What to do if the enamel on your teeth is worn away

Author of the article:

Soldatova Lyudmila Nikolaevna

Candidate of Medical Sciences, Professor of the Department of Clinical Dentistry of the St. Petersburg Medical and Social Institute, Chief Physician of the Alfa-Dent Dental Clinic, St. Petersburg

Enamel is the hardest part of the tooth. This tissue consists of enameloblasts, proteins, lipids and water. Although, at first glance, the enamel has a uniform structure, this is not the case. It varies in thickness in different areas of the teeth. But, unfortunately, even the strongest enamel on teeth can begin to wear off. How to prevent this unpleasant process? Let's try to figure it out.

Content

When should you start taking care of your teeth?
Why does enamel wear off?
What to do if the enamel wears off
The enamel is worn off, teeth hurt - what to do?
Solving the problem yourself

Poor dental health can cause dangerous illnesses. The health of these organs is especially important in a person’s life, since any food must be chewed well, and with unhealthy or missing teeth this is not easy. The front teeth experience high stress when eating food, and it is important that their enamel is complete. Worn enamel, among other things, deprives a person of the opportunity to smile, and his attractiveness is lost.

Clinical researches

Clinical studies have proven that regular use of professional toothpaste ASEPTA REMINERALIZATION improved the condition of the enamel by 64% and reduced tooth sensitivity by 66% after just 4 weeks.

Sources:

Features of personal response in the prevention and treatment of hypersensitivity of teeth against the background of type 2 diabetes mellitus A.K. YORDANISHVILI, Doctor of Medical Sciences, Professor, North-Western State Medical University named after. I.I. Mechnikov, Military Medical Academy named after. CM. Kirova, International Academy of Sciences of Ecology, Human Safety and Nature, N.A. UDALTSOVA, Candidate of Medical Sciences, Associate Professor, St. Petersburg State University of the Government of the Russian Federation; dental clinic No. 29, Frunzensky district of St. Petersburg, O.V. PRYSYAZHNYUK, head. surgical department No. 2, dental clinic No. 29, Frunzensky district of St. Petersburg
Report on the determination/confirmation of the preventive properties of personal oral hygiene products “ASEPTA PLUS” Remineralization doctor-researcher A.A. Leontyev, head Department of Preventive Dentistry, Doctor of Medical Sciences, Professor S.B. Ulitovsky First St. Petersburg State Medical University named after. acad. I.P. Pavlova, Department of Preventive Dentistry

When should you start taking care of your teeth?

The correct answer is from the prenatal period. It is from this time that the expectant mother should saturate her body with vitamins and calcium and take vitamin and mineral complexes specially created for pregnant women. A professional dentist will help in this matter.

Breastfeeding is important for a newborn baby, because mother's milk will provide the baby with everything necessary for proper development, including teeth.

When the child gets older, parents introduce him to sweets - this is the first factor that destroys teeth. From this moment on, there is a danger of caries. If there is not enough calcium, the enamel will be destroyed in childhood.

To avoid such danger, the mother must:

Reduce consumption of sugar and fructose;
Protect yourself from any diseases so as not to cause hypoplasia in the unborn child - underdevelopment of tooth enamel;
Feed your baby breast milk, because the share of sugar in infant formula is up to 30%;
Minimize the amount of cookies and sweets in the child’s diet;
Take vitamins as prescribed by your dentist.

Stages and features of treatment of tooth enamel erosion

Treatment of this disease is a rather long and complex process, the success of which often depends on the stage of its development. Based on this, appropriate treatment methods are selected.

Based on the intensity and depth of the lesion, the following stages of the disease are distinguished:

Initial. Not visually detectable. The top layer is affected.
Average. The disease becomes visually noticeable, there is a pronounced whitish tint, and all layers of enamel are susceptible to destruction.
Heavy. The entire enamel is affected, the upper layer of dentin is involved.

It is important to understand that this pathology does not appear immediately, but gradually destroys the enamel and leads to serious consequences.

The disease can be identified by a number of symptoms:

loss of the original shine of the enamel;
change in tooth color;
tooth sensitivity, pain when exposed to hot/cold food. This is explained by the appearance of a cavity in the affected area, which reacts to thermal changes and causes a corresponding painful reaction;
the contours of the teeth are unnaturally transparent in appearance.

If such symptoms occur, you should make an appointment with the dentist.

Why does the enamel on teeth wear off?

Scientists identify several reasons:

Bad habits - biting pencils and nails, alcohol and nicotine;
Straight bite;
Sharp closing of the jaws during stress, bruxism;
Violation of metabolic processes;
Work in hazardous industries - in the field of metallurgy, in coal mining, in confectionery shops;
Using brushes with hard bristles;
Inappropriate bleaching;
Culinary preferences (hot tea with ice cream, for example).

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Diagnostics

This disease can be diagnosed during a dental examination. The dentist detects the location of the erosive focus by thoroughly drying the tooth surface with a stream of air and lubricating it with 5% iodine tincture. The area of enamel affected by the disease becomes brownish in color.

Erosion differs from other pathological processes in its contours, localization, smooth surface and is usually located closer to the base of the root.

The earlier the pathology is diagnosed, the more successful its treatment will be.

Enamel has worn off, teeth hurt – what to do?

Seek help from a dentist and begin treatment. Various methods and drugs are used to eliminate the problem. It is impossible to restore the enamel, but the use of drugs will make it harder and protect it from further destruction. Scientists are working to create drugs that can restore worn enamel. The implementation of this task will be a truly great discovery.

Multidisciplinary approach to the treatment of anterior tooth wear: a step-by-step protocol

Taking into account an accurate risk profile, as well as predicting outcomes, are critical in planning and implementing dental treatment. Such treatment, in its essence, should foresee a minimal risk of complications, be promising and provide a stable long-term effect. In addition, open communication and collaboration with both the patient and other dental professionals is essential for clinicians to achieve treatment goals and desired results.

In this case, the patient sought help with long-existing wear on his front teeth. Although he had understood the essence of the problem for 10 years, he never had sufficient motivation for treatment until he got married and until his wife noticed the appearance of his smile. During a comprehensive dental examination, it was determined that severe wear of the anterior group of teeth was the result of their incorrect position. Functional diagnostics revealed limited masticatory excursion. Given that the back teeth had not been restored, an orthodontic approach was recommended as a possible option in the comprehensive treatment to improve the appearance of the smile. Careful planning with the orthodontist was aimed at correcting the position of the teeth and their alignment, improving the functionality of the dentition and providing sufficient space to restore the length of the clinical crowns.

Case review

A 42-year-old man sought treatment for severely worn front teeth and problems with his smile (Figure 1 and Figure 2). The nature of wear on the front teeth of the upper and lower jaws was not physiological for his age. The size of the central upper incisors was only 6 mm vertically. The back teeth were diagnosed with signs of erosion, and although they required restoration, their level of wear was minimal. The patient's medical history did not contain any information regarding this disease.

Photo 1. View of the patient’s face and smile before treatment: the patient has difficulty demonstrating the level of his teeth.

Photo 2. View of the maximum tubercular-fissure contact of the antagonist teeth: severe abrasion of the anterior teeth.

Diagnostic criteria, risk assessment and prognosis

Periodontal: during a periodontal examination, pockets 4 mm deep were found in the area of the molars of the lower jaw; near other teeth the depth of the pockets was no more than 3 mm. Radiographs revealed minimal generalized horizontal bone loss (<10%). The level of hygiene was assessed as satisfactory. Periodontal diagnosis according to the American Academy of Periodontology is type II periodontal disease.

Risk: low.

Prognosis: good.

Biomechanical: the patient had no clinical or radiological signs of carious lesions. Several restorations were found on the posterior teeth, as well as small areas of erosion. Erosion was present on the anterior teeth of the upper and lower jaws, most likely due to dentin defects resulting from inadequate functional load. Loss of anterior tooth structure due to increased wear significantly increased the risk factor of treatment and negatively impacted its future prognosis.

Risk: moderate.

Prognosis: satisfactory.

Functional: the patient had no complaints regarding the function of the temporomandibular joints. During stress tests, no joint pathologies accompanied by corresponding sounds were detected. However, the patient noted stiffness and discomfort in the masticatory muscles on both sides. Signs of severe tooth wear ranging from 4 mm to 5 mm were found on all anterior teeth of the upper and lower jaws from canine to canine. Minimal wear was noted in the posterior teeth. According to the medical history, the patient stated that tooth wear had been progressing over the past 5 years. These criteria, particularly severe isolated wear of the anterior teeth, are consistent with a diagnosis of limited masticatory excursion (Figure 3 and Figure 4).

Risk: moderate

Prognosis: unsatisfactory.

Photo 3. View of the upper jaw: restoration of the posterior group of teeth and wear of the anterior group of teeth.

Photo 4. View of the lower jaw: restoration of the posterior group of teeth and wear of the anterior group of teeth (similar to the upper jaw).

Maxillofacial: With a full smile or an “ee-ee” sound without the lips obstructing the visualization of the teeth, the patient had barely one-third of his front teeth visible. At rest, the teeth are not visible. With a wide smile, the patient’s gum level was also not visualized, which was due to low lip dynamics and the factor of minimal dental visualization.

Risk: low.

Prognosis: hopeless.

Treatment Goals

The goals of treatment formed a kind of triad.

The first goal was to improve the aesthetic appearance of the smile through conservative, minimally invasive treatment.
The next goal was to reduce functional risk and improve functional and maxillofacial prognosis while minimizing the need for tooth extraction and maximizing support for gingival health. This could be achieved through orthodontic repositioning of the teeth, which would help correct the condition of limited chewing ability and provide the necessary amount of space to restore the upper and lower anterior teeth to the more optimal crown length of 10 mm.
The third goal was to restore the anterior teeth initially with composite resin as a trial for a period of 6 months after completion of orthodontic treatment. This approach is compatible with the patient's financial capabilities, and at the same time it would help determine whether the length of the teeth is acceptable and appropriate for the installation of ceramic crowns at the end of treatment.

Treatment plan

The treatment plan consisted of the following steps.

A detailed description of the diagnosis, treatment goals, and rehabilitation plan was sent to the orthodontist prior to his scheduled consultation with this patient. Such communication contributes to an effective and productive consultation with the patient during an orthodontic appointment. After consultation with the patient, a meeting was scheduled between the treating dentist and the orthodontist to discuss in detail the treatment goals and the actual results that can be achieved through orthodontic intervention.
After completion of orthodontic treatment, it was planned to obtain a diagnostic wax-up model of the anterior teeth using models installed in the Kois Dento-Facial Analyzer.
Obtaining a rigid template from a diagnostic model to test the possibility of direct restoration of teeth with a composite.
After completion of the test period, the Kois deprogrammer is planned to be used to confirm a healthy, stable and acceptable occlusion or to possibly correct the occlusion if necessary.
Preparation and production of e.max (Ivoclar Vivadent) ceramic crowns for the anterior teeth as the final stage of treatment.

Treatment phases

Stage 1. Orthodontic treatment.

The patient wore fully fixed braces and ligatures for 13 months. Intrusion of the upper and lower incisors of approximately 1 mm and inclination of the upper incisors of approximately 2 mm were performed. The lower incisors were fixed back in a horizontal position as far as possible. During the process of orthodontic treatment, the patient reported an improvement in the condition of the masticatory muscles and the elimination of their discomfort, which was associated with the elimination of the friction factor of the anterior teeth and the expansion of chewing capabilities. At the end of orthodontic treatment, the patient had an anterior open bite in the incisor area and class I occlusion behind the canines. Because the orthodontist was concerned about the need to stabilize the position of the incisors before completing the restoration, he placed a lingual retainer in the mandible and a full cap retainer in the maxilla (Figures 5 and 6).

Photo 5. View of the maximum tubercular-fissure contact of antagonist teeth after orthodontic treatment: there is a place for restoration.

Photo 6. Smile after orthodontic treatment: there is a place for restoration.

Stage 2. Preliminary restorative treatment.

Models of teeth after orthodontic treatment were compared using a Kois dentofacial analyzer. A diagnostic wax-up was made in a dental laboratory to recreate the normal length of the anterior teeth, aesthetically harmonizing with the patient's facial shape. A solid template was formed on the wax and sectioned to visualize the facial surfaces of the upper teeth. The palatal part of the template with the attached incisal edge was used to restore the upper teeth with direct composite (TPH3, DENTSPLY). The space for restoration obtained through orthodontic treatment did not allow restoration of both the upper and lower teeth at the same time. In order to adequately lengthen the crowns and recreate the correct contour of the upper anterior teeth, all available available space was required. Taking into account the dynamics of the lower lip, it was possible to achieve an acceptable aesthetic result. The trial composite restorations were adjusted in such a way that when the patient bit the 200 µm articulation paper, no marks were found that would correspond to possible functional occlusal interference (Figure 7 and Figure 8).

Photo 7. View of the maximum cusp-fissure contact of antagonist teeth: trial composite restorations.

Photo 8. Smile with trial composite restorations.

Stage 3. Deprogramming.

Six months after placement of direct composite restorations, a Kois deprogrammer was used to test and determine optimal occlusal function. The 6-month period was chosen to provide sufficient time for the new occlusion to settle and stabilize. This stage, however, turned out to be unnecessary, since no chips or signs of wear were diagnosed in the area of the teeth restored with the composite, which indicates their acceptable functioning. In addition, when the patient completed a dental post-orthodontic assessment form (Kois Center), he responded negatively to all questions related to bite problems, jaws, and jaw function.

Stage 4. Recovery.

Once the stability of the new tooth position was confirmed and the patient approved of the appearance of his new smile, the decision was made to permanently restore the maxillary anterior teeth using e.max crowns. Because the composite restorations were used as a guide shape and guide for the final crowns, a very acceptable esthetic result was achieved at the end of treatment (Figures 9-12).

Photo 9. View of the maximum tubercular-fissure contact of antagonist teeth after installation of e-max crowns on teeth 6-11.

Photo 10. Patient’s smile after installation of e-max crowns.

Photo 11. View of the upper jaw with installed crowns.

Photo 12. Close-up view of the installed crowns.

Discussion and conclusions

The physician should be interested in finding motivating factors for the patient who seeks dental care. Over time, the level of risk may increase and the prognosis of treatment may worsen, although the patient is well informed about the potential consequences without treatment. In this case, the patient did not have the necessary motivation until he got married, after which he began to take the problems of wearing his teeth and an unattractive smile more seriously.

Comprehensive dental treatment is often an interdisciplinary procedure and involves the treating physician working with other dental specialists and technicians as needed. In this case, close communication between the orthodontist and the dental laboratory at specific stages of treatment helped achieve exceptional aesthetic results and stabilize an acceptable functional occlusion.

Posted by Chris Wilson, DMD

How to detect the disease in time

Erosion on the enamel should be treated immediately. The disease can progress very quickly and within a few months completely destroy not only the surface of the tooth, but also the dentin, leaving the pulp exposed.

There are three main stages of pathology.

First. This is the initial stage, during which it is difficult to independently detect signs of dental damage. During examination, the dentist may detect a loss of shine and a change in the shade of the enamel.
Second. At the middle stage, more pronounced signs already appear indicating increased sensitivity of the enamel: reaction to food (salty/sweet, hot/cold, spicy, etc.). Pigmentation becomes obvious.
Third. It is considered a deep and advanced stage. Part of the enamel may be completely missing. Dentin is exposed. Brown or yellow spots are visible on the preserved surface of the tooth.

The disease is also classified according to the nature of its course. There are two forms: active and stable. In the active form, the disease progresses quickly with a characteristic change in the color and structure of the enamel. The stable form is characterized by the absence of symptoms and restoration of enamel using the body’s resources.

Where can you find a qualified dentist in Ivanteevka?

High-quality dental care is provided by specialists from the Sanident clinic. We are one of the largest clinics providing our services in Shchelkovo and in the urban district of Ivanteevka. We have the most modern equipment, employ only professionals with extensive experience, who use progressive methods of dental treatment and provide competent advice. We regularly hold various promotions and discounts for our patients.

The activities of our clinic are aimed at creating maximum comfort for our patients, minimizing pain and discomfort. You can make an appointment with a specialist by calling the number listed on the official website of dentistry.

You can receive the necessary dental services at the following addresses:

Ivanteevka, st. Novoselki, 4;
Shchelkovo, st. Central, no. 80.