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Tooth wear and abrasion, what can you do about it?

Have you found that as you have got older your teeth have begun to wear? You might have noticed that the teeth look squarer at the edges, have yellow stains in them and generally look worn down? So what causes this and what can you do about it?

In this blog our Oxford dentist walks you through the tooth wear index, what to do if you have wear and abrasion to prevent it getting worse and what your dentist can do to restore your teeth.

What is tooth wear caused by?

The wearing down of teeth is caused by one of three phenomenon namely abrasion, erosion and attrition.

Tooth wear by abrasion

This is where a tooth wears by some action other than the teeth rubbing together or by chewing. The most typical type of abrasion is abrasion from pressing too hard whilst brushing your teeth with a toothbrush. Other forms of abrasion can be caused by wearing lip or tongue piercings or chewing things like toothpicks and pens for excessive periods of time.

Tooth abrasion from a toothbrush is usually most apparent on the cheek side (buccal surface) of the tooth as this is where many people put too much pressure, the abrasion is very often down towards the gum margin where the enamel is thinner.

Tooth wear by erosion

This is where tooth structure is lost via chemical contact. This can chemicals which are ingested such as highly acidic drinks like fizzy drinks or excessive consumption of fruit juice. Tooth wear by erosion can also be caused by naturally occurring bodily acids which come into contact with the teeth, this is typically from reflux disease or various eating disorders.

Tooth wear by attrition

This is the most common cause of tooth wear and can be attributed to the teeth grinding together either during chewing (mastication) or teeth grinding (bruxism). Teeth will naturally where as we age but this wear rate can be increased if the teeth do not bite together properly.

Measuring tooth wear classification using the tooth wear index

Your dentist can measure tooth wear using this index as originally described by Smith and Knight, this can be useful if you feel that your teeth are wearing over an extended period, your dentist can use this index to monitor the wear of individual teeth. The index is as follows:

  • 0 – No loss of enamel surface characteristics and no change of contour.
  • 1 – loss of enamel characteristics and some minimal loss of contour.
  • 2- enamel loss which is just exposing the denting and less than 1/3 of the surface. Defect areas less than 1 mm.
  • 3 – enamel loss just exposing the dentine which is more than 1/3 of the surface. Defect areas 1-2 mm.
  • 4 – complete enamel loss or pulp exposure. Defect more than 2mm.

You may begin to notice sensitivity in your teeth when your tooth wear index reaches level 2.

Tooth Wear Management

The first place to start with managing tooth wear is to speak your dentist. They can assess the amount of wear using the index above and advise as to the cause, abrasion, erosion or attrition.

Tooth abrasion management

Advice and guidance on how to brush your teeth can be provided by the dental hygienist. They will be able to assess the location of the abrasion and work out what is causing it, very often it’s caused by pressing the toothbrush in difficult to reach areas.

Many electric toothbrushes also have a pressure sensor which let you know if you are pressing too hard, this can be very useful adjunct in controlling tooth abrasion.

Once you have the cause of the abrasion established and eliminated your dentist can then look to replace missing tooth structure. In minimal cases this will often be done using dental bonding, in more severe cases dental veneers dental crowns may be required.

Tooth erosion management

If the erosion is caused by external assets being ingested then the dental hygienist will be able to give you dietary advice on the amounts of these acidic drinks you should be drinking. If the erosion is caused by medical condition their medical advice will need to be sought.

Tooth attrition management

Your dentist will be able to assess the way your teeth move together, how they work as a unit and how your jaw functions. This is known as your ‘occlusion’ and your dentist will be able to spot malocclusions and recommend the best treatment. Sometimes this is rebuilding back teeth using dental bonding, ceramic overlays or dental crowns. It may also involve orthodontics to move teeth to a better position.

Before and after tooth wear treatment

After treatment, notice how the upper teeth have been rebuilt on the incisal edge ( this is the tip of the tooth on the opposite side of the gum). A more natural rounded shape has been achieved using dental crowns.

This post has been written by Dr Ajay Murgai, he is a highly experienced General and Cosmetic Dental Surgeon. Dr Ajay runs clinics in Hertfordshire, South Oxfordshire and Harley Street, and carries out a full spectrum of treatments from Aesthetic Dentistry to routine examinations.

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I am dropping a note to say thanks for all the work you have done for me, I am aware that I am not the easiest of patients. Your patience and explanations whilst work is underway was very much appreciated. The bridge work is really outstanding, here’s hoping I need nothing more than routine checks for some time.
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