At the most recent Spears seminar that I attended in December, we concentrated on patients with significant loss of tooth structure. We started with an initial discussion of how tooth loss most likely occurs. Most patients who experience loss of tooth structure do so for one of two reasons:
- Chemical erosion
For each cause, the pattern of tooth wear is distinctive and gives insight into the causes, prognosis, and treatment for each individual.
Attrition is the act of tooth wear created by teeth that touch and rub against each other. Attrition wear usually shows sharp worn areas called facets. When models of upper and lower teeth are held together, the dentist can see the opposing sharp wear pattern match between the opposing upper and lower teeth, much like puzzle pieces.
Erosion is tooth wear caused by long-term exposure to acids. Acids exposure can be from external sources, such as ingesting acidic foods and beverages, or from internal sources such as stomach acid regurgitating into the oral cavity. The wear from erosion, unlike that of attrition, appears as cupped out areas on either set of teeth that don’t seem to match up. Rather than being sharply demarcated as in attrition, erosive wear appears smoother and satiny.
Erosion and GERD
Recently, scientists have linked nighttime tooth grinding, or bruxism, to GERD, or gastric reflux. Patients showing patterns of wear should be examined for reflux erosive tooth wear and referred appropriately to a gastroenterologist for treatment. Once a proper diagnosis and treatment (usually medications) is provided, the dentist can then help prevent future loss of tooth structure with a night guard and rehabilitation.
Bruxism, Sleep Apnea & Gastric Reflux
An often overlooked factor that can also trigger a nighttime grinding pattern is sleep apnea. Bruxism, sleep apnea, and gastric reflux can all work together to cause tooth wear and to damage overall health. It is important to properly diagnose the cause of loss of tooth structure and to treat appropriately for the underlying cause.
You could have tooth wear and not even know it
Wear patterns can continue throughout life, with most patients not even aware it is happening, and patients may ignore the first more-subtle signs. Left untreated, wear can later become so extreme that the teeth become worn to the gum line.
Returning normal function and aesthetics
At that point, root canal, orthodontics, and other reconstructive procedures can be used to return teeth – and the patient – back to normal aesthetic and functional health. The typical approach is to align the front teeth to their ideal positions, and then work backward to the back teeth to create the final pattern of reconstruction.
The factors of rehabilitation depend on the extent of tooth structure loss, the importance of a good aesthetic outcome and the time and effort needed to create an acceptable outcome for the patient’s teeth and overall health.
Need help with tooth loss?
If you have significant tooth loss and would like to find the cause, stop the loss and consider reconstruction to restore functionality, please call our office at 718-448-3366 or set up an online appointment.