Attrition and Abrasion
Why Teeth Abrade?
The natural friction of teeth moving against each other produces wear of the enamel. It is considered a natural process and happens over many years, so the changes are very gradual. Attrition (wear or loss of tooth substance) of the biting surfaces of teeth occurs one out of every four adults in the United States, or approximately 25% of the population.
You may notice these types of changes by observing that your front teeth appear to be chipping. These teeth might look shorter and the biting edges may appear discolored, especially on the lower front teeth. This process can occur more rapidly when you have a non-useful or non-purposeful biting, grinding, or clenching habit that can cause teeth to be in contact longer and more forcefully, either in waking hours or when sleeping.
Grinding and Clenching Habits
Grinding and clenching habits are most usually a physical expression of psychological or emotional stress. Many times, patients are completely unaware of their clenching, grinding, or biting habits. Most typically, this destructive habit occurs during sleep, and patients commonly deny knowing that it occurs. These habits can occur during periods of high stress or at times of high personal demand. Whenever nonfunctional wear of the teeth occurs, the enamel will wear much more quickly than can be normally expected. When this happens, the underlying dentin of the tooth is exposed, and this creates a problem.
Enamel is quite hard and resistant to wear. Dentin, on the other hand, has a higher organic component and does not handle the frictional forces of grinding, biting, and clenching very well. Consequently, once the outer covering of the tooth (enamel) is worn away, the underlying dentin will begin to wear faster, exposing even more of the dentin to the oral cavity. The tooth can chip and fracture. The dentin also has a tendency to show more stain from smoking, food, and drink. Coffee, tea, cola drinks, and red wine are noted for causing the unsightly brown/orange stain on the dentin.
Even when you eliminate the offending habit, once the dentin is exposed, it will continue to wear more quickly than the surrounding enamel. This will cause a dish- or donut-shaped area that progresses into a larger defect. At the very least, it is best to restore the areas as soon as possible (even if they are not yet cosmetic problems) to prevent further deterioration of the tooth structure.
There are several possible solutions to attrition and abrasion problems, depending on the level of tooth wear.
You can elect to do nothing. Your teeth will probably continue to wear down, stain, and become increasingly unsightly as they lose their proper shape, break, chip, and/or discolor. They may become more sensitive to temperature changes. Excessive wear may even require endodontic treatment (root canal therapy). In the most advanced cases, the back teeth are actually worn flat and the jaw relationships change to the extent that the jaw joint (temporomandibular joint [TMJ]) does not function properly, resulting in pain.
- A mouth guard or bite guard can be made, which prevents your teeth from coming into contact when you clench or grind. It is worn at times of high stress when you are most prone to clenching and grinding.
- Fractured and worn posterior (back) teeth can be restored. Cast restorations can be used to restore and maintain a proper jaw relationship. Cast gold is usually the material of choice for patients who suffer from clenching and grinding habits. The final decision on materials will be made on an evaluation of each individual situation.
- Exposed dentin on front teeth can be restored with a tooth-colored resin material bonded directly to the areas.
- Identify and eliminate the cause of your stress.
Unfortunately, once the tooth has been worn away, it will not grow back. It can only be repaired. It is much better to stop the progression of attrition. When is the best time to begin treatment for the bruxing and grinding habit? As soon as the problem is diagnosed.
If you have any questions about attrition or abrasion, please feel free to ask us.