Tooth wear refers to the gradual loss of tooth structure that occurs due to processes other than dental cavities. This common phenomenon affects a significant portion of the adult population worldwide. Understanding its various forms is helpful for maintaining long-term dental health and preventing further damage.
Understanding Different Types
Tooth wear manifests in several distinct forms, each characterized by a unique mechanism of material loss.
Attrition involves the loss of tooth structure from direct tooth-to-tooth contact, often seen on chewing surfaces. This wear can occur during normal chewing or during habits like teeth grinding or clenching.
Abrasion describes the mechanical wear of tooth structure caused by foreign objects rubbing against the tooth surface. Examples include aggressive toothbrushing, abrasive toothpastes, or habitual chewing on non-food items like pens or ice. Erosion, by contrast, is the chemical dissolution of tooth structure by acids, without bacterial involvement. This process often leaves a smooth, scooped-out appearance on the tooth surface.
Abfraction is a specific type of tooth wear that presents as a wedge-shaped or V-shaped notch near the gumline. It is believed to be caused by microscopic flexural forces acting on the tooth during chewing or clenching. These forces concentrate stress at the cervical (neck) region of the tooth, leading to the breakdown of enamel and dentin.
Common Causes
The causes of tooth wear are diverse, stemming from habits, dietary choices, and underlying health conditions.
Attrition is linked to bruxism, the involuntary grinding or clenching of teeth, particularly during sleep. Misaligned bites can also contribute by creating uneven forces during chewing, leading to accelerated wear on specific teeth.
Abrasion results from external mechanical forces applied to the teeth. Brushing too vigorously with a hard-bristled toothbrush or using abrasive toothpastes can wear away enamel and dentin. Repetitive habits, such as biting fingernails, chewing on pencils, or holding pins between the teeth, also cause abrasion.
Erosion is driven by exposure to acidic substances. Frequent consumption of highly acidic foods and beverages, including citrus fruits, carbonated sodas, and sports drinks, can dissolve tooth enamel. Medical conditions like gastroesophageal reflux disease (GERD), which brings stomach acid into the mouth, or bulimia nervosa, involving recurrent vomiting, also expose teeth to corrosive acids.
Abfraction is initiated by excessive occlusal forces, which are the pressures exerted on the teeth when they come together. When these forces are uneven or excessive, they can cause the tooth to flex slightly at its neck. This repeated flexing leads to microscopic fractures and loss of tooth structure in that area.
Recognizing the Signs
Early identification of tooth wear involves observing visual changes and experiencing certain sensations. Visually, affected teeth may show flattened biting surfaces, losing their natural contours and cusps. Small, shiny spots can appear on the enamel, indicating thinning. Existing dental fillings might appear to rise above the surrounding tooth structure due to wear.
In more advanced cases, teeth may exhibit chipping or fracturing, especially along the edges. The gum line can recede, exposing more of the tooth root, and a distinctive “notched” or V-shaped appearance might develop near the gumline. From a sensory perspective, individuals often report increased tooth sensitivity to hot, cold, or sweet foods and drinks as the protective enamel layer diminishes. Discomfort or pain during chewing, along with changes in how the upper and lower teeth meet, can also signal the progression of tooth wear.
Protecting Your Teeth
Preventing and managing tooth wear involves a multi-faceted approach, starting with adjustments to daily habits. Reducing the intake of acidic foods and beverages, or rinsing the mouth with water immediately after consumption, can help neutralize acids before they cause significant damage. Adopting proper toothbrushing techniques, using a soft-bristled brush with gentle pressure, helps prevent abrasive wear. Incorporating fluoride-containing toothpastes and mouthwashes can strengthen enamel, making it more resistant to acid attacks.
Addressing habits like teeth grinding or clenching is important; custom-fitted nightguards can protect teeth from attrition during sleep. Stress management techniques may help reduce the frequency and intensity of bruxism. Avoiding chewing on non-food items, such as ice, pens, or fingernails, eliminates a common source of abrasion. Regular dental check-ups are beneficial for early detection of wear, allowing for timely intervention. Dental professionals can offer treatments like dental bonding, crowns, or veneers to restore worn teeth, or recommend bite adjustments to correct misaligned forces and protect remaining tooth structure.