The concern that “my teeth are getting smaller” refers to tooth wear, where tooth structure gradually diminishes. It’s not about teeth shrinking, but the loss of outer layers like enamel and underlying dentin. This wear alters the shape, size, and appearance of teeth, making them appear shorter, flatter, or discolored. It impacts dental health and smile aesthetics, often progressing slowly and unnoticed.
Common Causes of Tooth Wear
Tooth wear results from mechanical and chemical processes that erode protective tooth structure. Three primary mechanisms contribute to this gradual reduction in tooth size: attrition, abrasion, and erosion.
Attrition
Attrition involves tooth-on-tooth contact, grinding away dental surfaces. This wear commonly affects chewing surfaces of back teeth and biting edges of front teeth, leading to a flattened appearance. Bruxism, the habitual grinding or clenching of teeth, often occurs unconsciously during sleep or in response to stress, is a leading cause of excessive attrition. Misaligned teeth can also contribute to uneven forces, accelerating wear.
Abrasion
Abrasion is mechanical wear of tooth structure from external objects or forces. This can result from aggressive or incorrect toothbrushing techniques, especially with hard-bristled brushes or abrasive toothpastes. Other common culprits include chewing on non-food items like pen caps, ice, or fingernails, and oral piercings rubbing against tooth surfaces. Abrasion often manifests as wedge-shaped or V-shaped indentations near the gumline.
Erosion
Erosion is the chemical dissolution of tooth enamel due to acids, without bacterial involvement. These acids can be extrinsic, from highly acidic foods and drinks like citrus fruits, sodas, sports drinks, and fruit juices. Intrinsic sources of acid include stomach acid from conditions like gastroesophageal reflux disease (GERD) or frequent vomiting. Erosion softens the enamel, making teeth more susceptible to physical damage from abrasion or attrition.
Recognizing the Signs
Identifying signs of tooth wear early helps prevent more extensive damage. One noticeable indicator is visible shortening or flattening of teeth. This change is particularly evident on chewing surfaces and biting edges.
Sensitivity
Increased sensitivity to hot, cold, or sweet stimuli is a common symptom. As enamel wears away, the underlying dentin becomes exposed, leading to discomfort. Teeth may also exhibit color changes, appearing duller or more yellow, as the loss of white enamel reveals yellowish dentin beneath.
Other Signs
Other signs include sharp edges, chips, or small cracks, especially with wear from grinding. Specific patterns of wear, such as “cupping” (concave depressions) on chewing surfaces or notches at the gumline, also indicate tooth wear. Changes in how upper and lower teeth meet might also suggest ongoing wear, particularly from clenching or grinding.
Treatment and Management Options
Addressing tooth wear begins with identifying and managing underlying causes to prevent further damage. For bruxism, a dentist may recommend a custom-fitted nightguard to protect teeth from grinding and clenching forces. Dietary counseling helps individuals reduce acidic food and drink consumption, and medical treatment for conditions like GERD or eating disorders can mitigate intrinsic acid exposure. Advice on proper oral hygiene techniques, such as using a soft-bristled toothbrush and non-abrasive toothpaste, can address abrasion.
Minor Wear
Once causes are managed, dental professionals can restore lost tooth structure and function. For minor wear, composite bonding involves applying a tooth-colored resin to rebuild worn edges and improve appearance. This is a minimally invasive option often completed in a single visit.
Significant Wear
When wear is more significant, porcelain veneers or crowns may be necessary. Veneers are thin, custom-made shells bonded to the front surface of teeth to restore shape, size, and appearance, offering protection from further damage. Crowns cover the entire visible portion of a severely worn or damaged tooth, providing maximum support and restoring its strength and function. Regular dental check-ups are crucial for monitoring tooth wear and determining the most appropriate treatment.
Preventing Future Tooth Wear
Preventing tooth wear involves adopting habits that protect enamel from mechanical and chemical assaults. Limiting frequency and duration of exposure to acidic foods and drinks is beneficial; if consumed, rinsing the mouth with water afterward helps neutralize acids. Using a straw for acidic beverages can also minimize direct contact with tooth surfaces.
Oral Hygiene
Maintaining proper oral hygiene is important. Using a soft-bristled toothbrush with gentle, circular motions and a non-abrasive fluoride toothpaste helps clean teeth effectively without causing abrasion. It is advisable to wait at least 30 minutes after consuming acidic foods or drinks before brushing, allowing saliva to remineralize the enamel. Chewing sugar-free gum after meals can stimulate saliva flow, which naturally helps neutralize acids and protect teeth.
Habit Management
Managing habits that contribute to wear, such as teeth grinding or clenching, is a preventative measure. Stress reduction techniques can help, and a dentist might recommend a custom nightguard to protect teeth during sleep. Promptly addressing underlying health conditions like acid reflux or eating disorders with a medical doctor can prevent severe intrinsic erosion. Regular dental visits allow for early detection of tooth wear and professional guidance on preventative strategies.