Tooth Wear Causes, Prevention & Treatment

With proper care, your teeth can last a lifetime. But a small amount of wear as we age is considered normal. By “wear,” we mean loss of tooth structure. Wear starts with loss of the hard, translucent enamel that forms the outer covering of teeth, and might, in more serious cases, progress to the softer inner tooth structure known as dentin.

Enamel is actually the human body’s hardest substance. It is highly mineralized and non-living, in contrast to bone and dentin which are living tissues. Enamel is highly resistant to wear and chemical attack, as it should be to be given what your teeth do every day: bite, chew, and come in contact with acidic foods and drinks.

Still, it is common for enamel to wear down for various reasons. But when tooth wear becomes noticeable or significant, intervention may be necessary to keep your bite functioning properly and protect your teeth.

Erosion

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 gastroesophageal reflux disease (GERD) 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.

Four main causes of dental erosion

Gastric Reflux – Digestive health can affect teeth. For those who suffer from gastroesophageal reflux, also known as acid reflux or GERD, stomach acids reach the mouth throughout the day. When these gastric acids travel up the throat and into the mouth they can wear away tooth enamel, usually on the inside surfaces of teeth, as well as the biting surfaces of molars.
Bulimia – Persons with bulimia may secretly binge, eating large amounts of food and then purge to rid themselves of the extra calories. As they do so, the acids associated with purging have an erosive effect on the teeth. It is mostly the inside of the upper teeth that is affected.
Carbonated Beverage Abuse – It’s the bubbly fizz that lowers the pH and raises the acid level of any beverage. Swishing carbonated beverages results in the tooth structure on the front surface of upper teeth being eroded away resulting in a yellowish, dished-out area near the gum line. Pooling, or letting the beverage rest in the mouth, results in more tooth wear on the biting surface of lower molars.
Citrus Fruit Abuse – Sucking on lemons, limes or highly acidic fruits can result in erosion of the front surface of tooth enamel on front teeth. The high acid content in many fruits and fruit juices can cause tooth enamel to weaken and demineralize over time.

Ways to prevent dental erosion

avoid dry mouth to ensure there is enough saliva to buffer mouth acids and remineralize tooth enamel
use toothpastes that strengthen teeth to make them more resistant to mouth acids
maintain regular dental visits to assess for signs of tooth erosion
seek assistance from a physician to treat the underlying causes of acid reflux
avoid unhealthy weight-control behaviors such as self-induced vomiting
seek the assistance of a relative, friend or physician at the earliest sign of an eating disorder
limit or avoid sports drinks due to high amounts of sugar which form acids in the mouth
drink carbonated beverages in moderation, no more than one per day – this includes soda pop, kombucha, sparkling water & any beverage that fizzes
drink carbonated, sugary or fruit beverages quickly to reduce the time that sugars and acids are in contact with teeth
limit fruit juices
use a straw when drinking harmful beverages to keep acids away from teeth
avoid swishing or pooling carbonated beverages in the mouth
avoid sour candies
after acidic meals or beverages, rinse your mouth with water, drink milk or eat a piece of hard cheese to neutralize mouth acids
wait 30 minutes before brushing teeth after drinking a carbonated beverage or eating an acidic fruit when recently acid-attacked tooth enamel can be more easily worn away
never suck on lemons, limes or any highly acidic fruit

Attrition

This is an effect of tooth-to-tooth contact, which happens many times throughout the day as your teeth bite and chew food. Biting and chewing normally generate forces between 13 – 23 pounds. Yet if you have clenching and/or grinding habits (of which you might not be aware) can subject your teeth to forces up to 10 times that. This can damage teeth. Many clenching/grinding habits take place at night and are associated with stress, obstructive sleep apnea, acid reflux, side effects of medications and more.

Ways to prevent dental attrition

exercise to help alleviate stress, a major cause of tooth grinding
relaxation therapies – yoga, massage, meditation
be aware – teeth should only touch when you’re chewing or swallowing
seek help – talk therapy to reduce severe anxiety/stress
take a warm bath before bed to relax jaw muscles
wear a protective dental night guard
be assessed for sleep apnea which is associated with tooth grinding
be assessed and treated for misaligned teeth to even out biting and chewing forces

Abrasion

Abrasion is a particularly common type of tooth wear. This form of wear occurs as foreign objects contact and move against the teeth. Abrasion causes a gradual loss of tooth enamel. Enamel loss results from a mechanical action aside from bruxism. This form of tooth wear is usually attributable to brushing with too much force. Those who brush too hard gradually damage the teeth’s enamel and elevate the notch at the crown’s junction with the root.

Those who use their teeth as tools also suffer from abrasion. As an example, using the teeth to open bags or remove bottle caps will likely spur considerable abrasion. Even using an abrasive toothpaste has the potential to cause tooth wear in time. It is best to use a soft-bristled brush and move it in circular motions across the entirety of a person’s teeth. Unfortunately, plenty of people rely on a horizontal brushing technique that is overly intense and abrasive. If someone suspects or knows tooth abrasion is occurring, he or she should meet with a dentist to review brushing techniques.

Ways to prevent dental abrasion

adopt a correct toothbrushing technique – use a pen-grip and avoid vigorous horizontal scrubbing actions with a hard toothbrush
consider the level of abrasiveness of toothpaste
select a toothpaste with properties that strengthen teeth and make tooth enamel more resistant to abrasive actions
teeth should not be used as a tool to grip or hold items
long-term use of tongue jewellery should be avoided
select plastic vs. metal tongue jewellery

Treating Worn Teeth

When examining worn teeth, our dentist in Beaufort SC will always seek out the cause of the wear before proposing treatment or a method of protection. For example, if you have a clenching or grinding habit, a centric-relation bite splint can be custom-made for you that will reduce (or even eliminate) grinding forces and protect your teeth during sleep or periods of high stress. If you have Obstructive Sleep Apnea, a different oral appliance can be custom-made to help you stop snoring, sleep without interruption and protect your teeth at the same time. If you suffer from abfraction, our dentist may recommend “equilibration” or bite balancing adjustments to your teeth, or she may recommend tooth-brush abrasion, changing toothbrush techniques and/or paste.

Lost tooth structure sometimes needs to be replaced so your bite functions properly and your teeth look great once again. Depending on the situation, this can be done with bonding, veneers, or crowns. Fortunately, modern dentistry can restore the normal shape, appearance and function of worn teeth — beautifully and successfully! To schedule an appointment contact us at (843) 986-0177 or feel free to use our online appointment form.