One would think that after a long life our natural teeth would wear out from years of simply chewing food. Yet we consistently see patients in their ninth decade that still have a rather complete set of teeth with minimal tooth wear. This shows that wear from normal function is actually quite minimal.
Yet many people are experiencing a breakdown of enamel on every tooth in their mouth. What tends to be noticed is a disappearing smile, or reverse smile; teeth that are not very visible when speaking or smiling. This happens so gradually that even those who visit the dentist regularly aren’t aware that the flat molars, worn eye teeth and jagged edges on their front teeth are not the normal progression of age.
Most tooth wear is a result of abnormal function in the form of grinding. Tooth grinding habits can be caused by stress, neurological disorders or interferences in the way that the teeth fit together. These disturbances can cause many people to grind their teeth, predominantly during sleep.
Tooth wear resulting from grinding is then accelerated by an acidic pH in the mouth. When the oral pH is acidic, the protective outer layer of enamel is softened, making it much more susceptible to wearing away.
The largest contributing factor to a lowered oral pH is Acid Reflux, also called GERD (gastro esophageal reflux disease). A condition in which stomach acid escapes the stomach and comes up into the mouth, directly affecting the integrity of tooth enamel.
Acid reflux is not primarily a disease of too much stomach acid, but rather the result of a weak muscular valve, the LES valve, which guards the lower end of the esophagus. The LES valve is influenced by our dietary and behavioral activities- large meals late at night, alcohol, cigarettes and sugar consumption. Snoring can also contribute by lowering the pressure in the upper airway, sucking the acid into the back of the mouth.
Many times the first signs of an erosive dental problem are small pot holes on the biting surface of the posterior teeth. These are actually little depressions on the surface of the tooth caused by acid erosion, not wear.
Once tooth material is lost, it does not come back without restorative materials, but destruction can be prevented once risk factors have been identified. Early diagnosis, controlling acid reflux and protecting teeth at night with a guard can prevent further tooth wear. In some cases, restoring the teeth back to their original appearance and function by a restorative dentist with advanced training is recommended.
Included within the energy we devote to keeping our bodies healthful, taking the time to learn about oral health and its contributing factors can be extremely beneficial. This will insure that as you live to be a very old age, two very essential pieces of a happy life are maintained; functional teeth and an attractive smile!
By Bonnie Meyer RDH, BASDH