Teeth are amazing. Unless you have a toothache, sensitivity, or dental problems that have caused loss of teeth you probably do not give them a second thought. Considering the amount of punishment and the hostile environment teeth exist in, it is amazing they hold up as well as they do. Even though they are incredibly tough, all teeth wear out over time. In this article, I will review the common insults our teeth endure and some basic strategies to counter them.
What is so hostile about the environment in the mouth? Biologically, the mouth is a warm and wet environment that is ideal for the proliferation of bacteria. We all have millions of bacteria which we feed every time we eat or drink sugars. The mouth is also acidic which allows bacteria to flourish and weakens teeth which allows them to erode. Bacteria and acidity are major factors in tooth decay and gum disease which are two of the most common diseases in humans.
Physically, the mouth is incredibly destructive on teeth. Consider how many times you chew per day and then consider that multiplied by 365 days per year and then over a lifetime. Teeth that touch will wear out over time and depending on your bite, this can
be rapid or slow. The constant cycling between hot and cold contributes to the challenges that teeth endure. The final challenge is us. Many people have habits that insult teeth such as using teeth for holding items, chewing nonfood items like fingernails, and traumatic events.
The following strategies do not apply to everyone, but hopefully they will cause you to consider if there is a possibility whether it affects you. If so, then I recommend discussing it with your dentist or dental hygienist.
The most common is bacteria and acid. Nearly everyone is aware of the cause of cavities and gum disease and the strategies to defend against them. But as a quick review, the most effective strategies include brushing teeth two times per day for two minutes with a fluoride containing toothpaste, flossing to clean between your teeth, using a mouthwash that will decrease bacteria and strengthen teeth with extra fluoride, eating a healthy diet with minimal snacking or drinking sugars between meals, and seeing a dentist regularly to catch any problems when they are small and easier to treat.
The strategies to protect teeth from physical assaults are less known so I will go in a little more detail on them. There are three main types of tooth wear: attrition, abrasion, and erosion.
Attrition is the rubbing of teeth across each other which causes them to wear and chip away. Up to 20-30% of young adults experience bruxism which is defined as grinding or clenching of teeth. This can happen during the day or at night. There are many causes for this including sleep disturbances, sleep apnea, reflux, or stress. Many people never realize they have bruxism or the underlying causes because it comes on slowly and they don’t know any different. Your dentist may see signs of sleep apnea or reflux before you know you have a problem and may refer you to a physician for an examination. Another cause is antidepressant medications. Over 25 million people in the US take these each month and a common side effect is an increase in clenching and grinding teeth.
Treating attrition can be approached two ways by either just treating the symptoms by having the patient wear a custom mouthguard to protect the teeth or by treating the underlying issue. Many times, it is difficult to adjust life stress or alter the medications, so the only option is treating the symptoms with a mouthguard. When possible, it is best to treat the underlying issue. Sleep apnea has been linked to many underlying health problems, therefore a sleep study and treatment with a CPAP or oral device is recommended. Reflux allows the teeth to be coated in acid which allows them to wear at an accelerated rate with bruxism. The challenge for dentists is that we will see signs, but many patients won’t realize they have reflux.
Abrasion is the wearing of teeth from something other than the opposing tooth. The most common cause are toothbrushes and toothpaste. Many toothpastes have excessive abrasives added, especially in whitening and tarter control formulations. Studies have shown that toothbrushes alone don’t cause abrasion but in combination with toothpaste is when there is a risk. Studies have also shown that the abrasion is
much more likely to happen within 30 minutes of an acid insult on teeth. This may seem counter intuitive, but it is best to not brush for 30 minutes after you eat, drink, or even throw up when sick. It is better to use a mouthwash in the first thirty minutes and then brush your teeth after the saliva has had an opportunity to adjust the acidity in your mouth.
Erosion is the eating away of teeth due to acid alone. Rarely is erosion from acid alone but in combination with abrasion or attrition. The most common causes are reflux, bulimia, acidic beverages, and citrus fruits. Dentists diagnose erosion by seeing wear on teeth that does not line up with where teeth touch and is not in a pattern consistent with toothbrushing. The strategies to deal with erosion are to do a dietary analysis to eliminate acidic foods and drinks, refer to specialists if bulimia is suspected or refer to a physician if reflux is suspected. In early stage reflux cases, the diagnosis is accomplished by having the patient use over the counter medications for several weeks to determine if they notice a difference.
A final issue that is not considered a category of wear but is something I see daily is cracks and wear from missing teeth. Many people decide to pull teeth instead of saving them in the hopes to save money. While it is less costly to remove a tooth on the short term, there are significant issues and potential costs in the long term. For every tooth that is removed the chewing forces need to be distributed to other teeth which leads to more cracks, wear and tilted teeth causing further problems. Therefore, a long-term strategy is to avoid extracting teeth if that is an option and consider replacing teeth if you are already missing teeth. With today’s technology with implants, there are many good options to replace missing teeth.
I once heard an older dentist describe our profession by saying a dentist’s job is to make the patient less worse at the slowest rate possible. In other words, your teeth are going to wear and degrade over time, our goal as dentists is to slow that process down in the hopes of preventing major problems throughout your life. Hopefully, the strategies discussed in this article help you consider whether you need to investigate any of the problems and solutions described.
This article was written by Dr. Joiner for the Staying Healthy Column in the Capital Democrat.