Toothbrush Abrasion: Preventing Tooth Destruction

The Cause

Brushing improperly (especially with a hard-bristled toothbrush) can cause erosion/abrasion of your tooth or teeth. This is a very common problem. It begins as a small V- or U-shaped area of wear near the gingival (gum) tissue right next to the tooth, usually where the tooth and gum meet. Improper brushing causes the gum tissue to recede; and the tooth may become sensitive to heat, cold, or air stimulation. With time, more enamel wears away and a small horizontal notch is seen on the tooth at the gumline. This is not an area of decay, but a mechanical “cavity” cut in the tooth. Eventually the enamel is worn completely through and the dentin becomes exposed. When that occurs, some people experience severe tooth sensitivity. It may be so severe that it is painful to drink cold fluids, breathe in air, or just brush your teeth. However, others experience little to no extra tooth sensitivity.

Once enough of the gum is brushed away, the root of the tooth becomes exposed. The root surface is not covered with enamel and is much softer than the enamel. It can also be unsightly to have the tissue recede. Since the root surface is not protected by hard enamel, if the improper brushing continues, the root cementum will be worn through and notch will be made in the dentin. This notch will increase in size, weaken the tooth, and sometimes make the area more prone to decay.

Tooth Sensitivity  

Some patients with little loss of tooth structure experience extreme sensitivity. This problem can usually be corrected with the application of a dentin-bonding material or other desensitizing chemicals. The sensitivity problem is often completely cured. The treatment can last (depending on your brushing habits) for 6 months or longer. If necessary, the tooth can be re-treated if the sensitivity returns.

Some patients with a tremendous loss of tooth structure notice little tooth sensitivity. Whether or not the teeth become sensitive, it is advisable to correct the brushing problem to slow down or eliminate the wear process. It is also recommended that the notches be restored with a tooth-colored filling material. This will restore the appearance of the tooth and protect the previously exposed dentin. In this way, even if you continue to brush improperly, the tooth will be protected.

In cases of minor sensitivity, we might recommend the use of desensitizing toothpaste as a low-cost alternative to the placement of bonded materials. Some cases might also be managed through the use of topical fluoride applicants.

Preventing Abrasion

The problems of improper toothbrushing are easily and inexpensively corrected when they are diagnosed in the early stages of development. If allowed to progress, the tooth damage will increase, as the cost to repair it. The best solution is prevention!

Brush your teeth thoroughly but not abusively. Do not scrub them or cross brush them (an exaggerated horizontal brushing motion). We will select a method of toothbrushing that will best meet your needs and teach you to care for your mouth. Use a soft toothbrush. Change to a new tooth brush every 3 months. But if it happens that you are creating the problem of toothbrush abrasion, get it corrected as soon as it is diagnosed. 

Gingivitis

Almost everyone knows what a cavity is. Because of the far-reaching effects of advertising by toothpaste and oral rinse manufacturers, by 2004 almost everyone had heard of gingivitis. What may not be quite clear to you, however, is exactly what gingivitis. You may recognize it as a problem but not know how serious it might be. You may even know that this is a type of gum (periodontal) disease. You may also know that it is somewhere related to plaque and tartar (calculus) on teeth. But why should you be concerned about having it?

Gingivitis is an infection of the gum tissues surrounding the teeth. It is a very common infection and affects almost 95% of the world’s population. This infection can be characterized by redness, swelling, and bleeding of the gums around the teeth. This gum infection absolutely needs to be treated as soon as possible. Gum infections are almost always preventable with sound daily oral self-care.

Gingivitis is the mildest form of periodontal disease and is reversible. By definition, there is no loss of bone that supports the tooth. If treated early, gingivitis can be eliminated. If left untreated, it can progress into the more serious form of periodontal disease called periodontitis. In its more serious form, the bone and gum tissues can be permanently affected. Bleeding gums, one of the signs of gingivitis, are a sign of infection in the mouth. Your gum tissues should never bleed. It is not normal for blood to appear on your toothbrush when you have finished brushing. Gingivitis does not generally hurt, so you may not even know that you have it. It can be localized (around a few teeth) or generalized (around most of your teeth. Gingivitis is seen most often in patients who do not brush and floss well daily, but it can also be related to medications. Bad breath can be another sign of gingivitis. If you are using mouthwash to get rid of bad breath, you may need dental attention. While bad breath can be related to some medical problems, most often it is just debris that is not cleaned properly from your teeth, gums, and tongue that is decomposing in the dark, warm, and moist environment of your mouth—a perfect place to breed gums.

If you have bleeding gums, you should be concerned. Healthy tissue anywhere in our bodies does not bleed. So what can you do to stop the bleeding?

We can help you eliminate the gingivitis. It involves a good professional cleaning and good oral self-care habits. Plaque (soft debris made up of bacteria) and tartar (calculus or hardened debris) must be removed before the gum tissues can heal and the infection can be eliminated. If it has some time since you had your teeth cleaned properly, it may take more than one appointment to get you back into shape.

Get your teeth and gums cleaned on a regular basis. Keep then clean with daily brushing and flossing. The infection you have will be eliminated. If you keep your teeth and gums cleaned, they can be healthy and trouble-free for your whole life.

Enamel Recontouring

Most people want straight, beautifully aligned, white teeth. Unfortunately, most people are not naturally born that way. When teeth are in poor alignment, rotated, tilted, and/or crowned, one obvious way to correct the problem is by orthodontics (braces). However, there are situations where it may not be possible or desirable to use braces to straighten teeth. You might feel that you are too old (although this is rarely the case), the cost of the orthodontics may preclude their use, you may not want to wear braces, or perhaps there are only a few areas that need attention and full orthodontics are not indicated.

In certain select cases, the appearance of your top and bottom teeth can be slightly or dramatically improved by recontouring the enamel. The upper and lower incisors and canines can be routinely altered. Sometimes teeth further back in your mouth can also be cosmetically improved. Recontouring is useful when there is slight to moderate overlapping if the front teeth, uneven wear, or teeth that do not have their biting and incising edges in harmony, in effect, an uneven “picket fence” look. Enamel recontouring is a painless procedure and no local anesthetic is needed. The enamel that is overlapping or poorly shaped is removed, recontoured, and polished. Depending on your individual needs, one or several teeth may require some reshaping. Different amount of enamel may be removed from different teeth. The teeth do not become prone to decay, are not made more sensitive to temperature changes, and are not made significantly weaker or damaged by the procedure.

Many times, recontouring is all that is necessary to significantly improve your appearance. Other times, when the poor alignment is more pronounced, it may be done in conjunction with a bonding procedure. The extent of your treatment will depend on your present conditions and on what you would like to see changed.

The procedure is not difficult for the patient and can often be done in only one appointment. The resulting change is immediate and permanent. Is does not take and artistic approach on the part of the dentist to determine what possibilities for change exist. We need to determine what enamel needs to be removed, where we must add material, and where the orthodontics is the treatment of choice.

If you have any questions about enamel contouring, please give us a call at 512-250-5012.

Metal Sensitivity

It has become clear that many people can develop sensitivity to some of the metals commonly used in dental restorations. This may or may not have been the case in past years. Perhaps patients were not as sensitive to metals then, or may be the sensitivity was not recognized and diagnosed properly. There are many different kinds of metals used in dentistry. We in this office have, for years, limited your exposure to possible problems by using either materials that have fewer combinations of metals or metals that have a very low potential for sensitivity reactions.

Women appear to have more reactions to metals then men. Studies indicate that at least one woman in seven has an adverse reaction to metals. It may be related to the costume jewelry that women wear, especially earrings for pierced ears. The posts can be made of stainless steel that contains nickel. You might then notice, after some time wearing the jewelry, that your earlobes get red, dried out, or itchy. It can also be seen any place that jewelry comes into contact with your skin—wrist, neck, fingers, etc. If this is your case, you are having a metal sensitivity reaction. If you have any of these problems, it is probably advisable that you limit contact with the problem metals. This can include metals used in restoring your teeth.

At times, you could even notice a metallic taste in your mouth. This can come from silver amalgam fillings that are commonly used. Some studies show leakage of metal through the tooth into the tooth supporting structures (periodontal ligament) from the posts bonded into the tooth after the root canal treatment. These posts are entirely surrounded by tooth or restorations and are not at all in contact with the oral environment. Other oral signs of metal sensitivity include gum tissue that remains chronically red and swollen or bleeds easily where it comes into contact with the metal crown or filling.

Which metals are used in dentistry? Silver fillings (available since approximately 1816) can contain copper, silver, zinc, mercury, and other metals. At this time, we know that several countries have mandated reduced use of silver fillings because of health concerns. Crowns are composed of gold, silver, platinum palladium, and others. A post used to strengthen a tooth after a root canal is either stainless steel or titanium. Sensitivity to each of these metals has been exhibited—some more than others. Gold and titanium rank low. Titanium has been used for years for joint replacements. Pure gold is too soft to be used in dental restorations and titanium is too brittle. If you have a metal sensitivity and need a crown, it may be better to use a metal that is only gold and platinum—or perhaps a bonded ceramic material. While these options may prove to be more expensive than others, metal sensitivity should be avoided.

Nonmetal Options

Options to metal restorations include bonded resins, ceramics, and porcelain. While it is possible that you could have sensitivity to some of the bonding materials, these types of sensitivities are not at all common. The advantages of silver fillings are that they are quick to place and comparatively inexpensive. Advantages of cast metal used under porcelain crowns is similar; the metal/porcelain crowns are less expensive to make and easier to place then full ceramic varieties.

We would prefer not to use silver/mercury fillings, especially for children and women planning to have children. Bonded tooth-colored resins significantly reduce the need for drilling a tooth. They look better and help keep the tooth stronger than silver fillings. If you have a proven metal sensitivity, we will automatically choose materials with less potential for causing you problems.

Wisdom Teeth (Third Molars)

Human beings have more teeth than they actually need: four more teeth, to be exact. The third molars (wisdom teeth) are the last teeth on each side and in each arch of the mouth. If we don’t need them, why do we have them? Hundreds of thousands of years ago, our ancestor didn’t look a great deal like we do today. They had smaller bodies but larger and more powerful jaws. Their diet dictated this jaw structure and number of teeth. Our ancestors ate a tougher and more abrasive type of food. It wasn’t cooked well, and it wasn’t ground up well. There were a lot of hard grains and foods that required lots of chewing. Big jaws were capable of holding more teeth for this chewing.

Today, we don’t need the heavy grinding capacity that early humans had. Food is easier to eat, less abrasive, and much softer. Evolution is reacting (slowly) to this fact by decreasing the size of our jaw bones and chewing muscles. The human jaw that once comfortably held 12 molars (32 teeth total) is now often only large enough to hold eight molars (28 teeth total). Unfortunately, our jaws are getting smaller faster than our wisdom teeth are disappearing. The wisdom teeth often do not have enough room to grow properly. Eventually, thousands of years from now, humans will not have wisdom teeth. They have lost their function and are gradually disappearing, just like the appendix.

Since the jaw is too small (for most people) to accommodate the third molars, they come into the mouth partially, poorly positioned, or not at all. They can be fully erupted, partially erupted, a soft tissue impaction, of full bony impaction. If teeth come in well and you are able to keep them clean, we leave them alone. If they are crowded or poorly positioned and cannot be kept clean, they are like an accident waiting to happen. Decay and gum infection are likely to result. These teeth are usually removed—ideally before they begin to cause big problems with the second molars that are directly ahead of them. Teeth that are partially erupted should always be removed: there is too much opportunity for gum infection to begin. If the teeth cannot be cleaned, chronic painful inflammation may occur (pericoronitis). The earlier they are removed, the better your healing will be.

Less complex extractions (fully erupted teeth or partial soft tissue impactions) can be done by a general dentist. We will refer difficult extractions to an oral surgeon for treatment. Depending on the type of extraction and the medical history of the patient, the extractions may be done in an office or in the hospital. This will be determined after viewing radiographs of the teeth. Having all four wisdom teeth out at the same time is a common practice. Postoperative discomfort can be minimal to extreme—in the case of difficult full bony impactions. Anti-inflammatory and pain relief medications are prescribed appropriately.

We do not need wisdom teeth to eat well. If they need to come out, it is better they come out (1) before they cause problems with the adjacent teeth that you really need and (2) when you are younger and heal well. If you need to have one wisdom tooth taken out, also have the opposing wisdom tooth removed. When a tooth does not meet an opposing tooth, it “super erupts” or continues to grow out of the normal position. When left for some time, the remaining tooth can develop decay and gum disease and cause the same thing to happen to the tooth in front of it.

You Can Have Whiter Teeth!

The least damaging and most conservative way of making your teeth lighter is with the use of a whitening solution. Contrary to what you might think, brushing your teeth harder with an abrasive toothpaste will not make your teeth white, but rather may darken them faster. The tooth-whitening concept has been around for many years, and the techniques have become easier and less expensive to accomplish. Tooth whitening was noted in the dental literature in the 1920s. The technique has become easier and the cost has decreased. Today, there are two convenient methods to whiten dark teeth: At-Home Whitening and In-Office Whitening.

Why Do Teeth Get Yellow?

The intrinsic (normal) color of your teeth is related to the color and thickness of the enamel and dentin, as well as the types of foods and liquids you ingest. The thinner the enamel, the darker the underlying dentin; the more coffee, tea, cola beverages, and red wine you drink, the darker your teeth will be. Cracks that are commonly found in the enamel of your teeth may provide a pathway for discoloring fluids to reach the underlying dentin.

If you have a yellow, brown, or orange shade to your teeth, in most cases it can be made lighter by the whitening procedure. Whitening works very well in removing age-related darkening of your teeth. This age-related darkening is most likely due to years of drinking the darkening beverages, or other environmental factors, rather than genetics. No drilling or anesthesia is required for whitening. Your teeth will not become weaker. Because the mineralization of teeth varies so much from person to person, there is no way to determine how many office visits it will take to effect the color change or how white the teeth will get. The darker your teeth are, the more time required for the change and the more distinctive the color change will be.

The whitening procedure will also work to a lesser degree on the teeth with tetracycline discoloration. We have seen several fair to good results from both in-office and at-home whitening. It does take more time to achieve good results on this type of stain, and unfortunately, sometimes the change is minor.

Two Available Techniques

There are two types of whitening available. One is done by the patient at home, and the other is done by us during an office visit. They can be done separately or in conjunction with each other. The at-home technique involves using a soft, thin, comfortable mouthgurad-like tray. An impression is made of your teeth, and custom whitening trays are fabricated. Then at home, you can place the whitening solution in the trays and wear them for an hour or two each day or sleep with then in place all night. With in-office whitening, you come to the office for 1 or 2 hours, and a stronger whitening solution is applied by us and activated for that time. Usually only one visit is required.

The color change should last for 3 to 7 years in most people. The color change you see immediately after the whitening is completed will regress one shade over the course of 1 to 3 months, with most change taking place in the first week. If you drink a lot of coffee, tea, cola beverages, red wine, or if you smoke, the teeth may begin to turn darker again. When this happens, the whitening process can be repeated.

The possible side effects include temporary white discoloration of the gum tissue of the office whitening solution comes into contact with the gum. This goes away quickly. The teeth may become slightly sensitive to temperature changes for a short time. This also goes away quickly. There is no damage to the tooth enamel, dentin, or pulp from the whitening process. Fillings and crowns do not whiten. When your teeth change to a lighter color, you may need to have those fillings and/or crowns redone. We will let you know whether this is a possibility before we whiten your teeth. There are other adverse effects known.

The teeth that show when you talk, smile, or eat are the teeth that would benefit your appearance most if whitened. Usually the top teeth are whitened because they are much more visible than the bottom teeth, but both arches can be successfully whitened. The lower teeth take about three times as long to reach the color change of the top teeth.

Impacted Teeth

An impacted tooth is a tooth that has not erupted (emerged fully in to the oral cavity). The impacted tooth can be totally surrounded by bone (a fully bony impaction), can be partially surrounded by bone (partial bony impaction), or be only surrounded by soft gum tissue (a soft tissue impaction).

Traditionally, the term impacted teeth usually refers to the wisdom teeth (the third molars, the teeth furthest back in the mouth). Both top and bottom wisdom teeth can be impacted. Many times if they appear to be causing no problems for the patient, they are left alone. If they are positioned in a fashion that they appear to be pushing up against the roots of the second molars (the next teeth forward) or if they are causing periodontal (gum) problems, they will need to be removed. While most general dentists are comfortable removing teeth, patients with impacted teeth are usually referred to a specialist (oral surgeon) for their removal.

Wisdom teeth are not the only teeth that can be impacted. Every permanent tooth can be impacted. If the impaction does not appear to affect adjacent teeth, no treatment may be required. If it affects other teeth, it may need to be removed.

It is not uncommon for “eye” teeth (canine teeth) to be impacted. This is usually discovered early in life, and recommendations for orthodontic treatment (braces) will be made accordingly. Most often, these impacted teeth are not removed, but rather surgically exposed and orthodontically moved over several months into their proper position. Early detection and diagnostic is important to the successful treatment of this situation.

Normally, there is bone separating tooth roots from adjacent teeth. If the impacted tooth, because of its angle and position, gets closer to the roots of the next tooth, the bone between the two teeth will dissolve. If this happens, it is possible that a deep, pathologic periodontal pocket may form. Further deterioration of the periodontal tissues surrounding the tooth in normal position could compromise its health and lead to additional dental treatment. To prevent this from happening, the impacted tooth is removed. If the impaction is deep and difficult to approach, and if there are four wisdom teeth to be removed at the same time, the dentist may elect to perform the procedure in a hospital or surgical center setting.

The more bone that surrounds the impacted tooth, the more difficult is it to remove. The position of the tooth near other teeth or nerves and the manner in which the impacted tooth is angled in the bone also affects the difficulty level of the extraction. The younger the patient is, the better and easier the healing appears to be. If there is a great deal of bone that is removed, the dentist may choose to place some “bone fill” material in the place the tooth used to be (the socket) to promote better healing of the bone.