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Tooth Wear / Bruxism

Slow loss

Slow loss of enamel usually goes unnoticed

Enamel is the hardest substance in the human body. As we age enamel is lost slowly and never replaced. Excess loss can lead to devastating problems. This is usually a non painful condition that patients are unaware of.

Tooth surface loss can be due to the following:

  • Bruxism (tooth wear)
  • Abfraction
  • Abrasion
  • Erosion
  • Tooth grinding
  • Tooth brushing
  • Acidic attack

Bruxism (also called Attrition is tooth wear from grinding).

grinding

Tooth loss due to grinding

Normal biting forces between the teeth when biting are about 20 lbs. Teeth usually contact top to bottom thousands of times each day with forces of about 0.5 lbs without biting. Teeth can usually cope well with this. However Tooth grinding can result in abnormal forces of about 250 lbs on each tooth. More than 10 times normal force.

Patients are nearly always unaware that they are grinding their teeth as they have been doing it for such a long time.

Tooth-to-tooth clenching and grinding is a common sign of psychological stress that occurs, for example, during sleep. Unless there are symptoms, many people are often totally unaware they grind their teeth until it is pointed out to them by a dentist.

Bruxism (Grinding) problems.

Abfraction wear due to tooth grinding

Abfraction wear due to tooth grinding


  • Small / worn teeth
  • Abfraction
  • Sensitivity
  • Fractured or cracked teeth.
  • Broken fillings
  • Incorrect jaw position.
  • Muscular and joint pain
  • Loss of facial height

Bruxism / Abfraction Prevention and treatment

  • Monitor wear rate with photos and models
  • Correction of incorrect bite
  • Reconstruct damaged teeth
  • Wear of a professionally fitted bite guard during sleep or stressful times

Abrasion

abrasion

Tooth surface loss due to abrasion

Abrasion is the loss of tooth surface by mechanical means – usually incorrect tooth brushing.

Abrasion prevention and treatment

  • Correct tooth brushing technique
  • A hard toothbrush should be avoided.
  • Use Fluoride tooth pastes and mouth washes.
  • Low abrasive tooth pastes.
  • Protect vulnerable areas with composite resin sealant.

Erosion

erosion

Acidic erosion of tooth enamel

Erosion is the loss of enamel from an acidic diet. E.g. The frequent consumption of fizzy drinks.

This can also be a problem for individuals with acid reflux and other eating disorders (e.g., anorexia, bulimia). Individuals with reduced saliva or dry mouths are also highly at risk.

Erosion Prevention and treatment

  • Reduce the frequency of drinking carbonated drinks and fruit juices.
  • Avoid acidic salad dressings, lemons and excess fruit.
  • Tooth brushing should be avoided immediately after consuming acidic drinks and foods for 20 minutes
  • Use Fluoride tooth pastes and mouth washes
  • Protection of areas vulnerable to erosion.

When is treatment required?

There are various levels of tooth wear and the extent of treatment is determined following a clinical examination and assessment. Treatment can range from some simple preventative advice to rebuilding the whole dentition.

Treatment is determined by age, condition of teeth and extent of the problem.

mild-wear

Mild wear

Thinning and loss of the enamel surface with minor chips.


moderate-wear

Moderate wear

Significant shortening of the front teeth with loss of facial height (And a consequent characteristic appearance of aging)


excessive-wear

Excessive wear

Advanced tooth shortening and flat aged teeth.


Following correction of a tooth grinding habit and a temporary period (3 years ) with composite build ups this case was restored with ceramics.

before-after
face-beforeface-after

A severe case of tooth wear reconstructed with ceramics and acrylic dentures

before-after
face-beforeface-after

A moderate case of tooth wear showing the stages of reconstruction

Initial situation.

Initial situation.

The canines were rebuild to correct the jaw position

The canines were rebuild to correct the jaw position

The front teeth were added to to increase the length.

The front teeth were added to to increase the length.

The final outcome.

The final outcome.

Tooth Surface loss due to abrasion

Defects and ridges at gum level.

Defects and ridges at gum level.

Protected with bonded resin in fills.

Protected with bonded resin in fills.

Abrasion defects from smokers tooth paste.

Before protection is applied(very sensitive)

Before protection is applied(very sensitive)

Teeth protected with bonded resin.

Teeth protected with bonded resin.

Minor tooth wear from grinding.

Minor chips and reduced tooth length.

Minor chips and reduced tooth length.

Front teeth rebuilt with bonded resin.

Front teeth rebuilt with bonded resin.

Substantial tooth loss due to grinding.

Chipped damaged teeth.

Chipped damaged teeth.

Reconstructed correct bite with ceramic.

Reconstructed correct bite with ceramic.

Excessive tooth wear due to bruxism

Pre-treatment

Pre-treatment

Teeth and bite rebuilt with composite bonding.

Teeth and bite rebuilt with composite bonding.