As we age, there is a natural and progressive breakdown that affects every part of our body, including our skin, bones, muscles, joints, internal organs and even our brains. Unfortunately, teeth are not immune to the effects of aging.
What is the normal amount of wear?
As we age, it is perfectly normal to have a certain amount of wear occur on our teeth. After the age of thirty, it is considered normal to lose about one millimeter of length of the upper front teeth, due to normal wear, for each decade of life. The average forty-year-old should not have more than one millimeter of wear on the edge of their front teeth, two millimeters for a fifty-year-old and so on.
A common problem today is excessive wear that occurs above and beyond expected age related wear. The result is an unattractive smile with short teeth and spaces between the teeth. Excessive wear can also result in temperature sensitive teeth, difficulty in chewing, chipping and fracturing of teeth, bite related problems such as headaches and TMJ (jaw joint) problems, and nerve exposure resulting in full blown toothaches. Unfortunately, many people are completely unaware that they have a serious tooth wear problem. Tooth wear can occur rapidly over a short period of time, or it can occur gradually over long periods of time. For many people, the wear goes unnoticed, especially if it has taken place more gradually.
Enamel is the hardest substance in our bodies. Once that is worn through, the inner soft core of the tooth, the dentin, is exposed. Dentin is where the nerve endings are located. Once the dentin is exposed, wear proceeds approximately eight times more rapidly because the dentin is much softer than enamel.
Often the front teeth that are worn have thin, sharp and jagged edges. The back teeth can have flattened surfaces and worn down fillings. If there are crowns or caps present on the back teeth they often can have holes present on the biting surface from being worn thin. The wear in these cases can be on front teeth only, the back teeth only, or both. Treatment can include fabrication of a night guard if the wear is minimal. If the wear is extensive, treatment often requires restoring the teeth back to the original height and establishing a balanced bite, which helps to eliminate the grinding problem.
Abrasion refers to wear that is caused by external forces. The most common are the type that is caused by hard brushing and the use of abrasive toothpaste. Also, depending upon cultural differences, certain diets can be highly abrasive. Typically, the type of abrasive wear that we see most is caused by toothbrush abrasion and it often results in notched out areas at the gum line. Treatment usually involves helping the patient to recognize the cause of the problem so that they can alter what they are doing and then restoring the worn away tooth structure. This treatment may only require a simple filling or two with composite bonding.
Erosion is the wearing away of tooth structure that is caused by acid. This is the least recognized form of tooth wear even though it has its own unique appearance that is quite different from attrition or abrasion. There are only two possible sources of acid in our mouths. There is the kind that we ingest, or bring in, and the kind that we regurgitate, or bring up.
The number one culprit of ingested acid is carbonated beverages or soda. Soda is highly acidic and the daily ingestion of soda can destroy enamel in a short period of time. Even acidic juice drinks like orange juice can have a deleterious effect on enamel. Ingested acid can damage the enamel on the surface of the front teeth, especially at the gum line, and at the biting surface of the back teeth.
Teeth that are worn due to acid erosion exhibit a satin-like surface texture and have rolled margins as opposed to sharp jagged edges seen in attrition from grinding. Treatment for all erosion cases involves identifying the cause of the acid and eliminating it. If soda drinking is causing the problem we will discuss and try to educate people about the harmful effects. Treatment in any case of acid erosion involves covering the exposed dentin and restoring the teeth back to their normal size and shape before any further damage can occur. In many cases the treatment will protect the remaining tooth structure, and prevent any further damage from occurring.
Excessive tooth wear is a serious problem that should not be ignored. In any case of excessive tooth wear, the key is proper diagnosis. Contact our office if you have any concerns.