Facing hard truths about teeth

Many of my patients are facing some hard truths, regarding their dental health. One patient recently lamented, “My life has been so stressful over the past few years. That stress is starting to take its toll.” He then told me that his parents lived to be in their 90s and explained “I think I’m going to live that long, and I want to have my teeth. But I’ve worn my teeth out so much over my 60 years of life. I don’t know what teeth I’ll have left.”

These are some common realities expressed by my patients that appear to exist among many of my other patients. First, everyone seems to be under a lot of stress. Due to current world circumstances, that stress level seems to have increased. Secondly, patients seem to be living longer and longer. Last, our teeth eventually wear out.

Everyone, no matter who they are, will experience tooth wear to some degree. How do you know when the tooth wear is beyond the normal threshold? What are the consequences of accelerated tooth wear? Finally, how do you know when treatment and therapy is required for optimal oral health? Here are some common questions and answers to help you make an informed decision.

How do I know if my teeth are beginning to wear out? 

The easiest way to test is look at the shape of your teeth in a mirror. Our front teeth are typically rounded at the corner. If your teeth are extremely flat, then it is likely they have some tooth wear. Signs of tooth wear include chips, cracks and fractures. Another typical sign of tooth wear is if the front top two teeth are different sizes, but one was worn out faster than the other.

What are the consequences of tooth wear? What if I ignore my tooth wear?

Tooth wear often takes years and years to occur. Remember, everyone experiences tooth wear to some degree. When the tooth wear is beyond the “normal wear and tear” many problems arise and patients may not even know these problems exist. These problems often include: cracks or fractures of teeth, irregular tooth movements, jaw joint problems, tooth sensitivity, unattractive teeth, discoloration of teeth, teeth loosening, and eventually loss of the teeth. Your dentist can help you identify these problems and how they can be fixed. You should always bring any concerns you have to your dentist.

What causes tooth wear?

Tooth wear can be caused by many things. There are three general categories, but this is by no means an all-inclusive list. These are commonly seen behaviors that accelerate tooth wear beyond the normal rate.

1)Grinding or Clenching. Perhaps the most common cause of tooth wear is grinding or clenching of our teeth. This most often occurs at night while sleeping. Clenching and Grinding can be extremely destructive to our teeth. Often this happens during periods when life is extra stressful. Since it happens often at night, you may not even be aware you are doing it. Although this occurs most often at night, clenching and grinding can happen during the day as well.

2)- Acidic Erosion. When an abundance of acid is introduced into our mouth our teeth wear out extremely fast. An overabundance of acid can occur when a person frequently drinks soda or acidic beverages. Occasionally patients will swish their soda in their mouth causing extreme damage to the tooth structure. Acid can also be introduced in our mouth through gastric reflux. Eating disorders, such a bulimia, can also introduce excess acid into our mouth.

3) - Poorly Aligned Teeth. When the teeth are in the incorrect position tooth wear is accelerated. Things like a deep bite, open bite, edge to edge bite or a cross bite can be extremely destructive. Teeth are designed to slide and move off one another in a very specific pattern. When that pattern isn’t met, the damage is accelerated.

If I think my teeth have significant tooth wear, what should I do?

Therapy for tooth wear can vary greatly depending on each individual patient and their situation. But generally, treatment will fall into 2 main categories: preventative measures and corrective measures.

Preventative measures

Grinding and Clenching - Wearing a mouth guard at night can help. Some mouth guards can be bought at a local pharmacy, but these don’t allow your teeth and jaw to move in the correct pattern and can cause TMJ problems. A mouth guard is best obtained through a dental office and dental lab. Though the cost may be more initially, the investment will have long term benefits.

Acidic Erosion - This can be tricky and often involves multiple doctors in the process. Determining where the acid is coming and why will determine the final treatment. If a person is experiencing GERD or any type of reflux, the patient should have a consultation with their primary care doctor. If the patient is experiencing an eating disorder, then a consultation with a physician or treatment specialist would be best. Acidic erosion from food, such as excess soda, can be managed by stopping or minimizing the exposure.

Poorly Aligned Teeth - Teeth have and need a very specific pattern in which the upper teeth and lower teeth interact, and slide off one another. If the teeth are poorly aligned this pattern is disrupted. Solutions such as clear aligners or traditional braces can correct the tooth position, and this can help prevent tooth wear in the future.

Corrective Measures

Because tooth damage is irreversible it takes a great deal of skill and training to correct excessive tooth damage. Many patients are surprised at the amount of time, expertise and financial cost needed to correct their damaged teeth. Often times treatment can vary from months to years in order to correct the damage. The cost of treatment will depend on the extent of damage and can vary drastically. Prevention is always better than corrective measures later.

For patients with significant damage and are in need of extensive dental work, finding a competent and skilled dental team that can properly treat your specific needs is often daunting. The dental team that is treating these cases needs to have time, training, and exceptional skill. Once a patient gets all of the damage corrected from their tooth wear, they should feel assured they have made an investment into their future health

Whether we will live for 50 years or 90 years, protecting and correcting our smile allows us to enjoy all the years we have. Check with your dental team and have them determine the overall health of your smile, because a smile is always worth wearing.