Tooth Wear

Happy 2018 New Year! The time is now for any new resolutions or healthy additions to lifestyles that may benefit...or alternatively harm us! One thing that I have noticed in our practice is tooth wear, which can be from a variety of factors: brushing, diet, 'grinding', or even from bulimia. All of these factors can be differentiated into 3 main types of tooth wear causes: Abrasion, attrition, or erosion.


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Let's talk about abrasions! Abrasions are defined as progressive loss of tooth structure caused by mechanical actions other than mastication or tooth-to-tooth contacts. What does this mean? It means that if you have any physical contact with another object that is not from another tooth causing tooth wear/loss, it is an abrasion! What is touching our teeth most of the time? Toothbrushes! Toothbrushes, or rather, incorrect toothbrushes and techniques can not only cause tooth wear, but also gum recession. Other things like biting nails or opening bottle caps also count, but the result is the same: typically some notching and root exposure at the junction of the tooth crown and root. The American Dental Association (ADA) recommends using only soft or extra-soft bristle toothbrushes. Hard or medium bristle toothbrushes have been shown to cause severe abrasion and tooth wear as well as gum recession. 

Attrition is the progressive loss of hard tooth substances caused by mastication or grinding between opposing teeth. This means that tooth wear can be caused by other teeth and/or what we are eating! The extent of attrition and wear will depend upon the use to which an individual puts their teeth. For example, people who typically clench or grind their teeth (a condition known as bruxism), e.g., during sleep, are more likely to have severe tooth wear. It will also tend to be more pronounced in people who eat a particularly fibrous diet. People who chew ice also show severe signs of attrition! Attrition typically presents itself as a shortening of the teeth over time as the enamel and softer dentin parts of the tooth start to wear away from what they are hitting against.

Erosion is the progressive loss of tooth substance by chemical or acid dissolution, and no bacteria are involved. Erosion of tooth surfaces is mostly the results of too frequent or inappropriate use of carbonated drinks (including sparkling water) and fruit juices with high levels of acidity. This habit would appear to be particularly common amongst teenagers and young adults. Erosion is also a problem in individuals who suffer from gastro-esophageal reflux disease (GERD) or from certain eating disorders (e.g., anorexia, bulimia). In addition, risk of erosion is high in individuals with a low “unstimulated” salivary flow rate. 


Crowns and fillings can be used to repair/replace lost tooth structure from tooth wear, however, they do not fix the cause of the problems. Learning to recognize the cause of the problems is the way to address and prevent it from happening in the future. Talk to your dentist if you have any questions regarding tooth wear, as all dentists are trained to look for and spot for signs and etiology of tooth wear!