Dentist Toronto

Overview

The 20th century saw huge advances in dentistry and major improvements in oral health. Caries and the periodontal diseases have been brought under control, fewer teeth are restored or extracted and the longevity of the natural dentition has been extended for many more people. Improved oral hygiene has been a major contributor to this — great news for both public health and individual’s quality of life.

However, dental practitioners are now seeing a paradox: these healthier longer-lasting teeth are showing signs of increasing tooth wear. In Europe, dental professionals consider acid erosion as the primary cause.

Acid erosion is strongly linked to the consumption of acidic foods and drinks. Acids demineralise and soften the tooth surface making it more susceptible to abrasion, particularly by toothbrushing with or without toothpaste.

In its early stages tooth wear is often thought to be harmless. However as it progresses tooth wear can result in dentine hypersensitivity, loss of tooth shape and colour, and may require complex restorative intervention. Yet many people remain unaware of the consequences of tooth wear and the measures that can be taken to protect teeth from this slow and insidious process.

At the 2005 FDI World Dental Congress international experts reviewed the prevalence, aetiology, diagnosis, pathophysiology, and management of tooth wear in front of a record audience of over 900 dental professionals. There was agreement that acid erosion is becoming a significant issue.

Causes

The awareness of tooth wear has increased markedly over recent years. Much of this is linked to changes in diet and oral care

1. Teeth are lasting longer

Increased success by dentistry in the control of caries and periodontal diseases has extended the longevity of the natural dentition. Healthier unrestored teeth are exposed for longer to the gradual processes of everyday wear.

2. The modern diet paradox

Modern diets are often rich in acids from a wide range of sources. Notably, many fruits, fruit juices and wine - have a low pH, sufficient to soften and demineralise enamel surfaces at approx pH 5.5 and below, and dentine at pH 6.5 and below, depending upon other factors such as titratable acidity, and calcium, phosphate and fluoride content.

Acid temporarily softens the surface of the enamel. It is a process normally mitigated by the natural action of saliva due to the presence of calcium, but frequent or prolonged acidic encounters leave less time for remineralisation to occur. In this weakened state, surface enamel is prone to wear from the abrasive action of toothpaste and tooth brushing.

Signs and Diagnosis

Everyone with natural teeth is likely to develop some signs of tooth wear, but many patients are unlikely to be aware that it is happening to them until it has reached an advanced stage.

Currently, dental erosion normally only reaches a diagnostic threshold when restorative dentistry is indicated. Improving recognition of the early signs and symptoms is crucial if effective preventative measures are to be taken.

The pathophysiology of acid erosion.

At any stage of dental erosion, dentine hypersensitivity may occur. This could range from infrequent twinges during consumption of hot, cold or sweet foods, through to fairly continuous sensitivity readily provoked by the mildest of stimuli. Occasional sensitivity may well go unreported by the patient during routine examinations.

Prevention

Early intervention is key. Increased vigilance during routine examinations together with lifestyle advice can slow the progression of symptoms.

Due to the range of potential causes, options for tackling tooth wear should ideally be tailored to an individual’s circumstances. Ask the patient whether they swill carbonated drinks around their mouth or retain food or drinks in their mouth for extended periods. Enquire after tooth brushing habits, and possible gastric conditions involving heartburn (oesophageal reflux).

Once clinical examination has identified the key factors, and a differential diagnosis of acid erosion has been made, recommendations may include:

• Reduce or eliminate intake of carbonated drinks
• Cease retaining acidic foods and drinks inside the mouth
• Chew gum or suck a sugar-free lozenge to encourage saliva production and protect enamel, or eat a piece of cheese after an acidic meal
• Leave brushing of teeth for at least one hour after consuming acidic food or drink
• Brush with a soft toothbrush, using a low-abrasion, low-acidity, high-fluoride dentifrice

Acid erosion and abrasion