Erosive Tooth Wear and Me

1. Avoid snacking on acidic fruit and drinks

• Cut down on snacking between meals on acidic food and drinks
• Fruit is an important part of a healthy diet. Snacking on acidic fruits, such as citrus, apples, pineapples, grapefruit can cause erosive tooth wear. But if you take thee fruits at meal times the risk is very low.
  • Less acidic fruits – bananas, coconut
  • Most erosive fruits – oranges, pineapple, grapefruit, apples
• Cut down on carbonated drinks and fruit juice
  • Limit them to mealtimes so they are washed out of the mouth/diluted by food when swallowing
  • Don’t sip over a long time

2. Fluoride toothpaste and mouthwash

• Fluoride combines with the ingredients in saliva to form a tougher version of enamel that is more resistant to acid
• Toothpaste should include at least 1450 ppm fluoride, if you have a problem with erosive tooth wear ask your dentist which is best for you
• Some toothpastes have ingredients optimised for the prevention of erosive tooth wear. Find out more about the causes of mechanical tooth wear here.
• However, don’t brush your teeth right after eating or drinking acidic foods or drinks.
• Surface softening by the acids and brushing teeth combine to remove enamel and cause Erosive Tooth Wear.
• Give time between eating and brushing your teeth.
• If you also suffer from sensitivity you may need a toothpaste with other ingredients.

3. Brush carefully

• Only brush two times a day
• Use a soft-medium toothbrush
• Brush in a gentle, circular motion
• Do not brush immediately after anything acidic
• Seek medical advice if you have erosive tooth wear due to acid reflux or frequent vomiting
• If you are on a medication that causes dry mouth, ask if you can be switched to one that doesn’t. Do not stop taking any medication without first consulting your doctor

Enamel cannot be replaced. Early on, when there is just surface softening, toothpastes can help re-harden the enamel. Click here to read more about what the other ingredients in toothpaste do.

Visit the dentist who can give advice tailored just to you. They may provide an in-clinic treatment such as a dentin bonding agent or sealant or a mouth guard if you grind your teeth at night

For those with sensitive teeth, some toothpastes have ingredients that combine with tooth-building ingredients in your saliva to help build enamel. Look for toothpastes with CSPS, stannous fluoride, strontium, etc. Click here to find out more about what causes sensitive teeth. Read more about what the other ingredients in toothpaste do here.

Tooth restoration - Explore the pros and cons here

• Restoration with tooth coloured filings: composite resin
• Restoration with crowns may be needed as most often more than one tooth is affected, sometimes all of them; these can be complex and possibly costly

Tooth restoration may be considered for reasons of appearance but most often this will be classed as ‘cosmetic’ so you may need to pay for it

It is not possible to be broadly prescriptive as the treatment options available depend on the severity of your tooth wear. Treatment options will also be influenced by your choices and the cost of care. Your Dentist will explain the options and inform you of the risks and benefits of each choice. It is then up to you to choose.

The challenge with tooth wear is that it affects multiple teeth. This makes the treatment more complex and therefore costly. Not all general dentists will be able to provide all the options as their training may not have included this.

1. Watch and monitor

Not all tooth wear, even at severe levels, needs treatment. If the wear mainly affects the posterior (back) teeth it may not show and your desire to have restorations may not be strong. We believe tooth progression is slow and therefore it is rarely necessary to make a quick decision. Treatment can be delayed for years, provided your dentist continues to monitor your teeth.

2. Restorations

These are often focused on the front teeth particularly when they become noticeably shorter. There are various restoration options available to you.

• Composites: These are tooth-coloured materials which can stick to teeth with the aid of special cements (this is often called “bonding”). These treatments conserve/preserve your existing tooth. However, over time they can break or fracture, and for some people this can happen quickly. Composite restorations are often the first-line choice.
• Caps or Crowns: For some patients, their tooth wear may be more severe, and composites may not bond to the tooth. After discussion with your dentist, you may decide on crowns or caps. These require drilling or removing more of the tooth to create space for the porcelain (tooth-coloured ceramic) cap or crown. This option can be expensive but many dentists believe they last longer and have less complications than composites. They are however not immune to fracture or breakages, although these happen more rarely than with composites.
• Crown Lengthening: In very rare instances, teeth may be so short they need surgical crown lengthening. In this procedure, Periodontal dentists strip back the gums to create longer teeth which are then crowned.
• Extraction: Even more rarely, the teeth are beyond saving and you will need them extracted and replaced with dentures or implants.