How do You Diagnose Tooth Wear?
The first and most important thing is to diagnose the problem correctly and determine which of the 3 factors- (erosion, abrasion and attrition are at play. It could be one single factor or a combination.
Because of the classic appearances that each of these create, most of the time this is diagnosed by the dentist simply examining your mouth.
The dentist is then likely to ask you a number of questions to get to the root of the issue. For example, if you have the classic appearance of regurgitation erosion (tooth wear on the back of the front teeth), the precise source of the acid needs to be determined.
If the cause is a hiatus hernia, obviously this is quite different, to morning sickness which is quite different to bulimia or anorexia, so the dentist would need to look at your medical history and ask some questions- hopefully in a (suitably empathetic manner) to find out.
The treatment depends on the cause.
Let’s say that the tooth wear looked much more like dietary erosion- then what exactly is it in your diet that is responsible? Now you know the sorts of things that can cause tooth erosion; you may even be able to put your finger on it straight away. At other times, it may be something that you think is quite harmless, that is actually doing the damage. The dentist will gently probe until they get to the bottom of things.
A good friend of mine, who I saw last week came in and there had been a noticeable increase in the amount of what I thought was dietary erosion. After a bit of a chat, we identified that every day at work- so 5 times a week- whilst at his desk, he would pretty much get through a bag of little oranges. Great for your health, but not for the teeth- he was shocked to find that this apparently healthy snack was the cause. So I advised him to limit the oranges to 2 or 3 a day and preferably at meals, so that his teeth got some good time off from sitting in acid inside his mouth. See our Stephan curve chapter for more of an explanation
Alternatively, he could eat a few, one after another as a snack i.e. 3 at a single sitting. It’s a balance; fruits are vital as part of a healthy diet and way better for you than most of the snacks around, but the effects of his excessive intake were apparent, and now he has a much better understanding of ‘ how to keep his teeth healthy’ whilst still enjoying his fruit.
Is the Tooth Wear Active or Inactive?
This is a very important question and part of the reason why, if you change dentists frequently, you are likely to end up having more ‘dental’ work done.
In the same way, that regularly seeing the same dentist allows them to monitor early decay and take preventive measures before drilling and filling, tooth wear is likely to appear a much bigger problem to the dentist who is seeing it for the first time.
Your regular dentist may have taken pictures, study models, notes or simply know that most of the wear occurred a number of years ago and has been stable ever since.
So a very important question is-‘ Is your tooth wear under control and stable or is it progressing?’
I will often bring something to a new patient’s attention who will reply,’It’s been like that for years,’