Enamel thoroughly covers healthy teeth. Enamel is the hardest tissue of human body. Nevertheless, teeth often develop erosion quite easily. Below the enamel we find the dentin. Dentin consists in millions of tiny tubules and tubes. The dental “core” is the pulp that contains the nerve trunk.
Whenever the enamel develops erosion, the dentin tubules get exposed and trigger the response to external stimula such as cold, hot diet, airflow, sweet or sour foods. This response is pain.
The majority of these lesions are non-carious losses and affect tooth neck. The tooth neck is the slightly constricted part of the tooth between the crown and the root. This specific dentin loss results from both chemical and mechanical abrasion.
What causes tooth neck wearing?
“Geometrically”, the tooth neck is highly prone to wear.
The teeth most commonly affected are premolars and canins, due to the protrusion of their cervical neck.
The abrasion of the enamel is yet enhanced by the destroying power of acids. Tooth neck erosion is but the first step. If the damage (noxa) persists, it leads to the total loss of dental enamel, such as in patients with anorexia and self-inflicted vomit.
The worn enamel is exposed to the mechanical trauma of a toothbrush either too hard or misused.
Acidic drinks and foods as well as intrinsic acids lower the pH level of the mouth (acidity). Among the widespread:
- gastricesophageal reflux or regurgitatin: gastric hydrocloric acid (HCL) comes into contact with the teeth thus destroying the enamel
- drinks such as colas: they can dissolve everything!
- all sparkling drinks
- sparkling mineral water
- vinegar
- citrus (lemons, oranges, grapefruits)
- coffee
- smoking
- cocaine and other orally taken drugs
The wearing of the enamel quickens dental mechanical abrasion. Aggressive toothpastes and an incorrect brushing technique thus find a weakened tissue.
The progression of tooth loss can be rapid since enamel is very thin in this region of the tooth. Once past the tooth neck, it affects the crown. Canins are the first target of chemical and mechanical abrasion: they are the so called “angular” teeth (the German word for them is Eckzahn, that means tooth of the corner), because of their location at the four transition points between frontal and posterior teeth. They sustain the mechanical chewing action of cheeks and lips. Besides, they most often suffer from gum recession, but this is another story.
Bruxism, such as other occlusal anomalies, is less frequently involved in dental wear.
Excessive grinding of the teeth and/or excessive clenching of the jaw may account for
micro-cracks in the enamel. These eventually turn into severe damages at the
tooth neck.
What can we do?
The easiest therapy is to remove the following causes:
- acids,
- do not use sodium bicarbonate NaHCO3 that the saliva turns into carbonic acid H2CO3
- hard bristled toothbrushes,
- overzealous brushing ( link article ” How to brush your teeth in 10 steps “),
- the presence of gastric acid from the stomach (regurgitation or self-inflicted vomit),
- abrasive toothpastes,
- excessive tooth bleaching
- brushing immediately after consuming food , as teeth will be softened by the low oral pH and the enamel will therefore be weaker. Leave at least half an hour of
time space.
Hereafter, we can perform:
- conservative restorations (fillings) in case of mere notches of the tooth neck,
- aesthetic veneers, in case tissue loss affects only the external portion of the tooth,
- full coverage crowns if all the tooth is damaged.
A protective (not functional) occlusal splint is suggested to patients who present bruxism, together with a psychological therapy. Commonly, a “ bruxist” is an apparently quiet and peaceful guy whose emotional stress is directed against his teeth.
dr. Massimo Mazza
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