Tooth wear is when you loose enamel and/or dentine from your teeth, due to any reason other than tooth decay.
Effects of tooth wear
Excessive tooth wear can affect the appearance of you smile, giving teeth a yellow colour, short and worn-down appearance, sometimes sharp jagged edges, or sometimes smooth shiny surfaces and edges. Sometimes grooves can been seen in the teeth near the gums, sometimes rough surfaces can collect staining and look brown.
Loss of enamel and exposure of dentine can cause tooth sensitivity, most frequently with cold, but sometimes with hot, sweet, and to touch (e.g. with brushing).
More severe tooth wear deep into dentine or into the pulp (nerve) can cause a toothache.
Loss of teeth
Severe tooth wear can leave very little tooth left to repair, sometimes there isn’t enough tooth left to repair with a filling or crown and so severely affected teeth may need extraction.
Causes of tooth wear
Tooth wear is usually multifactorial – meaning it usually has more than one cause. Possible causes can be:
- the way you brush your teeth
- acid in your diet
- acid from your stomach
- grinding and/or clenching your teeth
- bad habits using your teeth
- the relationship between your upper and lower jawbones and teeth
Dental abrasion – Traumatic brushing
Scrubbing your teeth back-and-forth can rub horizontal grooves into your enamel and dentine. This can be worse if you use a hard toothbrush, an abrasive toothpaste (like charcoal, baking power, Arm & Hammer, or a whitening toothpaste), or even just too much pressure when brushing.
Dental erosion – Acid exposure
If your teeth are exposed to lots of acid, the enamel and dentine in your teeth can soften so that your teeth wear down faster when you eat and brush your teeth, and especially if you grind your teeth or are overzealous with your brushing.
Dietary acid could come from fruit, fruit juices and smoothies, fizzy pop, sparkling water, lemon water, alcoholic drinks, vinegar or acidic/sour sweets. The effect can be made worse if you have habit of swishing or holding drinks in your mouth.
Stomach acid can have the same effect for people who vomit frequently (including with eating disorders, morning sickness with pregnancy, and other illnesses that cause vomiting) or suffer with heart burn (gastroesophageal reflux or GERD).
Dental attrition – Grinding and clenching teeth
If you have a habit of grinding or clenching your teeth, the enamel and dentine can wear away from the biting surfaces of your teeth.
Dental abfraction – Tooth flexure
Slight flexure of a tooth might cause enamel and dentine to splinter away on the side of the tooth near the gum.
Treating tooth wear
The most important treatment for tooth wear is to understand and control the causes so that you can stop or minimise more wear from happening.
Controlling your risk factors
The easiest way to avoid causing damage to your teeth (and gums) when brushing is to switch to an electric toothbrush with a pressure sensor.
A good base level oscillating rotating electric toothbrush
- Rotating oscillating
- Brushing timer
- Can use separate heads and share the handle between whole family
- Pressure sensor – lets you know if you are pushing too hard
If you suffer with uncontrolled acid reflux or GERD then you should talk to your GP for advice.
If you have a condition which is causing you to vomit frequently then you should discuss this with both your GP and dentist.
Try not to brush your teeth immediately after vomiting. Acid from your stomach softens your teeth so that your toothbrush might wear away enamel and dentine more easily. Instead, rinse with a fluoride mouthwash after vomiting and try to wait 45 minutes before you brush your teeth.
Try to cut down or eliminate acid drinks and food, especially between meals. Acidic drinks include fruit juices and smoothies, as well as beer, wine, mixers, lemon water and sparkling water. Acidic food includes fruit, fizzy/sour sweets and vinegar dressings.
Avoid holding or swishing your drinks in your mouth. Drinking through a straw wont protect your teeth since the acid will still wash over the insides and biting surfaces of your teeth.
Grinding and clenching – bruxism
If you grind or clench your teeth in the daytime then simply being aware of this behaviour and actively avoiding it can make a big difference.
Grinding or clenching your teeth is a symptom of stress. So steps you can take to manage your stress might help reduce or stop your clenching and grinding.
Some stress might be naturally time limited – if associated with an upcoming event – e.g. exams, moving house etc, and so clenching. On the other hand, some stress might be more long term. If you are able to reduce your stress this obviously may be of benefit. In situations where you are not able to avoid the stress then it may be helpful to take steps to help manage your stress:
- Downtime – reading a book, listening to an audiobook, having a bath or going out for a cup of tea, having some “you time” can help.
- Meditation and guided relaxation – try searching on YouTube or searching in your phone’s App store for meditation or relaxation.
- Sport and exercise – whether its weight training in the gym, playing football or netball, swimming, yoga, running or just going for a walk.
- Aromatherapy – the scent of lavender is proven to help reduce anxiety.
- Read NHS 10 stress busters.
- Ask for help – if you are struggling to cope with stress then you can always ask your for GP for help. We feel more comfortable seeking help for physical health issues like a broken arm or diabetes but your doctor can also help you with your mental health.
If you grind your teeth in your sleep then changing your bedtime routine may help. Especially trying something to help you relax in the 45 minutes before bedtime and avoiding blue light from your phone, TV or computer.
If trying to manage your stress is not helping enough or not appropriate for your situation, then you could try wearing a mouthguard in your sleep. Its important that you only use a mouthguard made by a dentist and not one bought from a shop. Shop bought mouthguards can cause problems with the way you bite. Mouthguards can be provided on the NHS under Band 3 but are sometimes cheaper for your dentist to provide privately.
Avoid bad habits with your teeth, like opening packets and bottles with your teeth or biting your nails or sticky tape.
If you play contact sports, ask your dentist for a sports mouthguard to help protect your teeth.
Your dentist may recommend simply controlling your risk factors at home, or one or more of the following dental treatments:
- Brushing advice
- Use of a fluoride mouthwash
- Use of a sensitive toothpaste
- Prescription of high fluoride toothpaste
- Application of fluoride varnish
- Selectively building up or protecting some worn teeth with fillings, onlays or crowns
- Referral to a specialist restorative dentist
- Full mouth rehabilitation – treatment with a combination of fillings, onlays and crowns to rebuild and protect all or most of your teeth