Pathological tooth wear (also known as tooth surface loss) is on the increase, as indicated by the most recent Adult and Children’s Dental Health Surveys.^1,2

Recognising that tooth wear has the potential to be a serious issue in the UK in the future if preventive action is not fully embraced, its incidence and significance was recorded in the Adult Dental Health Survey (ADHS) for the first time in 1998, and this exercise was repeated in the latest offering. Comparison of the two surveys shows that in just 11 years the incidence of tooth wear in England has increased by 10%.¹

As for the Children’s Dental Health Survey, it tells us, for example, that 33% of 5-year-olds

demonstrated tooth surface loss (TSL) on one or more of the buccal surfaces of the primary upper incisors, while a quarter of 12-year-olds were reported to have TSL on the molars and the buccal surface of the incisors. In addition, 15-year-olds were shown to be more adversely affected than the 12-year-olds when TSL on the occlusal surface of molars was measured (31% compared to 25%).²

So, what does this mean in reality for dental professionals and patients looking to the future? As Poyser and colleagues (20015) so succinctly stated: ‘The prevalence of tooth wear is likely to escalate as life expectancy continues to increase. As people expect to retain their teeth throughout life this has important implications on the type of preventative and restorative care that the profession will need to provide in the future. This also has an implication for training and funding for dental services. The management of TSL and the eventual failure of restorations placed to manage this problem are likely to be a significant issue in future years.’³

Commenting on this worrying trend, Prof. Andrew Eder, said: ‘Irrespective of age and circumstance, patients need to be aware that, amongst other issues, poor drink and food choices, eating disorders, stress-related bruxism and traumatic oral hygiene measures can all cause considerable tooth wear.

‘Once the first signs of tooth wear are recognised, a partnership approach offers the most effective way in which to prevent further damage. Left in the dark, patients – especially those in the younger age groups – are likely to continue in ignorance with their destructive habits, which will have nationwide dental health repercussions for many years to come if the figures published in the most recent surveys are anything to go by.

‘So, if we are to have any chance of subverting the oral health outcome that the statistics indicate, it is incumbent upon all dental professionals to meet this challenge head-on.’

The London Tooth Wear Centre^® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

For further information on the work of the London Tooth Wear Centre^®, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.

References

1. Adult Dental Health Survey 2009. Report 2: Disease and related disorders. Health and Social Care Information Centre 2011

2. Children’s Dental Health Survey 2013. Report 2: Dental disease and damage in children: England, Wales and Northern Ireland. Health and Social Care Information Centre 2015

3. Poyser NJ et al. The Dahl Concept: past, present and future. BDJ 2005; 198: 669-676

Professor Andrew Eder is a Specialist in Restorative Dentistry and Prosthodontics and Clinical Director of the London Tooth Wear Centre^®, a specialist referral practice in central London. He is also Professor/Honorary Consultant at the UCL Eastman Dental Institute and Pro-Vice-Provost and Director of Life Learning at UCL.

Almost half of British adults say they feel stressed every day – that’s according to the Mental Health Foundation. It is generally well known that stress can contribute to health problems such as depression and heart disease. What is less well known – but imperative to address for emotional and physical well-being – is that it can also damage your teeth.
 

This is what happens – one of the more common signs of stress is tooth grinding but there’s a good chance you don’t even know you’re doing it, as it often happens in your sleep. However, its effects cannot be underestimated, often resulting in physical symptoms such as tooth sensitivity, gum problems, difficulty chewing, headaches and neck ache, as well as the possibility of ultimately losing teeth, which can have a devastating emotional effect.
 

If a dentist examined your mouth, they might find teeth that are:

• Sharp or chipped

• Broken

• Shortened

• Loose

• Wearing flat and looking shiny and pitted.

The good news is that making a few simple lifestyle changes can be a big help, such as:

• Doing something relaxing before bed, such as yoga, reading or having a bath

• Learning to brush effectively yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity (ask your dentist for advice on this if you’re not sure).
 

In addition, if you’re suffering from sensitivity (which should be diagnosed by a dentist to ensure there is no underlying condition that needs treatment), using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste used when brushing or applied directly onto a sensitive tooth can also be helpful to calm any sensitivity.
 

Commenting on this growing problem, Professor Andrew Eder, an expert in tooth wear and Clinical Director of the London Tooth Wear Centre^®, said: ^‘If you’re worried that your teeth may be wearing, tell your dentist. They are, after all, there to help and will be able to make a diagnosis, provide guidance or refer you, if appropriate.
 

‘Possible treatment options include the provision of a suitable mouthguard to be worn at night to relieve pressure on the teeth and jaw, prescribing muscle relaxants or recommending care from a physiotherapist or osteopath with specialist knowledge of the muscles involved.
 

‘If there was one piece of advice above all others I’d offer, it would be this – don’t delay in seeking help. If damage resulting from tooth wear is diagnosed and addressed in its early stages, you can avoid extensive and expensive dental treatment that might otherwise be necessary to correct the situation. The bottom line is that you needn’t suffer alone or long-term.’
 

If you have any concerns about your oral health or would simply like some preventive advice, please contact your dentist. If you prefer, the team at the London Tooth Wear Centre^® is happy to help. For further information, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.

With the new school year just around the corner, there’s a good chance some of your younger patients may well be exhibiting stress-related symptoms, including grinding and clenching that will cause wear beyond that which we would expect for their age.

Given the potential to affect their oral health for a lifetime – especially once the permanent dentition starts to erupt – this is an issue that needs to be tackled as quickly as possible.

Signs and symptoms associated with bruxism in children might include changes to their facial symmetry, inability of the lips to form an adequate seal, pain in the area of the masseter or temporalis muscles upon palpation, headaches and earaches, dentine sensitivity, and temporomandibular disorders, as well as anterior and posterior cross bites and tooth wear.

If a child presents with warning signs that may be attributed to bruxism, it will be helpful to ensure he/she is brushing effectively yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity, as well as suggesting they do something relaxing before bed such as reading or having a bath.

In addition, a soft mouthguard to be worn at night may be customised to prevent further damage to the dentition, which will need to be changed regularly for younger patients as the child and their teeth develop.

The London Tooth Wear Centre^® offers an evidence-based and comprehensive approach to managing tooth wear. To request advice, make a referral or for further information on the work of the London Tooth Wear Centre^®, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.

According to charity Addaction, 54% of men and 41% of women are expected to drink over the recommended guidelines at Christmas, and so it is important to raise our patients’ awareness of the increased potential for tooth damage at this time of year.

As we dental professionals know all too well, alcohol is acidic and therefore highly erosive, especially when consumed frequently, in large quantities over an extended period of time. It may also be that the high alcohol intake occasionally causes vomiting, which can exacerbate the damage to the dentition.

To help prevent tooth wear, advise patients to:

1. Drink still water or low fat milk between meals

2. Limit fruit juice to once per day

3. Avoid carbonated drinks

4. Swallow any acidic drinks immediately to reduce contact time with the teeth

5. Use a wide-bore straw to drink acidic drinks to limit the contact time with the teeth

6. Dilute and keep any acidic drinks chilled, as this reduces the damaging low pH potential

7. Rinse the mouth after acidic foods and drinks with water for 15-30 seconds to dilute any remaining acids

8. Snack on cheese or drink some milk following consumption of an acidic beverage

9. Wait at least an hour to brush teeth after consuming any acidic drinks

10. Use a toothpaste that is fluoridated to 1400ppm and low in abrasivity

12. Use a fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after acidic drinks to help limit the erosive potential

12. Chew sugar-free gum, especially that containing xylitol, after drink to help neutralise the acidic environment in the mouth.

If you are concerned that any of your patients are showing signs tooth wear, simply visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.

It won’t be news to you that stress can damage the dentition in the form of attrition, but did you know that statistics indicate that one in three workers experience post-holiday blues? It makes sense that this can then exacerbate bruxism.

If a patient presents with pain and/or tooth wear that can be attributed to bruxism and they tell you that they are stressed, it is a good idea to let them know that making a few simple lifestyle changes can be of significant benefit, including:

• Doing something relaxing before bed, such as yoga, reading or having a bath

• Learning to brush effectively yet gently with a relatively soft toothbrush and a toothpaste low in abrasivity.

Further, prescribing muscle relaxants and the use of a suitable mouthguard, such as a Michigan splint, may prove useful. Such splints help to protect the teeth against bruxism and reduce TMJ pain by encouraging the patient’s mandible to assume the most comfortable and reproducible position. The overall aim with such a guard is to protect against any damage that may be caused by a habitual grinding pattern and to break the cyclical habit, if at all possible.

In addition, recommending care from a physiotherapist or osteopath with specialist knowledge of the temporomandibular joint (TMJ) might be appropriate to prevent further damage.

The London Tooth Wear Centre^® offers an evidence-based and comprehensive approach to managing tooth wear.

To request advice, make a referral or for further information on the work of the London Tooth Wear Centre®, please visit www.toothwear.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 020 7486 7180.