The enamel is a very important part of our dentition, and being the outermost part, it is susceptible to wear. A worn enamel causes poor appearance of the teeth, and could also lead to some negative dental consequences.
What Exactly is the Enamel?
Enamel is the shiny white and hard part of tooth structure that is visible when we talk, smile or eat. It is the hardest substance in the human body and as such brittle. It covers the dentin and the pulp.
The dentin is a yellowish hard substance, but not as hard as the enamel, that lies immediately below the enamel. An exposure of the dentin can result in sensitivity (shocking sensation) and/or pain.
The pulp is the living part of the tooth. It contains blood vessels and nerves. There is usually pain varying from mild, moderate to severe, if there is exposure of the pulp.
Worn enamel results from frictional force that causes gradual loss of enamel substance and may present some negative consequences on oral health.
What is Tooth Wear?
According to Mehta et al, 2012, tooth wear is a general term that describes the loss of hard tissues from the surface of teeth caused by factors other than dental caries, trauma or developmental disorders.
Lesions that cause tooth wear are generally referred to as non cariogenic tooth wear lesions. They are classified into four types: attrition, erosion, abrasion, and abfraction.
Attrition is the loss of hard tooth substance or restoration as a result of contact between opposing teeth. It occurs at the occlusal surface of the teeth.
Erosion is the loss of hard tooth substance as a result of chemical action other than bacteria. It is common on the upper anterior teeth. However, it can occur on other teeth surfaces.
Abrasion is the loss of tooth substance from mechanical processes other than contact between teeth. It occurs on the neck of the tooth; commonly on the buccal surface (the surface facing the cheeks) of posterior teeth.
Abfraction is a wedge-shaped tooth wear that is due to the forces of occlusion ( eating, chewing, biting, grinding) that cause stress concentration around the neck of the tooth.
Common Causes of Worn Enamel
Enamel wear does not just occur. Oftentimes, it results from some activities and practices we do from time to time.
Worn enamel is commonly due to mechanical or chemical causes.
If your enamel is wearing away, it might be due to one of the following factors.
Use of Hard Bristle Toothbrush
Brushing with hard bristle toothbrushes increases the frictional force between the teeth and the brush, which consequently increases the wearing away of the enamel and gums. Using toothpastes that have high abrasive content also causes worn enamel.
Using hard toothbrushes causes a type of tooth wear called abrasion.
Aggressive Brushing
Apart from using a hard toothbrush, applying excessive force while brushing or overzealous toothbrushing encourages non-carious enamel wear such as cervical abrasion.
Brushing Immediately after Eating Something Acidic
Acidic Foods and beverages have a deleterious effect on the enamel. They weaken the enamel and cause it to erode.
After eating something acidic, it is advisable to wait for about an hour or more before brushing your teeth.
Doing this will prevent the erosion of the weakened enamel by allowing it the time to remineralize.
Teeth Grinding
Teeth grinding or clenching otherwise known as bruxism also causes worn enamel. People who grind their teeth are sometimes unaware that they have such a habit. Grinding and clenching of teeth can cause non-carious tooth wear such as attrition and abfraction.
In addition to tooth wear, bruxism may also cause cracks or fracture lines on the tooth creating areas of weakness that may result in tooth fracture.
Chewing Hard Foods
Hard foods also play a role in developing worn enamel. Nuts, pop corn, chips, and other strong foods predispose the teeth to wear and tear and the risk of fracture. A worn enamel can result in a couple of consequences.
Acidic Foods
Taking acidic foods and beverages such as carbonated drinks, wines, and lime erode the enamel. An Acidic drink commonly causes worn enamel on the upper anterior teeth as the tongue protects the lower teeth.
GERD and Vomiting
The content of the stomach is acidic. Gastroesophageal reflux disorder (GERD) is a condition in which the acidic content of the stomach leaks into the esophagus. If the acid reflux comes in contact with the teeth, it can erode the enamel. It commonly affects the palatal aspect of the upper anterior teeth.
Similarly, vomiting affects the enamel, especially when it is a regular habit as seen in self induced vomiting common among people with eating disorders.
What Are the Consequences of Worn Enamel?
Enamel wear, whether as a result of mechanical or chemical causes, has a number of negative effects on dental health.
Tooth Sensitivity
One of the causes of tooth sensitivity (dentinal hypersensitivity), is worn enamel, which occurs as a result of exposure of the dentin.
Tooth sensitivity is the shocking sensation one feels on taking hot, cold, sweet or sour food substances. It also occurs when there is exposure of teeth to cold air.
A shocking sensation on the teeth can be very serious. It is usually sharp and of short duration, and sometimes makes eating difficult. Severe forms can cause headaches and also affect daily activities, thereby reducing the quality of life of the individual. Tooth sensitivity is a serious dental concern.
Pain
Toothache usually occurs when there is exposure of the pulp. This exposure allows ingress of bacteria and chemical agents into the pulp, causing it to become inflamed.
In some severe cases, worn enamel causes pulpal exposure and subsequently pain. Toothache can be severe, affecting both sleep and activity.
Unaesthetic Appearance
One of the complications of tooth wear lesions is their impact on the appearance of the teeth, especially the anterior teeth. Worn enamel causes esthetic problems for the affected individuals.
Severe forms of enamel erosion causes the dentin to reflect through the thin enamel making the teeth appear yellowish in color.
The gutter-like depressions on the teeth due to abrasions make the teeth have a poor appearance.
Esthetic concern is a common reason why people visit the dental clinic. It can affect an individual’s self esteem negatively.
Risk of Tooth Fracture
Tooth wear lesions weaken the enamel and make the teeth susceptible to fracture. Severely worn enamel may break under heavy masticatory forces.
Risk of Tooth Loss
Worn enamel could be a reason for tooth removal, especially if the wear is so extensive that the tooth is no longer restorable.
On the other hand, the tooth or teeth might still be restorable but if the financial implication is beyond what the patient can afford, and if there are complications like severe pain, or abscess formation, the individual might be advised to remove the tooth.
What Is the Treatment for Worn Enamel?
There are a number of treatment options for tooth wear. The treatment depends on the causes and the complications. Let us discuss some of the treatment options available.
Lifestyle Modifications
Someone may be wondering what lifestyle changes have to do with treating worn enamel. Changes in lifestyle are both preventive and curative. What do I mean? Adopting certain changes in the way we live life can be helpful in avoiding tooth wear.
On the other hand, where the enamel is beginning to wear, making certain changes can help halt the process.
Adopting changes in lifestyle helps to remove the causes of worn enamel.
Some of the changes that are helpful in managing worn enamel include:
- Avoiding hard foods.
- Use a soft bristle toothbrush and apply gentle pressure while brushing.
- Eat less acidic foods and drinks.
Dental Restorations
If you already have worn enamel, visit a dentist for appropriate treatment. After careful examination, the dentist may want to place a dental restoration in order to restore function and/or esthetics.
Common dental restorations that could be used for treating tooth wear include tooth coloured fillings, crowns and veneers.
Desensitization for Sensitive Teeth
As we have already seen, tooth sensitivity is a common consequence of worn enamel that causes pain and discomfort. Sensitivity can be treated by using a desensitizing agent, which can be used in the dental clinic, at home or both.
Desensitizing agents for at-home use come in the form of toothpastes, and are used mainly for the purpose of relieving tooth sensitivity.
Root Canal Treatment
Worn enamel is one of the causes of pulpal exposure, and when that happens, root canal treatment is one sure way to relieve pain and restore the tooth. The dentist usually places a crown on the tooth on which root canal treatment has been performed.
Use of Mouth Guard
Teeth grinding causes worn enamel, and to prevent that, your dentist may prescribe a mouth guard to help protect your teeth from damage.
A mouth guard can be worn at any time of the day, but since many people who grind their teeth do so mostly in their sleep, it is advisable to wear the mouth guard to sleep.
Tooth Extraction
In a situation where the damage to the tooth is so extensive that it cannot be restored, then it will have to be removed.
Tooth extraction is carried out when nothing else can be done to save the tooth.
Medical Treatment for GERD
If you have gastroesophageal reflux disorder(GERD), visit your physician for proper treatment. GERD is treatable with medications.
Certain lifestyle changes like avoiding alcohol, citrus, coffee, peppermint, and chocolate could be helpful.
Conclusion
Causes of worn enamel are both preventable and treatable. Always visit your dentist if you notice that your teeth are wearing away. Early presentation to a dental clinic helps to arrest the problem and prevent complications.
