When is Treatment for Tooth Wear Needed?
Treatment in the form of advice and preventive care is needed as soon as signs of tooth wear appear. This is the most important stage.
Left to its own devices, without a change of environment, it will progress and the longer it is left, the more difficult, expensive and time consuming it becomes to treat.
In fact, the only time treatment is really not needed is when the tooth wear is static and then, all that is necessary, is monitoring and re-enforcing the preventive measures aimed at slowing it down.
Ideally, people should be aware of the risks of tooth wear even before they have any trouble. That way, (hopefully) active steps are taken to prevent it from ever occurring in the first place.
Tooth wear is a very slow process. Teeth are hard- I mean seriously hard. Why do you hear of people dying in fires being identified by their dental records
Treating Tooth Wear?
The first line of treatment as we have already established is tooth wear prevention. In fact this is needed not just at the start, though it may be sufficient, but all the way along to prevent the problem from re-occurring.
The second aspect of treatment is restoration.
Significant wear, loss of the height of your teeth, facial changes and sensitivity are all signs that dental treatment in addition to advice may be needed.
It is often best not to wait until the amount of wear has become a problem for you, because this tends to be at quite a late stage- this limits the options available to the dentist and makes treatment far more complex (and expensive).
The most basic treatment required is for sensitivity.
We have good ways of dealing with sensitivity.
The most common cause of sensitivity comes from tooth brush abrasion causing gum recession and exposing the sensitive root surfaces on the sides of your teeth.
Your dentist has the following ways to reduce sensitivity:
- Sensitive tooth pastes such as Sensodyne or Colgate Sensitive Pro-relief (my personal favourite)
- Other more specialized sensitive products such as tooth mousse
- High concentration topical fluorides
- Bonding agents to seal the dentine such as ‘Seal and Protect’
- Root canal treatment– a total last resort and only occasionally needed when the nerve inside will not settle and irreversible pulpitis occurs.
If the amount of abrasion is mild; that is you have some gum recession but little actual wear of the root surface, then the first four options above tend to be the best approaches.
We normally start with advising a sensitive toothpaste because it is the cheapest and easiest and then progress down the list if the problem persists. If you have badly notched the softer root surface from tooth brushing, then a filling should be considered. Whilst fillings are never as smooth as the natural tooth and often aren’t needed for mild abrasion. However, they may be appropriate when:
- The tooth is extremely sensitive and you need an immediate solution
- The tooth is collecting plaque
- The wear is such that it approaching the pulp (the nerve chamber becomes visible through the tooth)
- The tooth itself has been considerably weakened because of the ‘notching’
- All other methods have failed
- The area doesn’t look good and you want to improve the appearance
- You need a protective covering to prevent further wear, if despite changes in brushing technique, wear is continuing.
Fillings, on the sides of your teeth, tend not to last as long as fillings in other positions and may need to be replaced more regularly. This occurs because the root surface is less suitable for bonding and because during ‘function’, the flexing of the tooth often concentrates in this area causing de-bonding. This flexing and subsequent loss of tooth is referred to as ‘abfraction’- the contentious fourth way in which tooth wear can occur.
If one of my fillings pops off within a year, I will replace it free of charge. It doesn’t take long- but remember… different dentists have different approaches.
Sensitivity, coming from the exposed dentine on the tops of teeth, is not quite so simple because of the lack of space.
If your bite allows enough space, white fillings may simply be used to protect the teeth. Teeth that have ‘potholes’ and are saucer shaped, i.e. scooped out lesions caused by erosion then theyare often suitable for this.
If wear has come from grinding and tooth to tooth contact, the teeth tend to have been made much flatter and the contact with the opposing tooth occurs across the entire top surface. This makes getting any material in there difficult without propping open your mouth, or drilling your tooth to create space for the filling.
White fillings, whilst quick and easy to do and comparatively cheap will wear down under the effects of attrition, and may need replacing periodically.
If you have already worn your teeth down considerably, reducing the height of your tooth even further to place a crown or onlay is not a sensible idea. In these cases we must first create some extra space (height).
If many teeth are involved and a more long- term solution is wanted, multiple crowns or onlays as part of a full mouth rehabilitation, may become the preferred treatment- in order to build up and protect your teeth and give you back a good looking smile.
This is complex and expensive treatment, that should be handled by experienced dentists used to doing this kind of work. A prosthodontist is a specialist in providing this sort of dental treatment.