Wear and tear at any age – Rachel Pointer

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  Posted by: Dental Design      5th June 2018

A modern enemy to a bright, healthy smile? Tooth wear. Younger patients may not think tooth wear is something that they need to concern themselves with. After all, it takes years for enamel to start wearing away, right? 


Of course, over time, wear-and-tear of the teeth will happen, due to chemical and mechanical factors. It is a normal process, cumulative with age and also irreversible. Enamel does not grow back. But that is only part of the story. The cause of tooth wear can be multi-factorial. Tooth wear can be severe and it does affect younger patients too, in growing numbers. In 2013, a study revealed that almost one in three 18-35 year olds suffered from tooth wear;[i]last year a paper outlined how young people are losing enamel in troubling amounts.[ii]Generally, tooth wear is on the rise for all age groups.[iii]


So although tooth wear has a simple definition, it has a less-then-simple explanation. Tooth wear can be severe and, young or old, prevention and early inception must be supported. Enamel loss can lead to a range of complaints that will impact on quality of life. These include: fractured teeth, discolouration, functional difficulties such as inefficient mastication and pain/sensitivity.[iv]


Solutions to severe wear include veneers and crowns, or even whole mouth rehabilitation. So monitoring is key. A patient of any age who is showing signs of tooth wear must be accurately assessed and all the factors that could be causing erosion discussed in order for a preventive strategy to be put in place. 


That their enamel can get worn away (never to be naturally restored) may be shocking to patients in the 35 and under age group. Their food and drink choices can impact on their teeth in ways they may not have considered. A diet full of fresh fruit and vegetables is a standard healthcare message, but citrus fruits in particular are highly acidic. Modern eating habits – as we move away from three meals a day and have frequent mini-meals/graze – means patients have to be careful of how long they are exposing their teeth to food and drink that is putting their enamel under attack. We know coca cola is bad for our teeth, but sipping a smoothie of, say, blueberries and mangoes over a prolonged period of time isn’t a good idea either. Ditto starting the day with a ‘cleansing’ shot of hot water and lemon juice, at around pH 2-2.35. What is a good idea, though, is to recommend using a straw when drinking acidic beverages so that there is minimal contact with teeth. Also, if someone does not want to live without their hot water and lemon, they should brush beforethey drink up.


Interestingly, a link was made between the increase in tooth wear with the rising levels of eating disorders among 16-24 year olds.[v]Forced vomiting will expose the teeth to stomach acid and lead to worn enamel. Also, gastro-intestinal complaints such as gastro-oesophageal reflux disease (GORD)caused by a hiatus hernia can contribute to tooth wear. Similarly, pregnancy related nausea and sickness could have comparable effects.


If a patient suffers from bruxism, the grinding mechanism will wear down the surface enamel. Bruxism, which is often stress related, can occur at night, making a diagnosis problematic. Mouth guards can be a solution but the root cause of the anxiety will need to be tackled, too. 


Preventing tooth wear is the only way to improve the statistics. Getting patients to think about how they consume acidic food and drink is important. As is learning how to clean in a way that actually protects the enamel. For example, they may think that a vigorous brush straight after a sugary snack is helping to clean away nasties, but over-zealous brushing will do more harm than good. Regular, abrasive cleansing is a cause of wear in itself.


The right tools for the job are fundamental. To stop a tooth wear time bomb, recommend brushes to buy in your practice. TANDEX have a range of brushes, including interdental brushes, that are soft, pliable, comfortable to use and will give an efficient, gentle clean. There is a non-abrasive GEL, too. Proper cleaning with high-quality products will not only help strengthen the enamel, but protect it against excessive tooth wear.


Being worried about caries is one thing – but tooth wear is highly damaging and will affect both form and function of a patient’s smile. Enamel doesn’t grow back! While practitioners are deciding on the best way to treat it and when to implement a restorative intervention[vi]recognise the factors that can cause tooth wear at any age. Solutions to severely worn enamel may be more invasive than a patient would like – keep advice simple and practical and they will keep their smile for longer.


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[i]BDJ. Study highlights the prevalence of tooth wear. BDJ 215, 365 (12 October 2013). Link: https://www.nature.com/articles/sj.bdj.2013.970(accessed December 2017).

[ii]Why young people are losing their tooth enamel. iNews, 5 October 2017. Link: https://inews.co.uk/essentials/news/health/young-people-losing-tooth-enamel/

(accessed December 2017).

[iii]Adult Dental Health Survey – 2009. Published 8 December, 2010. Link: https://digital.nhs.uk/catalogue/PUB01061(accessed December 2017).

[iv]Mehta SB, Banerji S, Millar BJ, Suarez-Feito JM. Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear. British Dental Journal. 2012 Jan 14; 212 (1): 17-27.


[vi]British Dental Journal. 2012 Jan 14; 212 (1): 17-27.

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