Tooth wear is the wearing away of natural tooth structure. There is a very high prevalence of this in the population spanning all ages from infants through to old age. There are different types of tooth wear, which we will be covering in this article. 

Erosion

This is caused by acidity in our mouth. Foods such as citrus fruit and beverages like soft drinks, wine and sparkling water all reduce the pH level in the mouth softening the enamel causing it to decompose. This exposes the dentine making the tooth more vulnerable to tooth-wear. Saliva is our natural defense maintaining close to neutral pH levels. This flow of saliva is often reduced due to medication resulting in higher rates of acid erosion. Acid reflux rising from the stomach may also cause enamel surface loss.

Abrasion:

Abrasion is the wearing away of tooth structure by mechanical forces from a foreign element. The main cause of this is hard tooth brushing using a toothbrush with hard bristles as well as the continual placement and removal of a dental appliance. This tends to occur mostly at the junction of the root and crown of the tooth. Hard brushing causes the gums to be pushed away from the crown exposing the root. The root, made up softer dentine wears away more easily causing it to become more sensitive to hot and cold.

Attrition:

Attrition is the loss of tooth structure by mechanical forces from opposing teeth. Attrition initially affects the enamel and, if unchecked, may proceed to the underlying dentine. Once past the enamel, attrition quickly destroys the softer dentine. Erosion is a very important contributing factor to the loss of tooth substance by attrition. The lowered pH level softens the teeth and as a result, it is easier for opposing teeth to wear away on chewing or grinding. Attrition also occurs due to a reduced number of surviving teeth present in the mouth increasing the load on the remaining teeth. This is typically seen on the anterior teeth when the posterior teeth are missing.

Abfraction:

Abfraction is a theory explaining the non-carious cavities around the gum line. The theory suggests that excessive loading forces during eating or due to grinding habits (bruxism), places excessive loads on the enamel. This is mostly seen at the crown-root junction causing this pattern of destruction of the enamel. 

Prevention of further tooth loss

• Dietary control on the intake of acidic food and beverages
• Soft brushing and the use of toothbrushes with soft to medium bristles
• Production of a custom-made mouthguard to reduce tooth grinding at night
• Frequent use of minimally abrasive tooth-paste containing formulas to strengthen and repair the teeth.
• Replacement of missing teeth usually posterior molars. This will help to dissipate the masticatory load on all teeth and not just a few.

Replacing tooth structure

• Minor cavities around the gum line may easily be filled with tooth coloured filling material such as composite resin. Porcelain fillings are more suitable to restore larger lesions due to higher abrasive resistance.
• For large areas of tooth wear including loss of tooth height, porcelain crowns, veneers and onlays are used to restore the lost tooth tissue and regain the aesthetics of the tooth.

Tooth wear may severely demean the aesthetics of the dentition not to mention the ongoing associated symptoms of sensitivity and nerve pain. Progressive tooth wear may lead to tooth fracture and eventual tooth loss. 

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