Tooth wear is the irreversible loss of tooth surface. The term used to describe the progressive loss of a tooth’s surface due to means other than those which cause tooth decay or dental trauma. As people age there is a certain amount of wear and tear that occurs and is considered normal but pathologic tooth wear is wear that occurs beyond the scope of what is considered typical. The resulting structural loss can harm appearance, impair function and chewing ability of an individual and can cause sensitivity and pain if tooth wear exposes the nerve or when natural reparative processes, such as remineralization, are no longer sufficient to protect the tooth.
Traditionally tooth decay and gum disease have been the main risks to teeth but increasingly perfect teeth are wearing down or dissolving away .The damage can also become costly and complex to repair.Dentists in Delhi are providing systematic full mouth rehabilitation treatment plans for generalized tooth wear in patients. Tooth wear is a very common condition that occurs in approximately 97% of the population.
Wear processes are implicated in the development of dentine hypersensitivity. Saliva confers the major protective function against wear due to its role in pellicle formation, buffering, acid clearance, and hard tissue remineralization. But saliva can modulate erosive/abrasive tooth wear through formation of pellicle and by remineralisation but cannot prevent it.
Teeth wear increases with age. For all age groups, males had a higher prevalence of tooth wear than females. It is sometimes difficult to determine the type of tooth wear present because different types frequently occur together.
The amount of tooth wear seen currently is considerably greater than in the past due to the fact that more people are now retaining their natural teeth into old age.
Tooth wear is majorly the result of three processes- Attrition, Abrasion and Erosion. These forms of tooth wear can further lead to a condition known as Abfraction where by tooth tissue is ‘fractured’ due to stress lesions caused by extrinsic forces on the enamel. Tooth wear is a complex, multi-factorial problem and there is difficulty identifying a single causative factor. However, tooth wear is often a combination of the above mechanisms.
Abrasion and attrition are sources of physical wear commonly associated with tooth brushing and tooth-to-tooth contact, respectively. A further process (abfraction) might potentiate wear by abrasion and/or erosion. A combination of erosion and abrasion or attrition exacerbates wear.
Abrasion is the progressive loss of hard tooth structure caused by mechanical actions from a foreign element (rubbing or scraping) other than mastication or tooth-to tooth contacts. Abrasion is commonly associated with incorrect or overzealous toothbrushing with hard bristle toothbrush, abrasive toothpastes giving rise to notching at the junction of the crown and root of teeth. It will also be seen in individuals who use their teeth as a tool (e.g., to remove bottle tops, to hold pins, clips, frequently putting foreign objects such as pen or nail biting). When abrasion is caused by a particular habit such as biting pencils or a lip piercing the pattern of notching or chipping will correspond to the habit or it can occur anywhere that the foreign object rubs on the teeth. Abrasive wear may be seen in a wide range of patients.
The signs of dental abrasion may include:
Erosion is the progressive loss or dissolution of tooth substance (enamel) by chemicals or acidic substances, and no bacteria are involved. If unchecked, will progress to irreversible loss of surface tissue, potentially exposing the underlying layer of dentine. The acid dissolves the calcium in the tooth .Sources of acid attack in the mouth is dietary, gastric or occupational. Erosion of tooth surfaces is mostly the results of too frequent or inappropriate use of carbonated drinks (including sparkling water), fruit juices with high levels of acidity, excess alcohol and frothing or swishing acidic drinks around the mouth increases the risk. This habit would appear to be particularly common amongst teenagers and young adults. Erosion is also a problem in individuals who suffer from stomach acid during the digestive process which is sufficiently powerful to dissolve any food, including bone and teeth(e.g. gastro esophageal reflux disease, hiatus hernia, heartburn) 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. Vomiting due to morning sickness and a number of medications such as vitamin C, aspirin and some iron preparations are also acidic and may contribute towards acid erosion.
Every time acid touches the surface of your teeth the enamel becomes softer and loses some of its mineral content. Your saliva will slowly neutralize the acid in your mouth and restore it to its natural balance. However, if the acid attack happens too frequently, the teeth do not have a chance to repair themselves and tiny particles of enamel can be washed or worn away. Minerals dissolve from the tooth surface and like a cliff face with a tide moving in and out, eventually collapses lost forever.
The presence of acid is not the only way in which the wear of enamel occurs. Another mechanism is called chelation. The type of acid, calcium chelating properties, and temperature and exposure time are factors that determine the amount of erosion that occurs. The lower the pH of a product, the more acidic it is but products such as citrus fruits appear worse as they bind (chelate) more calcium from the tooth. Hence orange juice is actually worse than cola.
Any food or drink with a pH lower than 5 may cause tooth wear and tooth sensitivity.
The signs of dental erosion may include:
Other factors that contribute to erosive tooth wear include:
Attrition is the progressive loss of hard dental tissue through physical tooth-tooth contact caused by mastication or grinding between opposing teeth. The extent of attrition will depend upon the use to which an individual puts their teeth. It occurs when opposing teeth surfaces contact for long periods of time and with higher pressures than normal. For example, it will increase in people who habitually clench or grind their teeth (a condition known as bruxism), e.g., during sleep or by a bad bite and therefore so many people are totally unaware of it. Others notice that they clench when tense or when doing certain activities. It is often painless and as tooth wear progresses very gradually it is easily overlooked. It will also tend to be more pronounced in people who eat a particularly fibrous diet. It is limited to the contacting surfaces of the teeth.
The signs of dental attrition might include:
Abfraction is loss of tooth structure leading to minute flexure of teeth that causes tiny fractures in enamel and dentin. Stress that leads to tooth flexure can be caused by chewing or by tooth grinding where the enamel is thinner and therefore is prone to fracture. Some patients may experience cold and touch sensitivity, like an electric shock when the neck of the tooth is touched by a finger nail. This is because the neck of the tooth flexes and cracks with excessive forces which together with erosion and abrasion can create a wedge like lesion. These areas of wear and tooth loss typically occur as a triangular lesions or notches at the cervical margins (gum line level) of the buccal surface of the tooth and are more commonly now referred to as non-carious-cervical lesions.
All tooth wear is likely to be multifactorial while it is not entirely preventable, it can be slowed down considerably. To minimize the risk-
Dentists in Delhi and Dentists in India are regularly doing treatments for the various types of tooth wear.
In fact in reputed dental clinics in Delhi, like Smile Delhi-The Dental Clinic, patients requiring full mouth rehabilitations are coming from other countries (as part of dental tourism) to get their entire rehabilitation done.
Posted By – Dr. Shriya