For The Independent Health Issue,
Sept 21, 2006
When Teeth Wear Down
By Dr. Tareq Khalifeh, DDS

You’d think that 21st century humans wouldn’t suffer from the dental problems that plagued the cavemen and women. But, when it comes to tooth wear, you’d be wrong!

The teeth of adults and children are susceptible to several processes that can destroy protective enamel, the tooth below the enamel, and even the nerves and blood vessels in the tooth.

Acidic Erosion
Your teeth can be severely damaged by excess acid exposure that leaches the minerals out of the tooth. And it often happens without any early symptoms. Your dentist may be the first to notice yellow spots on the backs of your front teeth. As the problem advances, the yellowing will spread, and if left untreated can eventually reach the tooth nerve and produce tremendous pain.

Erosive damage can be caused by frequent exposure to acidic substances in the diet, to environmental elementals such as chlorinated pool water, and to certain medications or food supplements, such as chewable Vitamin C or hydrochloric acid. The most common dietary culprits are carbonated sodas and waters, sugary drinks, citrus fruits, pickled products, and alcoholic beverages. The prevalence of soft drinks, sports drinks, and fruit juices in the diets of children and youth are particularly worrisome, and can set them up for lifelong tooth problems. Twice-yearly fluoride treatments provide some protection. But it’s also wise to consume sugary and acidy products sparingly, always rinse with a fluoride product after you consume them, and neutralize excess acids in the mouth with sugar-free antacids.

Intrinsic health issues can predispose people to erosion problems. For example, cancer patients and people suffering from Sjogren’s syndrome commonly have reduced saliva flow. Saliva dilutes and neutralizes erosive substances such as the phosphorous, nitrites, and citric acids in soft drinks. Sugar-free chewing gums or mints can help to increase saliva flow for these patients, and pharmaceutical intervention under a doctor’s care is also an option.

Individuals suffering from conditions that produce vomiting or excess acid in the esophagus also experience tooth erosion. Bulimia and other eating disorders can be very damaging to teeth. So is gastric reflux disease, where the contents of the stomach push back up the esophagus, causing symptoms such as belching, heartburn, choking, vomiting, or an acid taste in the mouth. If you are afflicted with any of these medical conditions, your dentist will refer you to a physician for appropriate assessment and intervention.

Tooth erosion is preventable and your dentist can instruct you on steps to take. Once damage has occurred, it cannot be reversed. Depending on the extent of damage, various restoration treatments can be used to protect the remaining tooth structure and to artificially restore damaged teeth.

Grinding Produces Tooth Attrition
As we grow older, we all lose some tooth structure to the mechanical wear and tear of chewing and grinding our food. Usually, our back teeth become a little flatter and our front teeth a little shorter as we age. But for individuals who involuntarily grind and clench their teeth, this type of wear—known medically as “attrition”—can become severe and can lead to facial disfigurement as well as sensitivity to temperature and sweets.

This involuntary grinding and clenching is called “Bruxism.” It occurs most often during sleep, and is often linked to anxiety and stress, or to abnormal alignment of the jaws and teeth. While difficult to eliminate, Bruxism’s damaging effects on teeth can be mitigated with the use of a soft plastic night-guard worn over the teeth during sleep, or a bite plate worn during waking hours. Damaged teeth can usually be restored with crowns or onlays.

Do You Brush Too Hard?
The final cause of tooth damage is “abrasion,” usually caused by overzealous brushing. Excess friction causes the gum surface to pullsaway from the tooth, revealing unenameled tooth surface that is extremely vulnerable to decay. Actual indentations in the tooth can occur as well.

Many people use a vigorous back-and-forth motion when brushing their teeth, rather than the recommended gentle up-and-down motion. Use of a hard tooth brush is often a contributing factor, too.

Abrasion can occur in young people as well as older adults. That’s why it’s so important to learn the right way to brush your teeth and to supervise your children’s brushing technique. Once abrasion occurs, fluoride treatments can help to protect exposed tooth surface. More severe damage may have to be covered with a tooth-colored filling.

Learn What to Watch For
Our Neolithic ancestors no doubt lost plenty of teeth to everything from decay to chewing leathery meat and animal skins. They suffered through without benefit of modern dentistry’s preventive and repair knowledge. Thank goodness we don’t have to. Loss of tooth structure is a debilitating and disfiguring problem that can generally be prevented. If you suspect you may be having a problem, consult your dentist today.

Dr. Khalifeh owns Philmont Family Dentistry, located on Rte 217 in Philmont, NY. A graduate of the New York City School of Dentistry, he completed his residency at Albany Medical Center and practiced in Albany until 2004. For more information, call 672-4077.