Tooth Wear

**The following information is from a review by Robyn R. Loewen, D.D.S., Robert J. Marolt, D.D.S.,John D. Ruby, D.M.D., Ph.D.

Tooth wear can be caused by erosion, attrition, and abrasion.

Abrasion loss of tooth structure by contact between tooth and another source, usually without any evidence of decay or decalcification.(i.e. tooth brush abrasion).

Attrition loss of tooth structure from tooth-to-tooth contact (i.e. tooth grinding).

Erosion loss of tooth structure by chemical substance (i.e. acid).

Gastroesophageal reflux disease (GERD) and frequent vomiting cause the loss of enamel on teeth. The causative agents of erosion are usually acidic substances, whether intrinsic (gastric acid from reflux or repeated vomiting) or extrinsic (consumption of acidic foods or beverages, repeated exposure to chlorinated water, and industrial chemical exposure.

The Truth Behind Sour Candies

• Sour candies are very acidic, with a low pH.
• Acid weakens and wears away tooth enamel.

The Signs of Tooth Erosion

• Sensitivity may occur when tooth enamel wears away.
• Discoloration is visible as a slight yellow appearance on the tooth crown or root surface.
• Translucency of the front teeth may appear along the biting edges.
• Rounding of teeth occurs along the surfaces and edges of the teeth.
• Cracks and roughness appear along the edges of the teeth.
• Cupping (appears like pot holes in the tooth) develop on the chewing surfaces of the teeth.  At this severe stage, fillings may actually appear to stand proud.

How to Protect Your Teeth

• Reduce or eliminate consumption of sour candies.
• If you do eat a sour candy, swish your mouth with water, drink milk, or eat cheese afterwards to neutralize the acids.
• Chew sugar-free gum to produce saliva which protects tooth enamel. We recommend Sugar free gum with Xylitol (I.e. Hershey's Ice Breakers).
• After eating sour candy or other acidic foods or drinks, wait one hour before brushing teeth. Brushing right away increases the harmful effects of acid on teeth.
• Ask us about ways to reduce sensitivity or minimize enamel loss if erosion has begun.

Diet and Hygiene Modifications

Every attempt should be made to reduce the frequency of consumption of acidic candies, and such foods should be restricted to main meals. For example, a change in the timing of eating sour candy between meals or at bedtime to a mealtime can reduce the severity of the acid attack due to more efficient clearance time and the buffering benefits of saliva. Patients are encouraged to finish a meal with something neutral or alkaline — cheese, milk, or sugar-free chewable antacid tablets. Chewing sugar-free gum will stimulate saliva flow, providing a natural buffering action. Rubbing bicarbonate-containing toothpaste on the teeth with a fingertip will reduce the acid challenge on the tooth surface. Also, rinsing with water rather than brushing teeth immediately following an acid challenge can reduce demineralization by clearing the acid from the oral cavity, and will prevent inordinate damage by toothbrush abrasion of the fragile enamel surface. Finally, patients should use less abrasive “sensitive” toothpastes or those with bicarbonate as an active ingredient, rather than highly abrasive whitening toothpastes.

Restoration

The goal of restorative treatment should be to maintain adequate function and esthetics of primary and permanent teeth. Erosion from the chewing or sucking of acidic candy primarily affects the top surfaces of the posterior teeth. Eroded primary teeth should be restored to maintain bite opening and tooth size, reduce symptomatic sensitivity, and provide nerve protection for the maintenance of vitality until the tooth is lost. Frequently, full-coverage stainless steel crowns are the most appropriate restorative choice for severely eroded posterior primary teeth.

The restoration of eroded permanent teeth requires choosing the least invasive procedure while providing maximum protection from the further loss of tooth structure. Sealants and resin-bonded restorations in “cupped” cusp tip lesions will provide mechanical protection for the affected surfaces, reduce dentin hypersensitivity, and improve the appearance of severely eroded posterior teeth. Many of these teeth will eventually require crowns to preserve remaining tooth structure and provide adequate esthetics and function. Since full-coverage restorations are costly and involve significant additional loss of tooth structure, it is essential that appropriate early counseling and behavior modification should occur to prevent the need for such invasive treatment.

Summary

• Acid in soft drinks, whether they contain sugar or not, is the primary cause of weakening tooth enamel.
• The acid attacks your teeth. Each acid attack lasts about 20 minutes.
• The acid attack starts over again with every sip.
• Ongoing acid attacks weaken your tooth enamel.
• Bacteria in your mouth cause cavities when tooth enamel is damaged.
• If you have a receding gum line, acid does more damage below the gum line than above it. This is particularly a concern for adults.
• Drink soft drinks in moderation.
• Use a straw to keep the sugar away from your teeth.
• After drinking, swish your mouth out with water to dilute the sugar.
• Never drink soft drinks or juice before bedtime because the liquid pools in your mouth and coats your tongue and teeth with sugar and acid.
• Drink water instead of soft drinks. It has no sugar, no acid and no calories.
• Get regular checkups and cleanings to remove bacteria buildup (plaque). Floss, too.
• Use a fluoride toothpaste to protect your teeth.

Data courtesy of Dr. John Ruby, University of Alabama Birmingham School of Dentistry, 2007. Also, most of this data can be found on the Minnesota dental association’s website.

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