Tooth Wear
This part of our web site will review some of the most important and overlooked problems many of our patients are affected by, the wearing away of valuable tooth structure. Most of this is preventable and treatable. Some of these topics are discussed in greater detail in other pages of our web site. Clicking on the highlighted text links will direct you there
If you, a relative, friend or coworker have any of these problems and your current dentist has not identified these problems, nor offered advice to help, please consider Dr. David A. Cook, and his team at Smiles @ France for your future dental care.
Bruxism—Clenching and Grinding of Teeth
Tooth wear from bruxism results in shortening, chipping, fracturing and roughening of teeth. It can destroy a healthy smile, weaken teeth, loosed them, cause them to shift, and alter speech by shortening the front teeth Bruxism is thoroughly discussed here (link). Bruxism is by far the most damaging cause of tooth wear and even tooth loss for our patients. Wearing a protective Tanner appliance at night offers significant protection from further damaging, protecting your valuable smile.
Tooling
“Tooling” is the act of using (abusing!) your teeth as a tool. You will eventually break, chip, wear or roughen your teeth if you use them to tool. Examples are:
- Trimming your fingernails or grooming your cuticles with your teeth.
- Opening cellophane bags, cereal bags or any bag with your teeth.
- Cutting plastic shopping tags with your teeth.
- Cutting loose threads from clothing or when sewing with your teeth.
- Cutting fishing lines with your teeth.
- Tearing duct or other tape with your teeth.
- Plus many more examples that we haven’t thought of!
Solution: Use a scissors, nail clipper, cuticle groomer or knife—not your teeth! Remember, your teeth are jewels, not tools!
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Tooling is a habit and is up to you to stop. If you want to see a fun video to help, visit Bob Newhart’s “Stop It” video on YouTube.
Tooth Brush Abuse—Gum Recession
If you scrub back and forth across your teeth, the bristles of your brush may damage your gums, irritating them to recess and expose the sensitive root of your teeth. While scrubbing does not clean them very well, it does wear the gum away. A gentle press and wiggle is a better technique.
If your toothbrush bristles flair out to the sides, you are scrubbing with too much pressure or too much velocity. Either way, you will damage your gums and teeth.
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The space between the normal gum level (green lines) and the present gum level (black lines) is the recession from aggressive tooth brushing. This distance is measured in millimeters and should be monitored by your dentist or hygienist.
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Tooth Paste Abuse—Loss of Tooth Structure
Now add some toothpaste to your aggressive scrubbing and the paste will erode the tooth away, creating extra sensitive divots or grooves on your teeth. The paste is the grit, or the abrasive, which does the damage. Modern soft brushes alone will not cause wear to the tooth, even if you scrub aggressively; you need to add some grit (toothpaste) for wear to occur.
Typically, we see this wear along the sides of the teeth near the gum line and often in combination with gum recession.
We recommend that you use a gentle brushing technique with no more than a pea-size amount of toothpaste, and never reload by adding more paste-the grit!
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The black circled areas show the worn teeth of toothpaste abuse and no gum recession. |
Acid Contribution to Tooth Paste Abuse—Accelerated Loss of Tooth Structure
Adding acid to your mouth on a regular basis will pre-dissolve the surface enamel on your teeth. This makes it easier for your toothbrush and paste to scrub it away—a double whammy! This may leave the teeth temperature and touch sensitive. Acid-corroded teeth are also extremely susceptible to decay. Acid comes from many sources as discussed below.
Enamel is the hard white covering over the softer, dark-yellow dentin. When the enamel is “scrubbed away,” the teeth look more yellow, aged and damaged as the darker dentin becomes exposed. Even though you may be tempted to do so, scrubbing harder does not get the teeth whiter—it just exposes more dark, yellow/orange dentin. If you brush right after stomach acid or acidic foods have softened your teeth, the abusive scrubbing wear is worse. Wait an hour to brush or eliminate the acid assault to your teeth!
If you are scrubbing to try to whiten your teeth, try professional whitening products that will do the job and not wear your tooth away.
Acid From Your Stomach—Gastric Reflux and Bulimia
Stomach acids can make their way into your mouth during sleep or when lying down. These acids rest on the surfaces of the teeth, slowly dissolving the tooth away. Tooth brushing, using a heavy hand and toothpaste as the grit, abrades teeth even faster.
Gastric Reflux Acids often accelerate wear on the back teeth more than the front. If you sleep on one side, that side may be affected more towards the cheek side of your back teeth.
Bulimia brings up the stomach acids and erodes the upper front teeth on the tongue side. As the tongue sides of the upper front teeth dissolves away, the edges chip, shorten, and often become a translucent blue from the thinning tooth loss. This tooth shortening is not aesthetic and can affect speech.
Sodas, Pops, Athletic Juices, Fruit Juices, Lemon Aid, Ice Tea, Wine, “Sour” Candies… Are Just a Few Sources of Acid
“Sip all day, get decay!” This is a message from the Minnesota Dental Association. This campaign emphasizes the decay that can form from the acids and sugars in our drinks. However, even the acids in diet, energy drinks, mineral waters and sports drinks, can add to the dissolving of your teeth. Consuming these drinks quickly does some limited damage, but sipping and nursing these drinks for an extended period of time can be devastating. It is the frequency and duration of time, not simply the volume that contributes to the destruction of your teeth.
Athletes and people who workout are becoming prone to this by consuming energy or mineral/electrolyte drinks that contain citric acid. Citric acid is more tooth-dissolving than phosphoric acid. The more “natural” or closer the citric acid is to being from a fruit, the more it dissolves the calcium and phosphorus that makes up your tooth. Sip water, but quickly down your energy drink if you need it to compete.
Carbonation adds acid to the fizz, because the carbon dioxide creates carbonic acid. If you think acidic diet beverages are harmless, think again! The acids to watch out for are citric acid, phosphoric acid, ascorbic acid (vitamin C), acetic acid (vinegar), carbonic acid. They all dissolve tooth structure. Read you beverage and candy labels carefully. Use these drinks thoughtfully by drinking, never sipping.
Take aggressive brushing, add some toothpaste (the grit) and watch the acid corrosion and the grit erosion irreversibly damage your teeth.
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Severe wear from acid erosion, toothbrush and toothpaste abuse, along with bruxism. |
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A Prescription for Severe Tooth Wear as Shown Above:
- Sip ice tea all day. Eat tart acid candies. The chronic acid pre-softens and dissolves away tooth surface.
- Add aggressive brushing with a toothbrush. This person literally saws the tops and sides of his teeth off with the brush, exposing the softer, dark-yellow/orange, sensitive dentin.
- Add a lot of toothpaste, which is the source of the grit abrasive. Reloading the brush makes it worse! Now you can really scrub/saw the teeth away.
- Grind teeth at night to add to the tooth loss and you get this extremely severe wear.
- Keep on going to the same busy clinic that does not advise you of these problems, nor take the time to offer solutions.
Excessive Citrus Fruit Eating
“Eat your fruits and vegetables.” Good advice for a healthy diet, but overdo it by eating citrus fruit throughout the day and the natural citric acids from oranges, grapefruits, and pineapples can dissolve the teeth. Chronic chewing on Vitamin C tablets (ascorbic acid) can also cause acid corrosion of your teeth. Enjoy your fruits with your meals of an infrequent snack.
What Do You Do If You Have Tooth Wear?
- Become a member of a dental practice that understands and treats these problems on a regular basis.
- See us and learn how to clean your teeth without damaging them.
- Ask us about prescription-strength, professional products that protect and rebuild your enamel and reduce sensitivity.
- Stop eating tart, acidic candies, especially your children!
- Reduce or eliminate intake of carbonated drinks, fruit drinks, energy drinks, juices, wine…
- If you like these drinks, drink them quickly and with a meal. Consider using a straw. Don’t sip, graze, nibble or snack on them.
- Don’t hold or swish acidic foods and drinks inside the mouth.
- Chew sugar-free gum with the sweetener Xylitol, which stimulates protective saliva and inhibits decay. Suck a sugar-free Xylitol lozenge or eat a piece of cheese after an acidic meal to encourage saliva and protect the enamel.
- Delay tooth brushing for at least one hour after consuming acidic food or drink.
- Brush with an extra-soft toothbrush, with a gentle technique. Use a low-abrasion, high-fluoride, anti-hypersensitivity dentifrice.
- Floss twice a day. Flossing may be more beneficial than brushing for prevention of tooth decay and periodontal disease.
- If stomach acids are a cause, see your physician for help.
- Invest in a custom-fitted hard appliance to protect your teeth from nightly clenching and grinding. Soft mouthguards may destabilize your bite and will increase your nightly clenching—avoid them!
“Your Prized Lamborghini” – A Story to Remember and Tell Your Friends!
Imagine that you own and drive the most exotic car you can envision, a Lamborghini, which you inherited from your late, rich uncle when you were 12—even before you could drive. You love this prized car and plan on keeping it for your entire lifetime! Now imagine that you live in the country and your car does not stay in a regular garage, it stays in your barn, a barn just for your car. You park this valuable automobile in the exact same place in the barn every day. You also have two prized pet homing pigeons that live in this same barn and roost directly above the hood of your car. 2-4 times a day they do what pigeons do—make a mess on the hood of your beautiful car with pigeon poop! 2-4 times is the same number of times you brush your teeth each day and the same number of times you clean the pigeon poop from your car each day. You have been cleaning this pigeon poop from your car since you were 12. Coincidentally, 12 was the age when you finally acquired most of your adult teeth!
Worse yet, these prized pigeons have a steady diet of acidic foods and drinks: pop, diet pop, citrus juices and ice teas—anything they can scavenge. This makes their pigeon poop acidic, able to dissolve and pre-soften the enamel finish on your car. Now imagine how you would go about cleaning this acidic pigeon poop from the highly polished enamel surface of your prized car, especially after it has dried on and the acid begins to soften the finish. We suspect you would proceed VERY CAREFULLY with lots of water, a gentle, grit-free detergent and a very soft cloth. You would be extremely careful so as not to scratch or wear away the beautiful finish on the hood of your car.
Would you ever consider taking your toothbrush, loading it up with your favorite toothpaste and aggressively scrubbing away the pigeon poop from the same place on the hood of your car 2-4 times per day every day from age 12 on? Would you pre-soften the car’s enamel finish with acid? Of course not! You instinctively know that this would ruin the enamel surface of your prized car and it wouldn’t remain beautiful through your old age as you had hoped.
It’s not as instinctive for people to know this, but treating your teeth this same way will ruin the tooth enamel surfaces too. You want your teeth to last through your old age. They require the same gentle care as cleaning a prized car would! Remember, aggressively scrubbing your teeth with a toothbrush loaded with an abrasive toothpaste can have the same detrimental effect on your tooth enamel as it would on the enamel surface of an automobile! Shouldn’t you be as careful with the beautiful enamel surfaces of your “prized” teeth as you would be with a car?
