Treating the Heavily Worn Dentition
No problem perplexes dentists more than the patient who walks into the office showing the initial signs of a wearing dentition. Though some wear of the dentition is normal (1/10th of a mm of enamel per decade) most patients nowadays far exceed their wear allotment. A normal thickness of enamel 1.5-2.0 mm should last easily to age 90 and beyond.
Enter the 21st century and we find teenagers having already worn out a lifetime of enamel! So what’s to blame??
There are two main causes of tooth wear and erosion. One cause is diet related. Popular carbonated drinks, fruit juices, energy drinks, colon cleansing regimes, fruit juice based diet regimes, salad dressings, etc., all have high acidic content. These acids are strong enough to erode away tooth enamel. These are all extrinsic or external causes of acid delivery to the dentition. But some of us produce our own intrinsic acid. Patients who suffer from various digestive disorders such as gastro-esophageal reflux disease (heart burn, GERD) can bring highly corrosive stomach acid back up into the throat and onto the teeth, not only doing potential damage to the tissues of the esophagus and throat but also dissolving tooth enamel.
Another cause of tooth structure loss comes in the form of stress that results in the various patterns of bruxism, (tooth grinding) which can occur day or night.
For the young patient this may be remedied to some degree by an occlusal equilibration, (bite adjustment) or the use of various forms of plastic night guards to slow down the ravages of these grinding patterns at night. However, this does little for those who continue to brux during the day or find it difficult to wear a nighttime appliance.
For the adult patient who has already suffered with the damage of years of bruxing the solution is even more complex and requires an extensive exam, model work up and photos to help design a restorative solution. Few solutions are easy and many quite costly as part or all of the dentition that was lost must now be replaced to regain the vertical height lost over the years.
The good news is that with modern porcelains, techniques and a lot of patience, we can now restore the patient back to normal function and appearance and hopefully have it last for the remainder of their life.