Tooth Surface Loss

Treatment of Tooth Surface Loss in Redding

Patients displaying signs or symptoms of tooth surface loss should be encouraged early on to seek a consultation with a gastroenterologist and a prosthodontist to prevent the rapid destruction of their dentition and avoid the necessity for complex restorative treatment.

Anorexia & Bulimia

Most everyone is familiar the physical and psychological condition associated with Anorexia and Bulimia. Less well known is the deleterious effect that it has on the teeth. By the time the person is aware of the damage to her of his teeth it is frequently so far advanced as to be beyond restoration or necessitate complex prosthodontics treatment.

Stomach acid is highly corrosive and readily dissolves enamel and dentine. The flow pattern during vomiting is such as to affect the biting surface of the lower molar teeth and in the back surface of the upper front teeth. The damage is progressive and not noticeable until the upper front teeth are quite thin. As the affected teeth wear down the opposing teeth over-erupt from their sockets to contact them. The prosthodontist is then faced with two problems. Firstly, the tooth is often too thin and weak to allow further tooth preparation and reduction for crowns or veneers. Secondly, there is little or no room to fit the new material of the restoration due to bite closure. Root canal treatment may be required or implants associated with complex prosthodontic treatment.

Once the teeth have lost their protective enamel layer, the dentine being less mineralized wear much faster. This change in shape of the teeth alters the manner in which they function with the opposing teeth and temporomandibular joints (TMJ). Those teeth then resemble a mismatched set of gears. The person will start grinding and clenching the teeth, causing breakages, further accelerating the wear resulting in TMJ symptoms. There will be an increase in tooth decay. Such persons will often conceal or ignore their dental problem because it will be a red flag or an admission of a secret serious eating disorder.

Chemical Erosion of Teeth

Acid erosion of teeth can occur from gastro-oesophageal reflux in competitive cyclists. In these cases the erosive wear pattern is slightly different but the destruction can be more rapid because the stomach acid tends to linger in the mouth and be re-swallowed if the person is asleep or cycling. Cyclists who sip from a bottle of a carbonated drink whilst riding are subjecting their teeth to chemical erosion. Acid reflux can also affect competitive swimmers.

Competitive swimmers can suffer acid erosion from the chemical “fumes” of chlorine in swimming pools. Occupational erosion can occur in workers in bakeries and battery plants. Some people like to suck on citrus fruit such as lemons, limes and grapefruit even though the habit slowly dissolves their teeth.

Carbonated beverages such as cola drinks or cocktails will cause erosion of teeth. Even small quantities of sodas such as “rum and cola” can be destructive when the drinker holds the beverage in his of her mouth for some time before swallowing. Different patterns of erosion occurs in each case.

It makes little sense to embark on a course of remedial prosthodontic treatment until the underlying cause of the problem has been arrested.

Abrasion & Attrition

Attrition usually occurs as a consequence of habitual grinding and/or clenching of teeth. It can occur in the absence of, or in conjunction with, chemical erosion.

Abrasion of teeth can occur progressively in pipe smokers, seamstresses, or carpenter, each of whom hold objects between their teeth when working with their hands. Musicians who play instruments, which are held between the teeth, such as a saxophone, will experience distinctive patterns of tooth wear. This can occur to natural teeth or teeth on a complete or partial denture.

Attempts to restore teeth worn as a result of the above habits causes problems for the prosthodontist and patient. Once the teeth are restored, the object (pipe, nail or needle) no longer fits or can be held as before. Affected musicians are frequently unable to reproduce the sounds with their new crowns or dentures so a compromise between aesthetics and function must be made.

Most frequently, patients experiencing tooth surface loss from chemical erosion, abrasion and attrition leave it too late before consulting with a prosthodontist or seeking a referral from a general dentist by which time they are experiencing TMJ pain and dysfunction.

Crystal Meth Abuse causes Tooth Erosion, Attrition and Abfraction

Crystal Meth Drug Abuse results in the person staying awake partying for extended periods of time often days on end. During this period the person taking the drugs craves sweet carbonated drinks and candy. Those people also clench and grind their teeth. Naturally the rate of dental decay erosion and attrition increases exponentially and the teeth break and crumble. This is a well-documented phenomenon with patients being recorded of losing many and often or all of their teeth by their late teens or early twenties.

Restoration of the Badly Worn Dentition

Once a person has lost 20% of tooth structure it is time to start restoring the tooth or teeth because the dentist has to reduce the tooth by a minimum of 20% to create room for the restorative material meaning that the residual height of the tooth is then only 60% of its original measurement. In cases of erosion and/or attrition, the pattern of tooth wear tends to be generalised, which means that the tooth cannot be increased beyond the height presented at the dentist otherwise the tooth would be higher than the rest. Patients who have suffered 20-30% tooth surface loss would usually require a reconstruction of his or her entire dentition. This advanced restorative dentistry is usually performed by a prosthodontist or a very skilful and knowledgeable restorative dentist. A greater amount of tooth loss would involve endodontic (root canal) treatment to most of the teeth significantly increasing the time and cost whilst reducing the prognosis due to the reduction in tooth structure.

Early consultation with a prosthodontist, diagnosis and treatment planning will simplify and increase the prognosis for treatment whilst greatly reducing cost to ensure optimum fit, function and aesthetics.

These are just some of the causes of tooth surface loss.

Dr. Wright provides specialist prosthodontics services for Redding, Shasta, and the neighbouring counties of Tehama; Siskiyou, Trinity; Modoc; Lassen; Plumas and Glenn.