There are a number of habits that can potentially damage the teeth and some of them are a lot more common than we think.
1- Increased intake of acidic food and drink
This can include but is not restricted to citric and acidic fruits and juices, fizzy drinks including sparkling water, vinegar and excessive alcohol consumption. These damaging foods and drinks lead to a condition known as acid erosion which is characterized by thinning and destruction of the top layer of the tooth, known as the enamel. The condition is non-reversible. The enamel is very strong but over time when subjected to all these acidic products degenerates and thins out exposing the inside of the tooth (which can also in turn be damaged) and this can lead to an increase in sensitivity and pain symptoms as well as increased susceptibility to decay. It also weakens the tooth.
2- Grinding and clenching teeth
This is a habit which is increasing steadily and seen much more frequently in many patients who present to us. There are many complex factors which lead patients to grind or clench their teeth and we see it more frequently at times of anxiety and stress. Other factors that play a role are genetics, arthritic changes in the bone and changes in the cartilage of the jaw joint, anatomy and muscular attachments, trauma, etc. Unfortunately, many patients who suffer from this condition are unaware of it and don’t realize they grind or clench (as they are usually doing it subconsciously or in their sleep) until they are informed by a clinician that there are signs of this in their mouth. If left unchecked, this condition can lead to a variety of problems and symptoms for the patient including thinning and wear of the teeth, jaw and muscular pain and headaches, difficulty in opening the mouth and chewing and cracking of the teeth.
This is usually coupled with the use of a hard toothbrush and/or an abrasive toothpaste. This leads to a condition known as abrasion. Abrasion is characterized by recession of the gum line where the overbrushing takes place and when left unchecked leads to an eventual formation of cavities at the neck of the tooth known as abrasion cavities. These can lead to severe symptoms of pain and sensitivity and it is often necessary to restore these teeth with a filling material to reduce the symptoms and effects of the abrasion. Occasionally, if the abrasion has been occurring for several years, gum surgery may be necessary to correct the recession of the gums.
The use of non-fluoride toothpaste is becoming more and more popular across the world owing to some negative advertising about the effects of fluoride on the body. Fluoride in very large doses can be toxic and can cause systemic problems however the amount of fluoride in toothpaste is minimal and is nowhere near those threshold doses.
It has been well documented with established studies that fluoride is critical in reducing the effects of decay causing foods to our teeth. Fluoride can also help remineralise tooth structure which has already been damaged (when in the early stages) hence reducing the need to fill those affected teeth. The adult dental health surveys and the child dental health surveys carried out in the UK show significant reduction of decay in patients following the introduction of fluoride to drinking water in certain cities with no adverse effects on general health and this, along with other well established clinical studies are proof enough of how effective fluoride can be to create a barrier against decay.
What is less well known is that smoking is directly linked to the progression of gum disease.
Smoking has a well-known adverse effect on the general health. However, what is less well known is that smoking is directly linked to the progression of gum disease. Gum disease is a very loose term used to describe any disease that affects the supporting structures of the tooth, namely the gums and bone. If left untreated gum disease progresses to a form of the disease known as advanced periodontitis which is characterized by significant bone loss and the loosening of the teeth. There are of course other factors that cause gum disease, mainly poor oral hygiene, however smoking has been linked directly with the progression of gum disease and the disease effects appear to be multiplied in patients who smoke.
Helpful prevention tips and replacement options:
● The effects of erosion unfortunately are non-reversible and when the disease progresses significantly we may need to consider restorative options such as fillings and crowns to protect the teeth. To reduce the effect of early erosion we must consider a change in dietary habits. Limiting our intake of acidic foods will help reduce the effect of erosion. This of course does not mean cutting out on eating healthy fruits, but changing the frequency of acidic intake, instead of 3 oranges or juices a day, consider having one. We can also change our diet from acidic fruits such as oranges, apples, pineapples and kiwi to non-acidic fruits such as pears and bananas. The use of a straw helps reduce the effects of erosion significantly as the fluid bypasses the teeth upon entry into the mouth hence reducing the effect it has on the teeth. Regular sips of still water following an acidic intake can help neutralize the pH of the mouth hence also reducing the effect of erosion. We must also consider when to brush after eating, as brushing immediately after eating or drinking something acidic multiplies the effect of erosion by pushing the acid directly onto the teeth, hence brushing in the morning should be considered prior to having breakfast if the breakfast contains acidic elements such as orange juice.
● Owing to the fact that teeth grinding is usually carried out subconsciously and that there are many factors that cause it, grinding is a very difficult condition to treat.
Treatment is usually confined to a minimalistic approach of:
- Awareness of the condition
- Physiotherapy exercises
- Reduction in local factors contributing to grinding such as high fillings
- Construction of a bite guard or shield which can also act as a de-programmer to reduce the effect of grinding
- Occasionally a referral to a physiotherapist may be necessary.
● The effects of abrasion can be reduced by changing the hardness of the toothbrush you are using to a soft or medium toothbrush. The finer the bristles the less abrasive they are. There is a fine line between overbrushing and ineffective brushing and this needs to be pointed out to you by your dentist or hygienist. The mode of brushing also needs to be altered from a scrubbing motion to a softer round or sweeping motion. If you are using an abrasive toothpaste (some whitening toothpastes are extremely abrasive) then consider changing to a milder, less damaging one.
● The use of modern electric toothbrushes has really helped combat this condition as they are equipped with sensors known as pressure sensors which identify when you are pushing too hard onto your teeth and reduce the pressure by either slowing down or stopping, or by flashing a red light to alert you to the damage that is being done. The better brushes do both hence minimizing the damage to the teeth. Some toothpastes on the market are made specifically for patients who suffer with erosion and these can help remineralise the teeth, although the remineralisation effect is very minor.
There is no substitute in protecting our teeth more effectively than the use of fluoride toothpaste.
● There is no substitute in protecting our teeth more effectively than the use of fluoride toothpaste. Herbal toothpastes may claim to have an antibacterial effect however these do not help remineralise teeth which are already decaying. The correct use of fluoride toothpaste in the right quantities should have no detrimental overall effect on the teeth or the general health whatsoever.
● Smoking is a very difficult habit to break. Support from the people around you as well as health care professionals will help make the process less daunting and you’d be more likely to succeed. There are many nicotine alternatives on the market such as patches, gums, inhalators and e-cigarettes, however the effects are still debatable as to whether they cause harm to the body. Other ways include the use of tablets taken daily to help reduce the cravings and even hypnotherapy. Ask your medical professional for help and they will be able to point you in the right direction.
Are there any measures to reverse this?
Unfortunately, many of the conditions listed above are non-reversible and the principal aim of treatment is to reduce the damage done and stop any further deterioration. Occasionally, interventional dentistry is necessary to try and reduce the impact of the damage carried out and this can be in the form of fillings, more complex restorations such as crowns and bite guards or occasionally even more complex surgical treatments need to be carried out.
Any further advice?
The best advice that can be given to any patient is to regularly visit your dentist to help identify any of the conditions listed above as well as any other conditions or diseases and minimize the effect early. Early intervention always yields better results and better prognosis long term. Most patients believe that if they are symptom-free then they are disease free and unfortunately this is simply not correct. An asymptomatic mouth is not necessarily a healthy one and problems may be brewing which can be very difficult to treat if left unchecked.
The role of the dentist is not restricted to treating any illnesses but also to give advice to prevent future problems and can be an invaluable source of information on how to keep your mouth healthy and disease free. Remember a healthy smile reflects a healthy body!