Monthly Archives: July 2013

Tooth wear another trap to avoid falling into?

Here at Northway Dental Practice we would like to help you to avoid a problem that is difficult to see or feel but which over the long term can cause a lot of difficulties – tooth wear. Dentists also call this “tooth surface loss”.

What is tooth wear?

Tooth wear is the process by which the teeth become worn at the surfaces, i.e. become thinner/smaller or become pitted. It is a problem as our teeth do not grow, they form completely (with the exception of a little internal growth) a few years after they come through the gum and from that point onwards they are gradually wearing out. There are three things that wear our teeth:

  1. Attrition – i.e.  chewing. As we chew the teeth rub against each other and chew against food and gradually small amounts wear away. This problem is worse if you have lost some teeth, as the remaining teeth have to work harder when you chew. This is a mechanical process.
  2. Abrasion – this means wear at the surface caused by abrasive things such as toothpaste, or tooth brushes. This is a mechanical process.
  3. Erosion – is where the teeth essentially dissolve because acids (from foods, drinks or plaque/bacteria) are destroying the surfaces. This is a chemical process.

What makes tooth wear more difficult to diagnose is that often all three processes are occurring at the same time.

Is it normal?

The answer is yes but the issue is how fast is it happening. This is vital in deciding if the wear we see is ongoing or perhaps it all happened in the past and isn’t happening at the moment. If you have mild tooth wear at 80 years old it is less of a problem; if you have severe tooth wear at 20 years old it is going to be very troublesome over the coming years.

Tooth wear is a problem that is becoming more common. There are a number of reasons why:

  • The population is ageing, there are more older people as a proportion of the population.
  • It is normal to keep our teeth longer as we get older. A statistic released in 2013 showed that in 1993 the number of people with no teeth at all was 27%. In 2013 it was just 6%!
  • We are eating more tough, unprocessed foods, as a result of moving towards a more “healthy” diet.
  • We are consuming  more acidic  foods and drinks including whole fruit, fruit juice, smoothies, beer, cider, wine and fizzy drinks. Often without realising it since diet fizzy drinks are also very acidic.
  • We are more inclined to use abrasive toothpastes such as those which are sold as whitening toothpaste.
  • As  we lose teeth  we end up with fewer chewing pairs of teeth, these then have to work harder and will wear away more quickly. Tooth wear accelerates as time passes, if teeth are lost.

One of the most troublesome aspects of managing tooth wear is that many people with it don’t realise they have it, either because they feel it is normal and therefore not worth trying to prevent/treat or because it happens very slowly and gradually and so they don’t notice it has happened. If the wear happened overnight it would be very dramatic and upsetting but it is a slow process so we get used it.

So how do we deal with tooth wear?

First we have to work out whether you have normal tooth wear for your age or advanced tooth wear for your age i.e. more than normal. This is one of the few areas in dentistry where age matters, since wear is more likely with the passing of time.

Next we have to determine if the wear is ongoing and at what rate it is happening. The way we do this is by measuring the thickness of the teeth, or by taking photos, or by making a set of models of the teeth. We can then come back to these in a few years time and measure again to see if things are getting worse, it is a slow process so it can be hard to tell by simply looking.

Presuming that you have advanced wear for your age, the wear process is ongoing, and the rate of wear is sufficient to cause future problems then we need to act to prevent and possibly treat the wear.

Prevention really is better than cure….

This is a much overused phrase but that’s because it’s true. The way to deal with wear is to minimise the amount we suffer from and avoid it. The best ways to do this are:

  • Cut down on acid drinks and foods – rinse your mouth after acids with water or mouthwash.
  • Do not use whitening toothpaste regularly – only use it occasionally.
  • DO NOT brush straight after sugars/acids. The teeth are soft after sugar/acid and brushing them immediately will cause more wear. Rinse straight after drinks/foods with mouthwash or water and wait 1 hour before brushing.
  • If you grind your teeth at night (i.e. wake up with soreness in your face/sides of head, or aching teeth in the morning, clicking jaw etc… ) consider wearing a niteguard to prevent wear. This is a soft plastic shield to wear over the teeth and is much less costly than treating tooth wear later.
  • Use plenty of fluoride which is in normal toothpaste and mouthwash or ask your dentist about high fluoride prescription toothpaste. More fluoride means harder teeth, less erosion and wear. It is sensible to avoid rinsing with water after brushing, just spit out the foam and leave the paste on your teeth – it is in contact longer and so has more chance to work.
  • Consider using a toothpaste designed to protect enamel, these are more gentle and less abrasive.

If tooth wear has already become a problem then treatment needs to be considered. It is very important to correct the causes first (see above) before treatment otherwise the problem will recur or the treatment may fail prematurely. There are a number of ways of restoring the damage caused by tooth wear:

  • Make sure you have a normal set of teeth to chew with, this might mean if you have lost some teeth, having dentures or implants to replace missing teeth. If missing teeth is the cause of your tooth wear this step is not optional, without it any repairs will quickly fail or wear out themselves.
  • You can have white fillings to build up the teeth if the damage is modest.
  • You can have crowns to build up the teeth especially if the damage is severe, they are stronger but they cost more and come with slightly higher risks of future issues.

The improvement after treatment can be dramatic cosmetically and can seriously improve your chewing, speaking and general confidence. With the right prevention further wear can be minimised and your teeth can be maintained in a good-looking, healthy state.

If there is a take home message it is “avoid wear by taking precautions” such as those above. Try to be objective about your teeth, generally none of us want dental treatment but when it is needed it will make a huge difference to our health. If the teeth aren’t functioning properly – seek help which is available from your dentist.

To speak to us about tooth wear see our website www.northwaydental.co.uk.

 

Gum Disease – avoid falling into the trap….

What is gum disease?

When talking about this topic there are a lot of myths that go around. I have heard over the years people say they caught gum disease from other people or even from their cat! You don’t catch gum disease; it is often a change that comes with time (age).

Gum disease, put simply, covers a range of conditions which if left unchallenged will cause or accelerate the loss of the bone from around the teeth. When there is very little bone around the teeth they become loose and can be painful. At this point removing them is often necessary.

It is worth also saying that all adults are gradually losing this bone over time but unless you have gum disease it should not cause any major problems until you reach an advanced age say 80+ years. If you have gum disease these problems will occur at a much earlier stage.

What are the signs?

There are various signs which are easy to ignore, and often are ignored. Bleeding gums is a major warning sign, tender or swollen gums are another. Often gum disease will NOT cause pain, this is one of the traps you can fall into – assuming that because the gums don’t hurt that they are healthy. This is not always the case. In the later stages you might experience loose teeth or painful teeth or gums.

What makes it worse?

There are a range of factors which make gum disease more of a problem.

  • Genetics – about 50% of us are susceptible to gum disease, if we aren’t careful we will have problems with it, for the others the risk is less. If your parents lost their teeth at a young age, say before they were 50, then you might be susceptible and ought to be actively involved in avoiding developing the condition yourself. You can do this in consultation with your dentist. 
  • Bad oral hygiene. Plaque and tartar will cause irritation in the gums, bleeding and soreness, encouraging the bacteria which cause the disease to worsen, to form and grow. It is vital to brush well twice per day for 2 minutes, preferably use a good quality electric brush and clean between the teeth using floss or inter-dental brushes at least once per day.
  • Poor general health, conditions such as diabetes or anything which makes our immune systems weaker, increase the risk from gum disease.
  • Poor diet can have an impact, frequent sugary foods and drinks will encourage bacteria (plaque) to grow.
  • Smoking is a major risk factor for gum disease. Smoking reduces the blood flow in the mouth, weakening the immune system and allowing more bacteria to grow.

What can we do about it?

  • Give up smoking – a lot of help is available now, consider patches/gum/ lozenges/tablets to help you quit. Join a quit smoking group (in person or on-line).
  • Eat fewer sugary foods and drinks and have them less often, ideally fewer than 4 times per day.
  • Brush very well, take your time, get an electric brush and get between your teeth with floss/inter-dental brushes. Every minute spent on good oral hygiene will improve the outlook for you mouth in the long run. 
  • Get some treatment from your dentist or hygienist. Treatment includes advice on lifestyle and brushing as well as cleaning above and below the gums to remove bacteria. It only works if you clean well and are willing to maintain a very high standard of oral hygiene.

So what is the trap to avoid – it is assuming that it won’t happen to you and that this is a problem other people have. Many people we see presenting for advice and treatment have already missed the boat in terms of preventing the disease and for them it is a case of damage limitation, we won’t always save every tooth. If your gums bleed or your parents lost their teeth early,  then you should consider actively preventing gum disease by avoiding the causes above.

Furthermore, some scientific studies are showing a link between gum disease and heart disease. So far we don’t know how this works but it makes sense to be cautious and presume that healthy gums might be part of the puzzle in having a healthy heart.

At Northway Dental Practice, Midsomer Norton, we are keen to help you avoid these problems and treat them when they do occur. Visit www.northwaydental.co.uk for more information.