Occlusal wear refers to the gradual loss of tooth structure over time, affecting the biting surfaces of teeth. While some degree of tooth wear is a natural part of aging, excessive or accelerated wear can lead to various dental problems and impact overall oral health. Understanding this process is important for maintaining a healthy and functional smile.
Understanding Occlusal Wear
Occlusal wear is the irreversible loss of tooth substance, specifically enamel and dentin, caused by mechanical action or chemical processes. It differs from dental caries, which are caused by bacterial activity. This loss can compromise tooth integrity, leading to increased sensitivity and a higher risk of decay.
Significant tooth structure loss can affect the alignment of teeth, potentially disrupting the natural harmony of the bite. This can lead to functional impairments, such as difficulty chewing, and may also contribute to muscle fatigue or temporomandibular joint (TMJ) disorders. Extensive wear can also impact the aesthetic appearance of teeth, causing them to appear shorter, discolored, or uneven.
Different Ways Teeth Wear Down
Teeth can wear down through several distinct mechanisms, each with unique characteristics.
Attrition
Attrition involves the loss of tooth substance due to direct tooth-to-tooth contact. This mechanical process affects biting and chewing surfaces and is often associated with parafunctional habits like teeth grinding, which can lead to significant wear.
Abrasion
Abrasion is the wearing away of tooth structure by friction from foreign objects. This can manifest as V-shaped or wedge-shaped indentations, particularly near the gumline. Common sources include aggressive toothbrushing, abrasive toothpastes, or habitual chewing on non-food items such as pens or fingernails.
Erosion
Erosion is the chemical dissolution of tooth structure caused by acids, without bacterial involvement. This process softens the enamel, making it more susceptible to further wear. Acids can originate from external sources like acidic foods and drinks, or internal sources such as stomach acid from acid reflux or frequent vomiting.
Abfraction
Abfraction refers to the loss of tooth structure at the gumline, often appearing as a V-shaped lesion. It is theorized to result from excessive biting forces causing the tooth to flex, leading to microfractures in the enamel, particularly at the cementoenamel junction. This type of wear is often linked to high occlusal forces and bite interferences.
Common Causes of Tooth Wear
Several factors contribute to the different types of tooth wear, often acting in combination.
Bruxism
Bruxism, the involuntary grinding or clenching of teeth, is a major cause of attrition. This parafunctional habit can exert substantial forces on teeth, leading to accelerated wear, particularly on molars and premolars. Stress and anxiety are also linked to an increased likelihood of bruxism.
Dietary Habits
Dietary habits play a significant role in dental erosion. Frequent consumption of highly acidic foods and beverages, such as carbonated drinks, fruit juices, citrus fruits, and even vinegar, can dissolve tooth enamel.
Oral Habits
Oral habits, beyond bruxism, can contribute to abrasion. Using a hard-bristled toothbrush, brushing with excessive force, or employing abrasive toothpastes can physically wear down tooth surfaces. Additionally, habits like chewing on pencils, biting nails, or using teeth to open packages can introduce foreign object friction, leading to abrasive wear.
Medical Conditions
Certain medical conditions can also contribute to tooth erosion. Gastroesophageal reflux disease (GERD), which causes stomach acid to flow back into the mouth, is a common intrinsic source of acid that can damage teeth. Eating disorders like bulimia, characterized by frequent vomiting, also expose teeth to corrosive stomach acids, leading to significant erosion. Medications that cause dry mouth can further exacerbate erosion by reducing saliva’s natural buffering capacity.
Improper Bite or Dental Work
An improper bite or poorly fitted dental work can also lead to uneven tooth wear. When teeth do not align correctly, certain teeth may experience excessive pressure and friction during chewing, accelerating wear on those specific areas.
Recognizing and Addressing Tooth Wear
Recognizing the signs of tooth wear early can help prevent more severe problems. Common indications include increased tooth sensitivity to hot, cold, or sweet stimuli, as the protective enamel layer thins and exposes the underlying dentin. Individuals may also notice changes in the shape or length of their teeth, such as flattening, chipping, or a more yellowish appearance due to exposed dentin. Jaw pain or headaches, particularly upon waking, can also signal tooth grinding related wear.
Untreated tooth wear can lead to various consequences. The continuous loss of tooth structure can eventually expose the dental pulp, potentially causing irreversible inflammation or tooth fracture. Aesthetic concerns, such as a more aged appearance of the smile, are also common. Functionally, significant wear can impair chewing efficiency and contribute to temporomandibular joint dysfunction.
Prevention strategies often involve identifying and addressing the underlying causes. For those with bruxism, a custom-made night guard can protect teeth from grinding forces during sleep. Dietary modifications, such as reducing the frequency and quantity of acidic food and drink consumption, are beneficial for preventing erosion. Proper brushing technique with a soft-bristled toothbrush and non-abrasive toothpaste helps minimize abrasion. Regular dental check-ups allow dentists to monitor for early signs of wear and provide tailored advice.
Addressing existing tooth wear involves various dental interventions depending on the severity and type of wear. For minor wear, dental bonding with tooth-colored composite resin can restore lost tooth structure. Porcelain veneers can be used to improve the appearance and protect front teeth that have experienced erosion. For more severely worn teeth, dental crowns may be necessary to cover and strengthen the entire tooth. In cases of bite misalignment, orthodontic treatment can help re-align teeth and distribute biting forces more evenly, reducing future wear.