Tooth Wear

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Causes of Wear

The surface and structure of teeth are progressively reduced as a result of internal &/or external forces placed upon them.

ATTRITION / ABRASION / EROSION / ABFRACTION

Attrition

Attrition is when the tooth structure is worn away due to grinding &/or clenching, what we know to be bruxism. Wear damage tends to be more severe for patients whom exhibit this behavior at night.

What is Bruxism?

Teeth grinding and clenching is a habit that dentists refer to as “bruxism".   Bruxism is associated with subconsciously clenching or grinding the teeth, especially in situations of stress &/or during sleep. In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to excessive wear & tear of teeth, fillings, and crowns or the jaw, even attributing to tension-type headaches, severe facial or jaw pain, or TMD.

Causes of Bruxism:

Chronic Stress

Many people notice that they grind or clench their teeth during periods of stress. It may be that you tighten your jaw during the day, or that you wake up in the morning feeling sore because your jaws have been grinding against each other through out the night.

Decreasing daily stress is often easier said than done. While stress isn’t always avoidable, some lifestyle changes can help. When possible, make changes to lower your stress level. Cutting back on caffeine, stimulants, and getting exercise can help your body to self-regulate.

Sleep Apnea

Certain types of sleeping disorders such as obstructive sleep apnea can also cause bruxism. The clenching and grinding occurs as your body tarts to feel deprived of oxygen, causing he muscles to tighten up as you gasp for air. Wear and tear of the teeth may be one of the first signs of sleep apnea. Your sleep partner may be the first person to pick up on the snoring, lapse in breathing, or noises from grinding your teeth.

Treatment Options for Bruxism

A custom bite splint or night guard is an excellent way to prevent the jaws from fully engaging to the point that teeth wear against one another, giving you just enough space so that the mouth can be closed yet still relaxed. We can decrease the wear and tear of our patients’ teeth and restorations, resulting in greater stability and longevity of both their fillings and dentition.

These oral appliances do not stop grinding or clenching activity, they are extremely helpful in preventing or stopping damage to the teeth, jaw muscles and temporomandibular joints (TMJs). The relief obtained by these devices is sometimes remarkable and can occur within a short period of time. These appliances produce the best results when custom-fit, monitored and modified over time. The process of fabricating the night guards involves quick impressions/molds in the office. Two weeks later we will have a lab-fabricated custom fit night guard ready for you. This second try-in visit usually requires quick minor bite adjustments. Over the counter night, guards are available but the vast majority of them will not fit well.  A good fit will increase the chances of proper compliance. Better compliance equates to more protection which is our objective for our patients. Additionally, OTC guards tend to provide a false sense of protection due to the dramatic decrease in thickness during the fitting process, similar to our issue with boil and bite athletic mouthguards.

Important to know, an oral appliance is not designed to move your teeth or rearrange your bite but instead serves as a shock absorber and oral cushion. It may be designed to be worn on your upper teeth or your lower teeth, depending upon the nature of your problem.

As for treatment of bruxism associated with sleep apnea, an oral sleep appliance may be able to provide effective relief and a better night’s rest with the first use. Such appliances position the lower jaw in such a way that the airway is naturally opened, and the teeth do not engage one another.

Erosion

Erosion is the reduction of tooth structure due to chemical forces. Over time, this acid dissolves the outer enamel layer, exposing the much softer dentin layer.

Causes of Erosion:

Intrinsic - Stomach Acid 

Regular acid exposure of stomach acids in the oral cavity can be catastrophic.  Some more common examples are:

  • GERD/Reflux 
  • Bulimia 
  • Vomitting during pregnancy 

Extrinsic - Diet & Environmental Factors

  • Organic Acids 
    • Citric Acid 
      •  in fruits and drinks and used as an additive in carbonated beverages, Vit C tablets 
      • Citric acid has the ability to continue dissolution of tooth structure even after ph increases 
      • One of the most potent erosive agents 
    • Fruits - Found in pineapples, grapefruits, apples, blackberris and black currants 
    • Carbonic Acid - found in all carbonated beverages 
    • Ketchup 
  • Acidic Medications 
  • Professional Wine Tasting 
  • Vinegar and vinegar-based foods & 
  • Swimming in highly/improperly chlorinated pool water 

Frequency & Contact Time of acids 

  • Holding & swirling acidic beverages 
  • Sipping on acidic beverages through out the day 

Management of Erosion:

  • Reduce the acid exposure by reducing the frequency & contact time 
  • Avoid chewable and effervescent/liquid formulations- choose tablets over liquid when possible  
  • Avoid acidic mouthwashes 
  • Avoid toothbrushing immediately after acid attack 
  • Chew with xylitol-containing gum/lozenges 
  • Drink Water frequently 
  • Consider Remineralization Strategy which promotes remineralization & pH neutralization
  • Regular check-ups with your medical doctors
  • Regular dental check-ups

Abrasion

Abrasion is physical wear caused by materials other than teeth. Abrasive wear can be caused by improper/overzealous  tooth brushing technique, excessive use of tooth picks, & use of teeth as a tool.

Causes of Abrasion: 

  • Abrasive Toothpastes - specifically daily use of whitening pastes 
  • Overzealous and improper brushing techniques 

Abfraction

Abfraction is the loss of tooth structure is from biomechanical loading forces. The loss of tooth structure is in the areas of stress concentration which present as notches near the gum line. 

Causes of Abfractions

  • Bruxism/Clenching 
  • Parafunction 
  • Stress from Swallowing & Chewing 
  • Premature contacts 
  • Habits- associated with biting hard objects: e.g. pencils/pipe stems/fingernails 
  • Eating hard foods
  • Occupations- holding nails with teeth, playing wind instruments 
  • Dental Appliances- orthodontics appliances, partial denture clasps/rest