Worn Down Teeth? Causes and Treatment

Worn-Down Teeth Causes and Treatment

Tooth wear has become increasingly common as of late, especially among the older age group of people. Although a grave dental condition, if diagnosed early on, it can be treated and even prevented. Tooth wear is the loss of tooth surface or substance by means other than dental caries. The incidence of tooth wear is so common that about 97% of the general adult population suffers from any varying levels of tooth wear at least in one or more teeth. Some wear to the teeth is a natural side-effect of the aging process, with the worn teeth coming smaller in size and darker in color, primarily due to the exposure of the underlying dentin.

What does the tooth enamel do?

The enamel of the tooth is the outermost protective layer that prevents the ingress of bacteria and acid into the underlying dentin and pulp. It is the hardest tissue material in the entire body and comprises the outer structure of the tooth crown. Because enamel is translucent in nature, light is readily reflected from it, giving teeth the gleaming whitish hue. Akin to the enamel, the dentin is also a protective layer that ensures that the innermost chamber of the tooth (the pulp) is secured and the nerves and blood vessels in it are not damaged due to the invasion of bacteria. However, unlike the enamel, the dentin is yellowish or white-ish in hue, which is why the exposure of dentin due to enamel “erosion” causes the affected teeth to look yellower than naturally prevalent.

What are the environmental causes of teeth wear?

Depending on the causative factor, accelerated tooth wear and tooth structure loss can typically be categorized into four major sub-groups, namely:

Attrition

Attrition is the physiologic loss of tooth structure mainly due to excessive or unnecessary tooth-to-tooth contact and movement. Here, the biting and chewing surfaces of the teeth (occlusal surfaces) are worn down and ground due to the contact with teeth of the opposite arch. A common offender for the onset of attrition is the parafunctional disorder of bruxism. Bruxism is a movement disorder that is majorly distinguished by the action of involuntary teeth grinding and jaw clenching. It can be of two types- awake and sleep bruxism. Awake bruxism (AB) has a superseded predisposition in women as compared to men and occurs in the daytime as a reaction to customary emotions like concentration, frustration, or the occasional anger.

Sleep bruxism (SB), on the other hand, is the rhythmic act of grinding, gnashing, or clenching of the teeth during sleep and is seriously linked to stress and it’s uncommunicated effects. The loss of tooth structure in attrition is characterized by the “flattening” of the occlusal surfaces of the teeth. In some cases, the teeth may even be reduced to stumps due to repeated grinding of the teeth. Often, the dentin is exposed, weakening the tooth and making it more sensitive to temperature extremes.

Abrasion

Abrasion is the mechanical loss of tooth enamel due to unwarranted friction between teeth and an external or foreign agent, most commonly, a toothbrush. It may be safe to say that we have all, at one point in our lives, encountered a person who brushes their teeth way too aggressively to the point where their toothbrushes become frayed in the duration of just a few days. Aggressive or violent toothbrushing is the key reason for abrasion whereby the force applied on the tooth enamel during brushing is heavily overloaded. This results in the “scrubbing” away of the tooth enamel.

The distinctive sign of an abrased tooth is the V-shaped or wedge-shaped ditch that appears on the tooth just adjacent to the gum line. In order to prevent this from happening, it is important to remember to use gentle pressure on the teeth with your toothbrush during brushing. You may also switch out for a less abrasive toothpaste for routine use.

Erosion

Erosion is the chemical loss of tooth structure that occurs when the oral cavity is exposed to high levels of acid that changes the pH of the mouth and results in tooth enamel deterioration. The tooth enamel may be dissolved through acid caused by the high intake of acidic foods and drinks such as carbonated drinks in your diet. Erosion is also a common symptom as seen in patients suffering from gastroesophageal reflux disease (GERD) wherein the patient tends to regurgitate the stomach acids, foods, and drinks back from the stomach into the esophagus.

Tooth wear due to erosion is manifested as a crescent-shaped ditch in the area of the tooth near the occlusal surface. The loss of tooth structure also gives teeth a smooth, shiny appearance. Tooth erosion is common among bulimic patients. Steer clear of acidic foods.

Abfraction

Abfraction is the pathological loss of tooth structure caused by the biomechanical loading forces that result in flexure and failure of the enamel. When teeth flex under pressure, they touch each other in occlusion, creating tension on one side and compression on the other side of the teeth. Due to excessive flexure forces, the tension side of the loading forces forms a V-shaped depression whereas the compression side forms a C-shaped depression.

The lesions from tooth abfraction are primarily at the cervical regions, typically wedge-shaped, with sharp internal and external line angles.

Treatment options for tooth wear

Once your dentist confirms that you are, in fact, suffering from tooth wear that in unnatural in its nature and progression, they will plan out the treatment procedures that will best benefit your teeth and oral health. In order to correct existing wear, the dentist may recommend you to avail of one of these treatment options.

Dental bonding

Dental bonding is a procedure where a tooth-colored resin material is applied onto your tooth surfaces that exhibit deficiencies or crevices. This is a minimally invasive procedure with a wide range of applications such as for mildly broken, chipped, discolored, worn down, or cracked teeth. The resin helps cover the worn surfaces and in turn, improves the appearance of your teeth. With teeth bonding, the dentist is also able to alter the shape and size of your teeth. So, even if your teeth have worn down to a significant degree, your teeth may still be corrected with the help of dental bonding.

Crowns

If teeth are grossly worn down on several surfaces, your dentist may opt for a dental crown. A crown is typically made of porcelain or composite and is a full-coverage solution to your worn teeth, while still looking as natural as possible. It covers the entire tooth and helps restrict any chips and crack from spreading while protecting the tooth from additional enamel damage and loss.

A 2009 study published in the International Journal of Prosthodontics found that the percentage of adults with severe tooth wear increases form 3% at the age of 20 to 17% at the age of 70. It is thus, a good idea to get evaluated for tooth wear early on and get treatment as soon as possible.