To waste your smile? It is possible. But fixing it is possible, too | Eva Magazine | March 2012

By Mariana Antonova
Photograph: Archive of Dental Clinic Petar Duchev

What shall we do if we feel that our teeth are wearing away?

Dr. Petar Duchev, a certified specialist in the treatment of tooth wear and owner of a clinic specialized in the treatment of this problem, provides the answer.

Dr. Duchev, why to teeth wear away?

The most common response is that they do because we use them. If the teeth wear away at a normal speed, their enamel will be worn away in about 100 years. If the wear is pathological, this happens very quickly. The enamel disappears and the dentin becomes visible. And since it does not have any protection against the aggressive factors which inhabit the mouth, it gets worn away extremely fast.

What are the reasons for the pathological wear of the teeth?

The first is the psycho-emotional stress. At times of stress, we tend to clench our teeth and thus wear them away. Another factor is the foods and drinks that contain a lot of abrasives. All fizzy drinks, for example, contain acid that leads to increased tooth wear. The chlorine in the swimming pools has a similar effect, the acid in the gastric juice when a person who has bulimia forces herself to vomit all the time, the evaporations of different fuels. I have recently finished the treatment of a 44-year-old patient who has been having a lemon every morning since she turned 18 in order to keep her weight at a certain level. As a result of this, almost nothing was left from the front surface of her teeth. Brushing your teeth more than twice a day wears all the enamel, as well.

Is the tooth wear a disease or merely a cosmetic problem?

It is mostly a cosmetic problem – the teeth change their color, chewing is made difficult which changes the height of the bite, the chin protrudes and the line under the lower lip becomes deeper. But it is a disease, as well. The chewing muscles become painful and at the advanced stages problems with the mandible joint begin.

Is it age-related?

No. The percentage of tooth wear is almost the same at any age.

How can we recognize that the process has started?

It usually begins with changes in the shape of the cuspids. They look as if they have been cut, their usual spear shape is missing. Soon after that the two front teeth (the central incisors) get worn away and they become as long as the other teeth, whereas it is normal for them to be 1.5 or 2 mm longer. Around this time a brownish line can be noticed on the lower front teeth which shows that their enamel is lost and dentin is visible in the mouth, which is very sensitive to the paints and dyes in the foods and drinks. These are the visible symptoms.

Are there any accompanying symptoms that can tell us the wear has started?

One may experience pain when consuming warm, cold, sour and sweet foods, the teeth gnashing that I already discussed, gum problems- bad breath, bleeding, periodontal pockets, periodontitis.

How is tooth wear treated?

There are several theories and methods. One of them is to put either a porcelain-fused-to-metal or an all-ceramic crown on the tooth. I don’t find this method particularly good because the grinding and the preparation wastes healthy parts of the tooth. Besides, it is possible to devitalize the tooth which is very undesirable. Another method is to restore the worn parts directly in the mouth.

Now you are already discussing the biomimetic composite restoration that you practise.

Biomimetics is a science that studies the restoration of human organs or tissues via artificial matters in the way nature itself constructed them. We, for example, replace the lost dentin and enamel with material that is closest to them in terms of physical and mechanical qualities. In order to do so, we use different composites (materials) supplied to us by one of the leading companies in the field. As a rule, all procedures must be conducted under anesthesia.

How long does it take before you restore the beautiful smile to the patient?

Before we start the treatment, we place a device on the lower teeth of the patient with which s/he sleeps. It is painless, easy to use and resembles the brace for teeth whitening at home. It prepares the masticatory apparatus for the future restoration that starts 20 days later and is concluded within 2 or 3 days in sessions of approximately 6 hours each. Our patients, therefore, need to have at least two free days, we work during the weekends, as well.

Where in Bulgaria can one get treatment of this problem?

Currently only in my clinic and in Ruse.

Can every dentist restore worn teeth?

No, they need to have a special qualification which is obtained abroad. I obtained mine at two places – in Ukraine and Switzerland.

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