Tooth wear / tooth wear
Tooth wear refers to the premature loss of hard tooth substance due to abrasion (attrition) or acid-induced loss of substance (erosion). The affected teeth do not lose a small amount of substance through natural wear and tear, but rather 10-20 times the normal wear and tear. What should normally last a lifetime is suddenly gone after a few years.
The causes of tooth wear are the effects of acid and abrasion of the teeth when eating and – above all – when grinding the teeth.
With regard to the causes of tooth decay, the effect of acids has long been the focus of dental interest – because bacteria that cause tooth decay excrete lactic acid as a metabolic product. In the meantime, however, the incidence of tooth decay is declining – and the incidence of tooth wear is increasing, especially among young adults. An examination of the ingredients of the food consumed by this group showed that soft drinks in particular are sometimes extremely harmful to tooth enamel.
A second cause is the abrasion of the teeth during teeth grinding. In the beginning, the effect is minor as long as the teeth are still intact and the surfaces are rounded. However, the more the teeth are rounded due to bruxism, the greater the effect of teeth grinding.
Additional consumption of soft drinks or bulimia or reflux massively exacerbate the problem.
Consequential damage from tooth wear therefore initially affects the affected teeth themselves and leads to their rounding. This is followed by a loss of height.
Dentistry refers to this as a loss of vertical dimension. As a result, the teeth become shorter vertically. When the jaw closes, the lower jaw moves geometrically further forward. This Christensen phenomenon was previously only a problem in connection with bone recession under complete dentures. With the increasing incidence of tooth wear, it now also occurs in fully edentulous patients. It initially changes the position in which the teeth meet and then also the physiognomy: the nasolabial folds become deeper and the chin becomes more prominent. However, as the process is imperceptible, it is only noticed (too) late.
However, the changes in the tooth contours are noticeable. The posterior teeth become flatter than their original shape. Functionally, this rounding is important because the normal (physiological) tooth shape has curves in the area of the occlusal surfaces that mesh with the teeth of the opposing jaw like a cogwheel. However, if these contours are flattened and the curves are lost, the cogwheel function no longer works. The teeth can therefore no longer engage clearly with the occlusal surfaces of the opposing jaw. As a result, those affected lose the feeling for the “correct” bite and seek a comparable feeling of secure interlocking.
Some sufferers achieve this sensation when pushing the lower jaw forward , by contact of the lower front teeth against the upper front teeth. This results in increased abrasion of the front teeth. These become increasingly pointed and thinner towards the incisal edge. The teeth also become shorter and give the impression of prematurely “chewed teeth“. Over time, the thin incisal edges appear to break off suddenly and crumbling teeth develop.
Other sufferers pull the lower jaw backwards muscularly and thus overload the temporomandibular joints; joint damage in the form of craniomandibular dysfunction (CMD) is the result. Tooth wear in itself therefore does not hurt at first, but if it progresses unchecked it can cause considerable damage to the teeth themselves and other structures. This makes it all the more important to recognize tooth wear at an early stage.
The diagnosis of tooth wear is now very reproducible. Our working group plays a leading role in the development of the relevant techniques.
The basic principle of diagnosing tooth wear is to divide it into two stages. The first stage is tooth wear screening. This involves a low-cost, indicative examination to determine the extent to which increased tooth wear is present. In 2020, our Amsterdam-Hamburg working group published the evaluation criteria internationally in one of the world’s highest-ranking journals.
If there are indications of increased tooth wear, a more thorough examination is required, the tooth wear status. This involves a thorough examination of the outer surfaces of all teeth with regard to increased tooth wear and their classification according to a multi-stage score. On this basis, a differentiated individual assessment of tooth wear is possible. This allows energetic steps to be taken to reverse the development or, if necessary, to restore the affected teeth in order to preserve them.
Treatment is required if the tooth wear is pathological and at least “moderate tooth wear” has occurred in several areas.
The criteria for pathology were published in 2020 by an international working group with the participation of PD Dr. Ahlers.
Moderate tooth wear occurs when the enamel has already been lost in places, but the majority of the tooth is still protected. In contrast, a third or two thirds of the tooth is lost in the case of considerable or extreme tooth wear. As a rule, this also affects the neighboring teeth to varying degrees. An individual strategy is therefore required in these cases to stop the process and save the affected teeth. You are in luck: this is what we specialize in (:-).
The treatment of tooth wear depends on the degree of wear determined in the diagnostics. This ensures an individualized treatment decision.
The diagnosis of tooth wear leads to an evaluation of the degree of wear and its distribution. This forms the basis for the treatment of tooth wear.
- In the case of moderate tooth wear, the main aim is to prevent the progression of tooth wear. Depending on the results of the diagnostics, treatment is aimed at eliminating the individual causes of wear. In addition, enamel defects are repaired as minimally invasively as possible without causing additional loss of tooth structure during treatment.
- The situation is different in the case of significant or extreme tooth wear, where the health and preservation of the affected teeth is at risk. The focus of treatment must therefore be on keeping the affected teeth healthy and functional. This usually requires restorative treatment, in which the missing part of the affected teeth is replaced as gently as possible. Such treatments are extremely complicated because not just individual teeth are usually affected, but numerous teeth. This makes it necessary to carry out the new
restorations in such a way that the patients get used to them well and do not develop craniomandibular dysfunction (CMD) as a result of the treatment. Where possible, we carry out these treatments ourselves so that all measures remain in one hand and are optimally coordinated.