Wirral Life November 2017 | Page 66

W DENTISTRY L WEAR, OH WEAR! BY RICHARD GIBSON Richard Gibson, Principal of Wallasey Orthodontics and Consultant to Liverpool University Dental Hospital talks to us about dentistry. Wear is a massive 21st Century issue but it’s not a new problem. It may have evolved but it still causes significant challenges to dentists in terms of its management and more crucially its prevention. Wear of the teeth can be broken down into 3 components, which can have an impact individually or synergistically on the dentition. As professionals we talk about attrition, abrasion and erosion – the cause of the wear being the discerning factor. Attrition is tooth surface loss associated with tooth to tooth contact. We probably all are or know a grinder and will be aware that this is a trickier issue because it has a strong association with stress levels and the subconscious – most of it occurring whilst you’re asleep. It is a normal physiological process and is commonly seen in association with ageing. Abrasion is the pathological loss of tooth surface usually associated with some sort of mechanical process whether that b e your hygiene with your toothbrush or whitening toothpaste, from dental appliances or indeed some habits – like nail biting or chewing objects. Finally, erosion is irreversible tooth surface loss associated with contact with an acid (not of bacterial origin). Historically, dentists have had to deal with attrition and indeed the body has been used to managing this from a functional perspective anyway. Attrition tends to be, in isolation, a slow process with decades of wear and tear resulting in shortening of front teeth and flattening of the back teeth. In the face of these low grade chronic changes the teeth are able to lay down additional material on their inside resulting in the nerve of the tooth shrinking which frequently means that people experience less symptoms than you might expect. There are, of course, exceptions and parafunction where the attritive element is present persistently and for long periods of time can cascade into more acute episodes with cracked teeth, chips, fractures and sensitivity – potentially even resulting in loss of vitality of the teeth. The most common presenting complaint may be aches of the jaw joint or headaches associated with the muscles that work your jaw. If the symptoms persist then your dentist may consider discussing with you exercises to normalise the way you open and close your jaw or even providing you with a soft mouthguard to sleep in. Abrasion again has been a challenge for a number of centuries – initially related to a coarse diet and then with the advent of current oral hygiene regimes. There has been such a range of dentifrices used over the centuries from coal to modern fluoridated toothpastes – all of which have the potential to abrade the surface of the tooth based on their physical makeup but also the frequency of use. Abrasion is most commonly seen on the necks of the 66 wirrallife.com side teeth where the hard enamel outer layer meets the soft covering of the root (dentine/ cementum). The differential resilience of the dental materials becomes starkly apparent as the dentine/ cementum wears at a much faster rate, causing grooves at the gum margin. Because of the shorter timescales these areas are frequently sources of sensitivity and probably were the major factor in the development of sensitive toothpastes. These toothpastes work by blocking the freshly opened channels in the dentine of the roots which are directly connected to the cells lining the nerve of the tooth (the pulp). Erosion, however, has exploded in the late 20th and now 21st centuries and is a problem for the young and old alike. As I mentioned above – it is related to acids coming into contact with the teeth through a non-bacterial cause i.e. not through the process of tooth decay or periodontal disease. Bacteria in the mouth ferment sugars in the absence of oxygen and produce acids as a by-product. This is the process by which we get tooth decay. Non-bacterial acids tend to come from dietary factors or from the stomach. We see signs of erosion in people with gastro-oesophageal regurgitation (reflux) where the acidic contents of the stomach makes its way into the mouth but also where vomiting is a regular occurrence – whether self-induced or for another reason. The pattern of wear tends to be different depending on which side the acid is coming from so when dietary related we would tend to see it on the front surface of the incisor teeth and on the back when it is coming from the stomach. This explosion, in an adolescent age group, of problems they will need to live with for the rest of their lives is concerning and largely related to the massive consumption of carbonated/ fizzy drinks. A relative increase in the prevalence of eating disorders certainly complicates the matter and creates its own challenges in terms of finding a solution. The fizzy drink phenomenon is an easier fix because these drinks have to be purchased. By simply taking them off the table as a choice we help protect ourselves and our children from the potentially debilitating consequences. Using a straw to drink through and having them with a meal certainly helps but is not a substitute for complete removal. By raising awareness of dental erosion and its consequences hopefully we can motivate ourselves and others to finally burst the bubble on the popularity of fizzy drinks! For more information on the types of treatment we offer or the results we can achieve, please visit www.wallaseyorthodontics.co.uk