn Teeth Treatment, Symptoms, and Causes

Dental erosion, a form of tooth wear, is primarily caused by the chemical dissolution of tooth enamel and dentine by acids not derived from bacteria. These acids can originate from extrinsic sources, such as dietary acids present in foods and beverages like citrus fruits, soft drinks, and wine, or intrinsic sources, such as gastric acid in conditions like gastroesophageal reflux disease (GERD) or chronic vomiting, including that associated with eating disorders. Saliva plays a crucial protective role against erosion by neutralizing and buffering these acids, and a reduction in salivary flow or a change in its composition can exacerbate the risk. Environmental factors, such as exposure to chlorinated swimming pool water, can also contribute to dental erosion. The process is distinct from mechanical forms of tooth wear, such as attrition or abrasion and is not caused by bacterial action, as seen in tooth decay. Understanding these causes is critical for both prevention and management of dental erosion.

Tooth grinding, clinically known as bruxism, is a condition often caused by a combination of physical, psychological, and genetic factors. Physically, misalignment of teeth (malocclusion) and an abnormal bite can lead to bruxism, as the body subconsciously attempts to adjust the teeth to a more comfortable position. Psychologically, stress and anxiety are significant contributors, with individuals often grinding their teeth in response to emotional tension, especially during sleep. Sleep disorders, such as sleep apnea, are also commonly associated with bruxism. Additionally, certain lifestyle habits, including smoking, heavy alcohol consumption, caffeine use, and specific medications, particularly antidepressants, have been linked to an increased risk of tooth grinding. Genetic predisposition plays a role, too, as bruxism tends to run in families. Understanding these multifactorial causes is crucial for effective management and treatment of bruxism.

Acid wear on teeth, also known as dental erosion, is primarily caused by the exposure of teeth to acidic substances. These acids can originate from external dietary sources such as citrus fruits, carbonated beverages, and wine or from internal sources like gastric acid, which may come into contact with teeth due to conditions like gastroesophageal reflux disease (GERD) or recurrent vomiting, as seen in bulimia nervosa. The acid acts by dissolving the calcium and phosphate minerals in the tooth enamel, leading to its softening and eventual wear. This process can be exacerbated by certain lifestyle factors, such as poor oral hygiene, high frequency of acidic food or drink consumption, and inadequate salivary flow or composition, which normally helps to neutralize acids and remineralize enamel. Unlike mechanical forms of tooth wear, such as attrition from grinding, acid wear often presents as smooth, polished surfaces on the teeth and can lead to increased sensitivity, aesthetic changes, and, in severe cases, significant structural damage to the teeth.

Brushing teeth too vigorously is a significant contributor to tooth wear, particularly in the form of dental abrasion. This type of wear occurs when the tooth’s hard tissues are mechanically worn down, not by chewing, but by external factors, in this case, the toothbrush. Overzealous brushing, especially with a hard-bristled toothbrush, can gradually erode enamel, the protective outer layer of teeth, exposing the softer dentin underneath. This exposure can result in increased tooth sensitivity and susceptibility to decay. Moreover, aggressive brushing can also harm the gum tissue, potentially leading to gum recession, another form of tooth wear. Using a soft-bristled toothbrush and employing gentle, circular motions while brushing is essential to avoid such adverse effects. This approach effectively cleans the teeth and minimises the risk of tooth wear and gum damage.

Tooth grinding, clinically known as bruxism, significantly contributes to tooth wear, specifically in the form of attrition. This condition, often occurring during sleep or in times of stress, involves the repetitive clenching and grinding of teeth. Such forceful contact results in the gradual but persistent wearing down of the tooth enamel, the protective outer layer of teeth. Over time, this leads to the exposure of the underlying dentin, which is softer and more susceptible to wear and decay. The implications of this enamel loss are multifaceted: it increases the risk of tooth sensitivity and decay, can lead to changes in the bite or occlusion, and may cause or exacerbate temporomandibular joint (TMJ) disorders. Moreover, bruxism-induced wear can alter the appearance of teeth, often leading to flattening of the biting surfaces and a shortened, aged appearance of the teeth. Therefore, identifying and managing bruxism is crucial in preventing excessive tooth wear and maintaining overall dental health.

Toothwear, a multifactorial condition affecting dental health, manifests through various signs and symptoms, crucial for early detection and management. The most common indicator is the gradual change in tooth appearance, where teeth may appear shorter, flatter, or more rounded. Enamel thinning is another key sign, often resulting in increased translucency, particularly at the biting edges of the front teeth. Patients frequently report increased sensitivity to hot, cold, or sweet stimuli as the protective enamel layer wears away, exposing the underlying dentin. In severe cases, cracks or fractures in the teeth may occur. Additionally, patients may experience changes in their bite, difficulty chewing, or jaw pain, particularly in cases where tooth wear is due to bruxism (tooth grinding). Aesthetic concerns are also prevalent, as tooth wear can lead to a more aged appearance of the smile.

Treatment options for tooth wear are diverse and tailored to the severity and cause of the condition. In cases of mild wear, preventive approaches like fluoride toothpaste or varnishes and addressing dietary acids or habits contributing to wear, such as bruxism, are recommended. For moderate wear, restorative interventions may be necessary, including composite bonding, which involves applying resin to worn areas or inlays and onlays for more extensive damage. Severe wear often requires more comprehensive treatments like crowns or veneers to protect and rebuild the tooth structure. Additionally, if tooth wear is due to grinding (bruxism), a night guard may be prescribed to protect the teeth. It’s crucial to treat underlying causes simultaneously, such as managing acid reflux or modifying diet, to ensure the long-term effectiveness of these treatments. Regular dental check-ups are essential for monitoring and managing tooth wear effectively.

Preventing tooth erosion, a key concern in dental health, involves a multifaceted approach focusing on lifestyle modifications and proactive dental care. Firstly, dietary adjustments are crucial; limiting the consumption of acidic foods and beverages, such as citrus fruits, carbonated drinks, and wine, is essential, which can erode enamel. Rinsing the mouth with water after consuming acidic substances and waiting at least 30 minutes before brushing helps to neutralize acids and prevent abrasive damage to weakened enamel. Utilising toothpaste with fluoride strengthens tooth enamel, offering a protective barrier against erosion. Additionally, addressing medical conditions like gastroesophageal reflux disease (GERD) or disorders that involve frequent vomiting, which can expose teeth to stomach acids, is vital. Regular dental check-ups are essential for early detection and management of erosion. Protective measures like custom-made mouthguards can be beneficial for those who grind their teeth, a habit that exacerbates erosion. Educating patients about proper brushing techniques and soft-bristled toothbrushes can prevent mechanical wear contributing to erosion. Combining dietary management, appropriate oral hygiene practices, medical intervention when necessary, and regular dental consultations, this comprehensive approach represents the most effective strategy for preventing tooth erosion.

Dental abrasion, a form of tooth wear, is primarily caused by mechanical actions other than chewing or biting. One of the most common causes is aggressive tooth brushing; specifically, using a hard-bristled toothbrush or applying excessive force can lead to the gradual erosion of enamel, particularly where the gums and teeth meet. Additionally, the habit of using teeth as tools to open or hold objects can contribute significantly to abrasion. Other factors include abrasive toothpaste, especially those designed for whitening or tartar control, which can wear away the tooth surface over time. Habits such as nail-biting or chewing on hard objects (like pens, ice, or hard candy) also contribute to this condition. In some cases, certain dental appliances, like poorly fitting braces or retainers, can cause abrasion.

Tooth attrition is a specific form of tooth wear that results primarily from tooth-to-tooth contact, often seen in patients with bruxism (habitual grinding) or clenching habits. Unlike other forms of tooth wear, such as erosion or abrasion, attrition is characterized by the mechanical wearing down of the biting surfaces of the teeth. This is evidenced by the flattening of the cusps and incisal edges, and in severe cases, can lead to exposure of the dentin or even the pulp, leading to sensitivity and increased risk of dental caries. In contrast, erosion is the chemical dissolution of tooth enamel and dentin due to acids not derived from bacteria, commonly seen with excessive consumption of acidic foods or gastroesophageal reflux disease. On the other hand, Abrasion results from external mechanical processes, like aggressive brushing or toothpicks. Understanding these distinctions is crucial for accurate diagnosis and appropriate management of tooth wear.