Tooth Wear Department of Orthodontics and Restorative Dentistry Information for Patients i
What is Tooth Wear? Tooth wear refers to the loss of tooth substance that is not caused by dental caries or trauma. Almost all patients have some minor tooth wear which does not cause any problems. However, some patients show accelerated tooth wear that may result in: Sensitivity Poor dental appearance Difficulty chewing Sharp teeth Concerns about further tooth wear Figure 1: This patient with tooth wear had poor dental appearance, sharp teeth, sensitivity and difficulty chewing. 2
Causes of Tooth Wear? There are 3 main causes of tooth wear: 1. Erosion: This is the chemical dissolution of tooth substance by acid. Erosion may occur with excessive consumption of acidic foods and drinks such as alcohol, carbonated drinks, fruit juice, citrus fruit and vinegar. Erosion may also occur in medical conditions such as indigestion, eating disorders and pregnancy related sickness; all of which may cause repeated vomiting or reflux of gastric acid. Some patients are however unaware that they suffer with gastric acid reflux. 2. Attrition: This results from direct tooth to tooth contact and tends to affect the biting surfaces of the teeth. Attrition is often caused by repeated clenching and grinding of teeth (bruxism). Some people may not be aware that they grind their teeth as it occurs when they are asleep. 3. Abrasion: This is the loss of tooth substance through mechanical means other than direct tooth to tooth contact. Causative factors include vigorous tooth brushing, pipe smoking and nail biting. 3
What can be done to Prevent Tooth Wear? It is important to think about your lifestyle, diet and possible habits to determine the cause of your tooth wear. You should think about both your current and historical situation. If the cause of tooth wear can be identified it can be addressed. All patients should brush their teeth twice daily with a Fluoride containing toothpaste and use a Fluoride containing mouthwash at a separate time to brushing. This will harden the surface of the teeth and help with any sensitivity. If you clench or grind your teeth you may benefit from wearing a splint which can be made by your own dentist. Splints wear over time and do require replacement but this is preferable to further wear of your teeth. We normally recommend a hard acrylic splint as this can be easily adjusted to ensure an even bite. Try to avoid snacking between meals and limit the amount of acidic food and drink that you consume. Water, milk and tea/coffee (without sugar) are preferable to fizzy drinks and fruit juice. 4
What can be done to Prevent Tooth Wear? If you have problems with recurrent vomiting or reflux of stomach acid see your GP. If you vomit regularly, avoid tooth brushing immediately afterwards as this leads to greater tooth wear. Do I Need Treatment? Not all patients with tooth wear require treatment. When tooth wear is mild and not causing any problems it should be monitored. This will be done by your dentist with clinical photographs, study models and putty indices. When tooth wear becomes more advanced, or it causes problems, treatment is often required to prevent further tooth wear, improve dental appearance and relieve symptoms. 5
What Treatment is Available? We will often recommend that worn teeth are built up with composite restorations (white fillings). These restorations are usually recommended because they do not damage the underlying teeth and allow the teeth to be built back up to their normal size and shape protecting the underlying tooth structure. These composite restorations are usually placed high so that you only bite in a few areas. This will feel strange initially, however, most patients adapt within a couple of weeks. Your other teeth will usually move to meet each other with time although this may take up to 18 months. With time composite restorations stain, chip, fracture and debond. This is to be expected and the composite restorations will require repair and replacement in the future. Studies show that composite restorations usually work well over 5-7 years. 6
What Treatment is Available? Figure 2: The upper anterior teeth show tooth wear (attrition) Figure 3: The upper anterior teeth shown in Figure 2 have been built up with composite restorations 7
What Treatment is Available? Where teeth are severely worn we may recommend crowns. Crown preparation may cause the underlying tooth to die off causing pain and necessitating root canal treatment or extraction. With time, crowns may chip, fracture and debond. Tooth decay can also occur around crown margins if good oral hygiene is not maintained. If there is not enough tooth it may sometimes be necessary to lengthen the gums around worn teeth surgically to expose sufficient tooth to bond a crown on to. In some situations we will recommend an overdenture. This is a denture that fits over worn teeth. Overdentures require removal at night and after each meal for cleaning. Overdentures may chip, fracture and wear with time. If the teeth underneath the denture are not kept clean they will decay. 8
What Treatment is Available? Figure 4: The upper anterior teeth show significant tooth wear Figure 5: The upper anterior teeth shown in Figure 4 have been restored with crowns following surgical crown lengthening 9
Who Will Undertake my Treatment? We will usually advise that any recommended treatment is provided by your dentist. Where tooth wear is caused by an underlying medical condition, such as Amelogenesis Imperfecta or Dentinogenesis Imperfecta, treatment may be undertaken within the Department. If you do have treatment within the Department you will be discharged back to your dentist once treatment has been completed. It will then be the responsibility of your dentist to maintain, repair and replace any work that has been provided. 10
If you have any questions, write them down here to remind you what to ask when you speak to your consultant/dentist. 11
Leaflet Produced: January 2016 Next Review: January 2018 (Vere) Orthodocntics - SUR104-0116 Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959