Carmel, Indiana patient came in with extremely worn and discolored teeth. A major smile rejuvenation was required.Patient has a loss of vertical dimension contributing to bruxing.Patient was TENSed with ULFTENS and placed in a Neuromuscular orthosis to reestablish her vertical dimension and bite comfort. An ideal wax up was done to the new bite position established by the orthosis made from the TENSed bite position.Patient loved the new bite position and form and function could now be re-established with a full mouth rehabilitation.
Top and bottom teeth were restored with Empress porcelain veneers and crowns to the new Neuromuscular bite position.This was done in two phases.The top was restored to a lower fixed orthosis and after a month of validating form and function the bottom teeth were restored.Minimal adjustments were needed due to the precise technique that we use and teach.This full mouth rehabilitation can be a very big undertaking but the end result is determined before starting the procedure and patient goes on a trial run in the orthosis before any teeth are restored.A win / win for all involved.Pictures taken on day of delivery as there is slight tissue irritation. Staining between teeth is due to tissue irritation which is a temporary post operative condition.
TOOTH WEAR
Tooth wear is the term used to describe the progressive loss of a tooth’s surface due to actions other than those which cause tooth decay or dental trauma. Tooth wear increases with age. The prevalence of any tooth wear (where dentine is exposed on at least one tooth surface) among the dentate (possessing natural teeth) population reported during the 2000–2002 National Surveys was
- 17.4% for 12-year-olds,
- 29.7% for 15-year olds,
- 38.1% for 16–24 year-olds,
- 76.2% for 35–44 year-olds
- 93.0% for 65+ year olds.
For all age groups, males had a higher prevalence of tooth wear than females.
The amount of tooth wear seen currently is considerably greater than in the past due to the fact that more people are now retaining their natural teeth into old age. Tooth wear is caused by three phenomena: erosion, attrition and abrasion.
Erosion is the progressive loss of tooth substance by chemical or acid dissolution, and no bacteria are involved. Erosion of tooth surfaces is mostly the results of too frequent or inappropriate use of carbonated drinks (including sparkling water) and fruit juices with high levels of acidity. This habit would appear to be particularly common amongst teenagers and young adults.
Erosion is also a problem in individuals who suffer from gastrooesophageal reflux disease (GORD) or from certain eating disorders (e.g., anorexia, bulimia). In addition, risk of erosion is high in individuals with a low “unstimulated” salivary flow rate.
Attrition is the progressive loss of hard tooth substances caused by mastication or grinding between opposing teeth. The extent of attrition will depend upon the use to which an individual puts their teeth. For example, it will increase in people who habitually clench or grind their teeth (a condition known as bruxism), e.g., during sleep. It will also tend to be more pronounced in people who eat a particularly fibrous diet.
Abrasion is the progressive loss of hard tooth substances caused by mechanical actions other than mastication or tooth-to tooth contacts. Abrasion is commonly associated with incorrect toothbrushing technique, giving rise to notching at the junction of the crown and root of teeth. It will also be seen in individuals who use their teeth as a tool (e.g., to remove bottle tops, to hold pins, clips or nails).
The long-term use of tongue jewellery also causes tooth abrasion, when the jewellery is hitting against the teeth.
Prevention
Reducing the frequency of drinking carbonated drinks and fruit juices with high levels of acidity is the key to preventing erosion of the teeth. Attrition is a slow-progressing condition and many people will only be made aware of the damage to their teeth on visiting the dentist. In the case of bruxism, treatment may require the wearing of a bite guard during sleep.
Abrasion can be reduced by adopting a correct toothbrushing technique. Avoid hard bristle tooth brushes. Teeth should not be used as a tool to grip or hold items. Long-term use of tongue jewellery should be avoided. Toothpastes vary in their level of abrasiveness; whilst abrasives help to remove tooth stain they may also contribute to tooth wear. Those concerned about tooth wear could seek a less abrasive fluoride toothpaste. Fluoride toothpastes also help to combat tooth wear, specifically erosive tooth wear, as the availability of fluoride promotes the formation of a calcium flouride layer (CaF 2).
