Have you ever looked back on a photograph of yourself from twenty years ago and noticed some differences? A few more lines on your face, less hair for the gentlemen or a little greyer perhaps? But what about the teeth? Have you noticed anything different about your smile? Have a closer look, as there is a good chance that your teeth may appear shorter or flatter. You may notice that you show less of your teeth on a smile. This could well be due to worn teeth. Worn teeth are caused by one of three types of tooth wear. Tooth wear can be defined as loss of the enamel and\/or dentine of a tooth by a process other than decay, trauma or developmental conditions. The three types of tooth wear that we are going to discuss are attrition, abrasion and erosion. Attrition Attrition can be defined as tooth wear caused by wearing or grinding down of teeth by friction caused by tooth against tooth action. Attrition can be a normal \u201cwear and tear\u201d process, as everyone\u2019s teeth will shorten slightly with time and use. However, it can be caused by a problematic condition called parafunction or bruxism. Parafunction or bruxism is when the teeth touch or rub at times when eating is not occurring. It is a habit consisting of involuntary rhythmic or spasmodic gnashing, grinding or clenching of the teeth. Most people will call this tooth grinding. Teeth are only really supposed to touch for a total amount of fifteen minutes per day. A person whose teeth touch for significantly longer per day may end up with abnormal amounts of tooth wear due to attrition. This is extremely common and is a common reason why patients at our dental clinic in Fleet come to see us. What causes people to grind their teeth? Many studies have shown the correlation between stress and teeth grinding. The more stressed you are, the more likely you are to grind your teeth both during the day and whilst asleep. Many studies have shown the link between job related stress and teeth grinding. Psychological disorders and anxiety are also significantly related to grinding teeth whilst sleeping. Bite Problems. Some people can grind their teeth due to an interference in their bite. Maybe their teeth do not align in their bite evenly, or their jaws are out of alignment. Sometimes, a new dental restoration such as a crown or a filling can cause a patient to grind if it is left high in the bite or if it interferes as you slide your jaw from side to side. Sleep Disorders. In recent years, research has begun to link teeth grinding with sleep disorders, most notably obstructive sleep apnoea. In obstructive sleep apnoea, the airway partly or completely obstructs during sleep, causing a reduction or complete stop of air intake. Research has shown that this obstruction causes a micro-arousal in the brain in order to partially wake the individual to start breathing again. This micro-arousal has been shown to be followed by rhythmic movements of the jaws. This movement of the jaws may be the brain\u2019s way of opening the airway to intake more air, as when the lower jaw is thrust forward, the airway opens. How can attrition be stopped? In order to prevent attrition, it\u2019s cause must be fully diagnosed and understood. For stress or anxiety conditions, a number of lifestyle changes can be made in order to reduce the stress levels in an individual\u2019s life. Realistically, this is only possible for a certain amount of stress. Therefore it is important to think about protecting the teeth during sleep. A night guard can be made for you by your dentist. There are a number of different designs of night guards. The different designs of night guards will be the subject of a future blog. But for now, there are just a few important features that your night guard should have. It should be made from a hard, durable material, it should be custom made for you (not boil and bite) and it should have a design that reflects the problem that you have as an individual (not all night guards are suitable for all patients). For bite problems, it is important to see a dentist who is appropriately trained and experienced in managing complex bite issues. At our dental clinic in Fleet, Hampshire, we are more than comfortable in dealing with these issues, so please email or call us if you have any questions or think that you may have a bite issue. However, if the problem is down to a recent dental restoration, the dentist who placed the restoration should easily be able to adjust this to remove the problem. If a sleep disorder such as obstructive sleep apnoea is suspected, it is really important that you are appropriately screened and diagnosed. Obstructive sleep apnoea has many detrimental effects on your overall health that are more dangerous than some tooth wear, so it is vitally important that you are diagnosed and treated for this condition if it is present. The screening, diagnosis and treatment of sleep disorders are the topic of another blog. However, recent research suggests that treatment for sleep disorders such as obstructive sleep apnoea, may not only improve the condition, but also reduce the amount of teeth grinding that occurs. At our dental clinic in Fleet, Hampshire, we screen all of our patients for potential obstructive sleep apnoea and refer for diagnosis if appropriate. So if you think you may have a snoring condition or potential obstructive sleep apnoea, please feel free to contact us and we can make sure that you get the appropriate screening, diagnosis and treatment. Abrasion Abrasion can be defined as the tooth wear that occurs from an external material that causes friction against the tooth. In other words, not by tooth against tooth contact and not by chemicals. The most common abrasion that we see causing worn teeth is tooth brush abrasion. People who brush their teeth for too long, too hard or with an inappropriate abrasive paste can cause the teeth to wear down. The most common area to be effected by tooth brush abrasion is near the gum, or the neck of the teeth. The reason for this is that the enamel is very thin in this area, or if any level of gum recession has occurred, there may be no enamel, but exposed dentine instead. Dentine is a much softer tissue than enamel, so when exposed, it wears away much easier. Here are some other common causes of worn teeth due to abrasion: Charcoal toothpastes Lip or tongue piercings Chewing pens Holding nails or screws between teeth Nail biting Erosion Dental erosion is the progressive loss of tooth surface due to acidic chemicals. These acids can be from the outside that we take in, contained in foods and drinks. They can also be from the inside, contained in stomach acid. Dental erosion is quickly becoming one of the most common causes for worn teeth. It can cause sensitivity and a negative effect on the appearance of the teeth. In severe cases, it can cause the nerve to die within the tooth. We are going to split this section into two; acids from diet and acids from within the body. Acids from the diet Acids in people\u2019s diets have increased greatly in the past twenty years. One of the most damaging causes of dental erosion is the consumption of fizzy drinks. This has increased greatly in recent years. One of the most misunderstood factors of erosion from fizzy drinks is that it does not matter if there is sugar in the drink. Sugar will cause tooth decay, but this is completely different to dental erosion. Sugar does not cause erosion, it is the acidic chemicals in the drink that cause the wear of the teeth. Diet drinks have even slightly more acid than regular fizzy drinks, therefore are just as bad, if not worse for dental erosion. Many patients who I talk to at our dental clinic in Fleet, are surprised to learn this. These patients believed that they were being kind to their teeth by switching to the diet versions of their favourite fizzy drinks, but in reality the dental erosion was still causing their teeth to wear. Another common mistake that people make is to drink water with lemon frequently. This is a modern health fad that is quite common for people to do. People think that it is healthy or \u201cdetoxing\u201d, however lemon juice is extremely acidic and can cause irreversible wear to your teeth if drank frequently. Here are some common erosive dietary foods and drinks: Any citrus fruit Any drink that is carbonated (fizzy) Vinegars Sour sweets Some wines Acids from within the body The stomach contains an extremely acidic digestive fluid that is produced from the stomach lining. This fluid is supposed to stay in the stomach. However, there are many conditions that cause the fluid to leave the stomach and rise into your throat. This fluid can make it\u2019s way into your mouth and come into contact with your teeth. If this happens frequently, it is likely to cause severe erosive damage to the teeth. There are several reasons why stomach acid can come into contact with your teeth including: Gastric reflux Snoring and sleep apnoea Conditions causing recurrent vomiting such as bulimia nervosa Snoring and sleep apnoea is increasingly being linked to gastroesophageal disease. This is thought to be due to a pressure change in the chest when snoring forcefully, that causes acid to be pushed up into the throat. The most common cause of stomach acid being found in the mouth is a condition known as gastroesophageal reflux disease or GERD for short. Symptoms of gastroesophageal reflux disease include heartburn (burning in centre of chest), an unpleasant taste in the mouth, a hoarse voice or bad breath. Acid from your stomach ranges in pH from 1-3 which is extremely acidic. At the strongest, it is near the acidity of battery acid. As you can imagine, battery acid would not be good for your teeth! The acid from your stomach dissolves the enamel and then the dentine on your teeth with devastating effects. Gastroesophageal reflux disease is extremely common, with over 20% of adults in the UK suffering from it. In addition to this, a study showed that 30% of people diagnosed with severe gastric reflux disease, had no idea that they had an issue, and the only clinical sign that they had this disease was severe tooth wear. Therefore, it stands to reason that this disease is often picked up by a visit to the dentist. At our dental clinic in fleet, we have sent many patients to be investigated for gastroesophageal reflux disease after discovering severe erosive tooth wear with no other explanation. Many of these patients are diagnosed with gastroesophageal reflux disease. Worn teeth are a commonly overlooked issue by dentists in the UK. In part, this is because the treatment for this condition can at times be complex if the tooth wear has progressed too far. However, if caught earlier, preventive treatment can be very simple and cost effective. If you have any concerns about having worn teeth, it is extremely important that you speak to a dentist who can help and advise you. If you have any concerns, please feel free to email any questions to us at firstname.lastname@example.org or call us on 01252 614818 to make an appointment for a consultation.