Not to be underestimated – Rachel Pointer discusses why dental practitioners should pay attention to tooth.
Tooth wear, defined as surface loss that has been caused by chemical and mechanical activity and not caries or trauma, is something that dentists are encountering more and more frequently. This is especially true as people are living longer and often retaining their own teeth, thanks to better oral hygiene.
But excessive tooth wear can lead to functional as well as aesthetic problems; monitoring the progress of tooth wear and managing it will help your patients to avoid a whole host of issues. These include pain in the jaw and difficulty chewing because surfaces have worn flat. Aesthetically, teeth may develop a sharp, chipped or pitted appearance and look dull and lose their whiteness. When an individual is self-conscious about their smile and reluctant to show their teeth, this can have a negative impact on confidence.
Isolating the reason for tooth wear can be problematic because it might be due to several factors working in combination. For example, people who habitually grind or clench their teeth will wear down the surfaces enamel. Often a symptom of stress, bruxism frequently occurs during sleep, meaning the patient might not be aware of how severe is it.
Mouth guards and splints worn at night can help, but if bruxism is stress-related, dealing with the underlying cause of anxiety can help your patients beat it for good. In such cases, a multidisciplinary approach with the dental practitioner working alongside the GP should be discussed. Improving sleep routines can work wonders for reducing stress levels, allowing body and mind to rest properly. These include setting a fixed bedtime and switching off all electronic devices an hour before sleep. Exercise is a tried-and-tested stress-buster – even just walking the dog for half an hour longer can makes a difference. If the cause of stress or anxiety is serious and more deep-rooted, the GP may refer the patient to cognitive behavioural therapy (CBT).
Excessive consumption of acidic food or drink may leaf to erosion of the tooth’s surface as well. If a patient suffers from gastro-oesophageal reflux, when stomach acid is regurgitated into the mouth, or an eating disorder such as bulimia nervosa, when the digestive system is deliberately purged, they may also be susceptible. Xerostomia caused by a low salivary flow means acidic substrates will not be naturally rinsed from the enamel as efficiently.
Erosion-based tooth wear is common among children and young people who regularly consume carbonated, sugary drinks. These score low on the pH scale, giving them a high acid content. Soft drinks in particular are getting bad press of late as we see a multi-agency attempt to reduce their consumption, including the much debated sugar tax. Whatever the impact of the new guidelines, we’ll still see the cumulative results of a childhood diet that was high in sugar and acids in our adult patients. According to one study, “the consumption of soft drinks in the UK increased seven-fold between the 1950s and the 1990s.. With adolescents and children accounting for 65 per cent of all purchases”.
The last Adult Dental Health Survey (2009), reported an 11 per cent rise in adult tooth wear since the previous report a decade earlier, possibly due to a change in dietary habits during that period.
Abrasion can lead to tooth surface loss. A diet high in coarse-textured foods or long term use of mouth jewellery can be the culprits here. Other mechanical actions, like constantly chewing on pens, are examples of abrasive tooth wear, as it regularly cleaning interdentally with anything other than a specifically designed tool. In one recent poll, respondent named crisp packets, business cards and even a penknife as items they have used to remove food debris from between teeth.
The biggest cause of abrasive tooth wear, however, is overzealous brushing using an incorrect technique. Spend time teaching your patients how to brush gently yet efficiently, without damaging the enamel. Parents should supervise brushing until they are confident their child can clean independently. Proper cleaning with high-quality products, such as the Tandex range of brushes and interdental brushes, will not only help strengthen the enamel, but protect it against excessive tooth wear.
If tooth wear is addressed while in its early stages, you can avoid the need for future treatment. “Normal” tooth wear is cumulative with age, but excessive wear is clinically significant and must be managed. A thorough evaluation of all the factors that could be causing it is imperative. Encourage your patients to make sensible choices and adopt a preventative approach and they will avoid the effects of tooth wear for longer.