Most people think that it is. If teeth do wear away, they do so very slowly; so, a typical dental patient does not even realize that he or she may have as much as twenty to fifty percent attrition. Patients with such wear rarely feel pain, are still able to eat well, and are simply unaware that a problem exists.
In fact, tooth wear is not normal, but is one of the three classic signs of an unstable bite. Dentists regularly see older folks whose teeth exhibit almost no wear. These folks have healthy bites, no destructive oral habits, and avoid foods and beverages which contribute to wear. Dentists also frequently see teenagers and twenty-somethings whose teeth exhibit wear that one would expect to see in a senior citizen. The causes of such wear run the gamut. I recently saw a 26-year-old who exhibited at least thirty percent wear on four of his front teeth. In this case, the cause was very straightforward – a tongue bar (piercing) with which he developed a habit of playing with his teeth. Simply removing the bar helped to slow his wear problem, but did not solve or reverse his attrition. Repairs are required to avoid additional wear due to the exposure of the softer layers of his teeth – but more on this later.
A more common cause of tooth enamel erosion is the presence of acid which softens exposed tooth surfaces. Sources of acid include stomach digestive fluids which enter the mouth because of chronic acid reflux through the esophagus, eating disorders like bulimia, or frequent ingestion of acidic foods like soda or citric fruit juices. Patients often do not realize that they have a potentially life-threatening problem with acid reflux (GERD). Such patients may develop severe ulcers on their esophagus and may begin to notice chronic heartburn. But, fortunately, the appearance of a specific type of tooth erosion indicates this condition, and our routine examinations will uncover it.
What is the most common cause of tooth wear? Occlusion – or really malocclusion – as I alluded to in our previous blog. Teeth that meet prematurely (before all the others) will respond by wearing down, getting loose, or moving out of position. Sometimes, teeth just do not have a “home” place to meet opposing teeth, and during the chewing movement such teeth must withstand destructive forces. Similarly, patients frequently exhibit extensive wear on teeth which oppose old crowns and bridgework. Most such dental work is made of porcelain, which is much harder than natural teeth. If the bite is not quite right in these cases, the natural teeth lose the battle of which tooth is in the way. Still other people have a habit of grinding or clenching their teeth. And, if such patients have any irregularities in their occlusion, aggressive tooth wear is a quite common consequence.
I could ramble on about the myriad of causes of tooth wear, but let us get to the crux of the matter. A tooth is composed of three basic layers. The outer layer, which is visible above the gum, is called enamel. Enamel is the hardest substance in your body and is the beautiful, white, outermost, non-sensitive layer. Just under the enamel is dentin. Dentin is yellowish in color, and much softer (some sources say seven times softer) than enamel. This layer can sometimes be sensitive if exposed. The innermost layer is called pulp. Pulp contains nerves, blood vessels and soft tissue. If the enamel wears away enough to expose dentin, the wear process will speed up because the dentin is so soft. Since dentin supports enamel, as dentin wears away, the enamel eventually begins to chip leaving a ragged appearance to the edges of the teeth. And, by the time a patient realizes that his or her teeth have worn down enough to warrant some repair, a more invasive, expensive and time-consuming service will have become necessary. In advanced cases of tooth wear, the only solution is full mouth rehabilitation if the patient chooses to save his or her teeth. Finally, as tooth wear advances, the jaws can get closer and closer together. As this occurs, the chin and nose get closer together as well, causing an aged appearance of the face. Earlier is definitely better when it comes to addressing occlusal wear problems.
If you have any concerns or questions about tooth wear, please feel free to call us to discuss your problem (908.359.6655) or you may email @ info@DesignsForDentalHealth.com. Finally, if you have any suggestions for future blog subjects, we would appreciate hearing from you.
