Tooth wear prevalence is rising, with UK rates now as high as 80 per cent among the adult population. In younger demographics, such as 15-year-olds, 44 per cent have tooth wear on the lingual surfaces of the incisors – this problem is not confined by age or gender, although it does become more damaging over time.
Most affected patients do not know they have it until their dentist advises as such. As tooth wear becomes increasingly common, diagnosing, managing and educating patients is essential to enhance and prolong their oral health.
Dental erosion is considered the most prevalent factor of tooth wear in the UK, caused by exposure to non-bacterial extrinsic or intrinsic acids. However, some cases may be more directly caused by dental attrition or abrasion, so understanding the aetiology of tooth wear is key to controlling or preventing the loss of tooth structure – this requires open communication with the patient.
Old habits diet hard
The dietary habits of the patient are an appropriate place to start. Diets defined by acidic foods, like citrus fruit, increase the risk of dental erosion by exposing the teeth to damaging extrinsic acids. Biologically, patients with a low saliva rate are more at risk, as the limited saliva may struggle to neutralise the acids.
Soft drinks containing vitamin C have been found to have the greatest erosive potential, and carbonated beverages are associated with erosive lesions in the anterior teeth. Energy drinks are the fastest growing product in the beverage industry since bottled water, and their increased consumption is also associated with a high risk of dental erosion.
Discussing a patient’s daily oral hygiene routine can establish if they are protecting their teeth, no matter their diet, appropriately. In addition to the standard daily oral hygiene recommendations, practitioners should encourage patients to avoid toothbrushing within an hour after eating or, in cases of bulimia nervosa or gastroesophageal reflux disease, vomiting.
Problem solving
Left unfought, dental erosion can have numerous consequences such as dentine hypersensitivity, dental pain, unsatisfactory aesthetics and impaired oral function. Without diagnosis or management, individuals with severe tooth wear may seek help when these problems manifest, requiring restorative rehabilitation to restore their quality of life.
Part of the problem is that, among adult demographics, one study found that only 57.4 per cent of people had heard of dental erosion or erosive tooth wear. Knowledge on the aetiology of tooth wear is also low among adolescents. It is therefore necessary to promote relevant dental health education among the entire population, but especially people at highest risk, encouraging them to turn away from erosive food and drinks and motivating them to change their lifestyle. Within a practice, brochures, posters and leaflets can detail the damages of acidic foods and drinks.
Motivating patients to incorporate a consistent oral hygiene routine can be the most difficult part for dentists to address, making it the biggest barrier that prevents change. Empathising with the patient can help broaden their dental education, so asking open-ended questions can be beneficial by showing that you care about their point of view. Such questions should give the patient opportunities to explore their ambivalence towards change, helping to motivate them once they acknowledge their own barriers. By doing so, their oral health can improve.
Broaden your ability
Identifying tooth wear and the biggest risk factors for individuals will improve the management strategy created for each patient. But it is also important that clinicians can provide effective treatment options as well. It has been observed that an alarming gap in education may exist between tooth wear management in general UK dental practices compared to the published guidelines. As such, developing your awareness of tooth wear treatment options is a must.
If you would like to enhance your knowledge of tooth wear management, you could consider becoming a member of the British Academy of Cosmetic Dentistry (BACD). The BACD offers and encourages education on a broad range of clinical areas that dentists need to identify, manage and prevent tooth wear – as well as many other concerns – with confidence. This November’s BACD Annual Conference is celebrating 20 years of excellence, and attendees will have access to world-class speakers, covering tooth wear management and many other relevant topics. It has never been a better time to become a BACD member – learn from the best so you can be the best.
As tooth wear rates rise, educating patients and providing effective management techniques is paramount. By expanding knowledge of tooth wear for yourself and your patients, you can be a crucial part of preserving the UK’s oral health.
References available on request.
For more information visit www.bacd.com