Worn Teeth: problems of a Modern Society

I see more patients that suffer from worn teeth than ever before. This seems to be a phenomenon of our modern style of living. The advent of processed foods, sugar and chemicals in our diets could be a factor along with the high stress lifestyles we have all grown accustomed to (or have we?). Combine this with people living longer and keeping their teeth longer the dental profession faces new challenges in predictably treating these cases.  Cosmetic and reconstructive dentistry has become more desirable and affordable, and now patients more than ever people want to have their teeth restored back to a more youthful appearance.

Most often people begin to notice that their teeth appear shorter or they don’t see their teeth as much when they smile. But treating worn teeth can be more complex than just “making the teeth longer”. When evaluating these types of cases the first thing we need to do is determine what caused wear and appearance. The most common causes I see today are: 1) abrasion due to grinding and 2) erosion due to diet or gastric reflux.

          Many people grind or clench their teeth, usually at night when they are sleeping but daytime clenching and grinding is becoming more common. Bruxism is the term for this condition.   Stress, sleeping habits, misaligned teeth all could be contributory factors for bruxism. The goal for successful treatment is to attempt to reduce the grinding and restore the teeth to ideal esthetic forms. Because it may be impossible to completely eliminate grinding we need create a biting environment (occlusion) that works for that patient. Also protection of the restored teeth after treatment needs to be considered.

          Erosion can cause similar wearing of the teeth to grinding but how you get there is completely different. Erosion is a chemical process whereby the tooth structure is weakened by acids then worn away by normal things like chewing and brushing. Erosion appears to be a modern problem. Primitive teeth studied prior to the introduction of   sugar and soft drinks into our diets didn’t seem to suffer the effects of erosion. Soda and citrus fruits are very acidic and if consumed frequently can cause serious erosion of teeth. Teeth eroded in this way have a very specific appearance but once identified the diet can be changed and the problem corrected. After the teeth are restored there is then little risk moving forward.

          Acid reflux, GERD and bulimia cause acids from the stomach to attack the biting surface of back teeth and the back of front teeth. The damage to the teeth is a combination of the acid demineralizing or weakening the enamel and then chewing and brushing removes the softened tooth structure. This type of erosion has a unique appearance and its own treatment considerations, but as previously described once the problem is corrected the teeth can be restored back to their original form and function.