Monday, August 23, 2010

Tooth Abrasion

Treatment of dental disease is obviously what we are trained to do. However it is very exciting to be able to teach patients how to avoid needing treatment in the first place. One of the most common findings of a routine dental examination is the appearance of abrasion at the neck of teeth. Usually we see these areas from the canines (I teeth onwards) towards the molars (back teeth.)

In this photograph, you can see that the patient has abrasion at the junction of the teeth and the gum and it even involves the crown placed on the molar.

Causes of tooth abrasion:

• Aggressive tooth brushing in a scrubbing motion
• Using a toothbrush with hard bristles
• Using toothpaste, especially ‘ whitening toothpastes’ more than twice a day
• Bite issues where the forces borne by the teeth are higher than they are designed to bear and are in the direction that is unfavorable to the teeth. For example, the molars are primarily designed to withstand vertical forces so any side to side directed forces will be harmful to the tooth.
• Movement of the teeth during orthodontic treatment
• Susceptibility of the cervical area of the tooth due the bone covering it being thin
• Positioning of the tooth in the arch can higher the risk of abrasion. For instance, if a patients canines are prominently place in the arch (stick out), then they have a higher risk of abrading the enamel when they brush
Since the enamel is thinnest at this area, it doesn’t take much to see the effects of any of the above causes. Recession of the gum tissue quickly follows. Both abrasion and recession are irreversible.

Symptoms of tooth abrasion:

• Asymptomatic
• Sensitivity to cold
• Esthetic compromises to smile
Complications of tooth abrasion
• Progression of symptoms mentioned above could lead to a patient avoiding certain foods and drinks like ice cream and cold beverages
• Abrasion of enamel could be followed by entry into dentin which dictates treatment options that are more aggressive- like a crown
• In extreme cases, the nerve of the tooth maybe exposed making a root canal and a crown unavoidable.
• Loss of protective gum tissue (attached gingival- due to recession) that acts like a turtle neck around the tooth and helps keep out harmful bacteria that would cause the tooth to loosen in its socket

Photograph of an advanced abrasion that is complicated by long standing bite issues. Treatment of this case requires a thorough diagnosis and evaluation.

Prevention of Abrasion:

• Use a soft or super soft toothbrush
• Use only a small amount of toothpaste twice a day. If brushing during the day, try using Listerine or no toothpaste- instead relying on gentle circular motion of the toothbrush to remove food particles and bacteria
• Use minimal pressure while brushing
• Place the bristles of your toothbrush at an angle in the sulcus of the gum (at the junction of the tooth and gum) and gently move the brush to and fro/circularly on the spot. Try not to brush more than 2-3 teeth at a time. Do this about 10-15 times per area for the front and back of all teeth.
• Switch to a rotary brush if you cannot control the pressure with which you brush. Remember to operate it at the lowest setting possible.
• Switch to your non dominant hand while brushing. If you are right handed, try brushing with your left hand so you apply less pressure.
• Try brushing with your thumb and 2 fingers instead of grasping the brush with your hand.
• Brush slowly and deliberately.

Remember that abrasion is a condition that is preventable- not reversible. We are specially trained to detect early signs and symptoms of bite problems and damage that is caused by aggressive brushing. It is our practice mission to help you develop healthy hygiene practices and to prevent your bite from damaging your teeth.
I will have some tips to help you change your brushing habits in the next blog entry.

'til then,
Be well,
Live well,
Do well.