At the beginning of the 21st century we notice lower prevalence of the primary dental caries and higher prevalence of pathological tooth wear, which means that healthy parts of the tooth are lost too fast. It affects 25% of the adolescents under 18, and 51 to 60% of the population that is up to 40 years of age. The most characteristic feature of tooth wear is that it makes the smile appear less young, toothless and aged. Functional problems are experienced as well, the process of biting off and chewing the food is disturbed, headache which cannot be explained, neck stiffness and gastrointestinal problems begin. The causes of tooth wear are many – the daily consumption of fizzy drinks, beer, foods with an increased content of abrasives, chewing gum, more and more aggressive toothpastes, bad habits, etc. Very often the dentists do not pay attention to these processes at the initial stages, thus failing to assist their patients.
In order to have some of our questions answered, we sought the assistance of Dr. Petar Duchev, a certified specialist in the treatment of tooth wear and member of the American Academy of Cosmetic Dentistry .
At the beginning you would not experience pain or any other discomfort. Usually tooth wear starts with a change in the shape of the cuspids and the two front teeth which begin to look as long as the other ones (whereas they normally are 1.5 to 2 mm longer). The patients report that their front teeth and their edges in particular become more transparent and little pieces start falling off. In this way the teeth become uneven and notched. The main desire of our patients is just to correct the unevenness, but this is not real treatment and merely exacerbates the problem. Around this time a brownish line can be observed on the edges of the upper and lower incisors, because the enamel is worn off and the dentin is visible in the mouth. The dentin is very sensitive to the color additives and dyes in the foods and drinks. These are just the symptoms you can see in the mirror, in reality the tooth wear in 82 % of the patients has already affected all teeth, the chewing ones including. This is how we become ruminant “animals”, rather than predators who tear off and chew their food.
At the beginning pain is missing, but it soon begins to appear during consumption of hot, cold, sour and sweet foods. The temporomandibular joint is affected, pains, discomfort, bouts of headache and muscle stiffness are experienced, which makes the problem quite a complex one. Oftentimes the tooth wear is combined with teeth clenching and grinding – bruxism – as well as with gum problems – bleeding, bad breath, periodontal pockets and periodontitis.
The goal of the treatment is to restore the lost tooth parts, the lost height of the worn teeth and the overall functioning of the masticatory organ. There are several theories and treatment methods:
– Putting either porcelain-fused-to-metal or ceramic crowns on the teeth. This is not a particularly good option especially for young patients and patients at the initial stages of the disease, since healthy parts of the tooth are lost while it getsprepared for the crown.
– Restoring the worn teeth parts directly in the mouth by placing artificial dentin at the place of the lost dentin and artificial enamel at the place of the lost enamel (biomimetic restoration with a composite). We have neither unnecessary preparation, nor root canal treatment. The materials added in the mouth are similar in elasticity to the teeth and do not disturb the natural balance of the masticatory forces. I personally support and practise the second treatment method. For us the most important part of every restoration is to obtain a tooth with anatomical shape, color and microstructure which are identical to the natural ones. Our goal is to be as close to the natural aesthetics of the dentition as possible.
In direct restoration of the teeth, the treatment of a patient is divided into two sessions lasting between two and three days each – one is for the upper jaw and one is for the lower jaw. During the treatment, the patient is lying down and has video glasses or a music player, thanks to which s/he is relaxed. S/he feels nothing because of the anesthesia, so these eight working hours pass very fast. Of course, we both take lunch and refreshment breaks. The advantage is that the doctor has a single patient for the day and devotes all of his/her attention to one person, which reduces the possibility of error to practically zero.
In order to practise it, however, special qualification of the dentist is needed, as well as more specific equipment. We work with magnifying equipment at a certain room temperature, tempering the composites themselves and following a certain protocol. As a rule we work with rubber dam – a special system for teeth insulation, which makes the long life of the restoration possible. Our clinic is in close contact with some of the leading practices in the world which apply a multidisciplinary treatment approach. These methods are mostly developed in Switzerland (the University of Geneva), Italy (the Universities of Milan and Siena), and Ukraine.
In the first place I recommend an annual dental prophylactic examination, special attention to the oral hygiene and limited consumption of fizzy drinks. Still, prevention is the most important thing. If tooth wear is discovered and treated at its early stages, the patient will be spared many complications and lengthy manipulations.