It should be stated from the outset: in order to avoid damaging consequences, tooth wear and erosion phenomena should neither be underestimated nor neglected. To deal with the problem, solutions that are both reliable and relatively uninvasive are now available - which is a relatively new development. Because they are relatively complex, these solutions are not always applied in all dental practices; they require improved techniques and more knowledge about the materials to be used plus an expert knowledge of dental bonding techniques. In the article “A rational and conservative approach to advanced tooth wear”(1), Alain Vanheusden, a professor in the Dental Science Department of the University of Liege, sets out the application and aftercare required for a long and precise procedure which makes it possible to treat these kinds of cases. The objective is clear: to restore masticatory function and give patients and their dentists their smile back.

For several years, the problem of tooth wear and dental erosion has plagued dentists - and some of their patients. In fact, "more and more young adults consult dentists due to tooth tissue loss of non-carious origin", explains Prof. Alain Vanheusden, head of the Fixed Prosthetics Department at Liege University Hospital. Is it a serious problem? It certainly has the potential to become one.

Among the individuals concerned the tooth enamel becomes worn to the point of disappearing and resulting in the exposure of the underlying dentine which wears away quicker than enamel. This loss of tooth tissue is a serious problem. It causes sensitivity, the tooth becomes fragile to the point of breaking and this results in a visible esthetic difference with regard to the height (size) of the tooth. Another potential risk is present, that of an imbalance in dental occlusion.

Dental occlusion refers to the fact that our jaws and teeth should fit together snugly but dental erosion can “erase” or modify the indispensable points of contact between the teeth of the two jaws. In time, this imbalanced occlusion alters masticatory function and dental esthetics. In some cases, imbalanced occlusion can cause a malfunction in the temporomandibular joint (this is the joint that enables the mouth to open and close). The possible consequences of this are symptoms such as pain, spasms, jaw clenching and headaches and all of this is caused by “worn” teeth in the first place!

Formidable enemies

Since the end of the 20th century most European countries including our own have seen a reduction in the incidence of tooth decay. This represents real progress from a public health point of view! “The effects of fluoride, dental health campaigns, and improvements in techniques used and conservative dental materials have proved fruitful”, states the head of department. Yet dentists, and the wider population should not be content merely to fight against tooth decay (and caring for gums), but they should also deal with those other enemies of teeth, tooth wear and erosion.

“The hundreds of scientific articles that have been published on this subject during the last five years show the extent to which the problem has become a major preoccupation for dental practices”, says Alain Vanheusden.  This increasing threat has been caused by a combination of factors. Firstly, thanks to more efficient and conservative treatments (conservative refers to the preference of dentists for preserving and saving teeth when possible) the average life-expectancy for teeth has increased. Because we are living longer we keep our teeth for longer and this means they are even more exposed to tooth wear or erosion.

Other causes linked to our lives and behaviour come into play here. Our stress levels, our dietary habits and our medicines all play a part in the phenomenon of tooth wear and erosion. Under the effects of stress we can grit our teeth and/or grind them involuntarily and sometimes even unconsciously particularly during sleep. This bruxism applies a mechanical force to our teeth but the latter are not equipped to definitively resist this force. “It is important to point out that the intensity of the forces exerted greatly exceed those that apply during mastication”, explains Prof. Vanheusden. Stress, which is a social phenomenon, is therefore indirectly responsible for oral health problems…

Vanheusden, Alain , Approche prothétique rationnelle et conservatrice d'usure dentaire avancée, in Revue d'Odonto-Stomatologie [=ROS] (2014), 43(3), 251-268 Septembre 2014.