Enamel wear at the gum line. Why fill?

Patients are very often present with excessive tooth wear at the gum line of teeth. This is most commonly seen (and ‘felt’) as a ditch or groove in the face of the tooth crown just above the level of the gum line; frequently in the side teeth, particularly the canines and premolars. Such ditches are often associated with receded gums.

What causes this condition?

  • Invariably, the most common cause is aggressive horizontal hand toothbrushing, particularly so if one uses quite ‘hard’ bristles.
  • Aggressive night-time tooth grinding (bruxing) can also cause and certainly accelerate the loss of enamel at the gum line of teeth most exposed to the excessive pressures of such sideways grinding.

Why be concerned if you have such areas?

  • The ditch does represent a permanent loss of the hard tooth substance (enamel) in this ‘gum line’ area, which does not grow back.
  • Equally one needs to be concerned that receding gums ( which also do not grow back) do not progress.
  • The loss of enamel in such an area exposes the underlying dentine, which is much softer than enamel. Left unprotected, the dentine will also wear at a more accelerated rate and so the ditch becomes progressively deeper.
  • The exposure of the dentine and particularly further loss of this dentine (deeper grooves) will also result in significantly increased levels of temperature sensitivity, particularly to ‘cold’ ( but also hot ) and even to ‘sweet’. This can become fairly extreme, at best uncomfortable; at worst unbearable.
  • Such loss of tooth substance and damage to the teeth can be quite obvious, particularly in a smile and so have ‘unaesthetic ‘ consequences.

Why treat such a condition?

  • Quite simply, primarily to prevent the ditches from becoming bigger and deeper, so destroying more healthy tooth substance and getting closer to the nerve of the tooth.
  • To either prevent or treat temperature hypersensitivity that results from the condition.
  • To restore the healthy appearance of the teeth.

How is the condition treated?

Gum line before treatment
Gum line after treatment
  • Firstly, the horizontal toothbrushing habit must cease. Used properly, electric toothbrushes ( rather than hand brushes) act in such a way as to avoid such damage.
  • If there is associated night-time bruxing (grinding), then this condition needs to be addressed separately.
  • Logically, the best treatment is obviously to ‘replace’ the missing tooth substance with a colour matched synthetic material (see ‘after’ photos).
  • This can be done without any further damage (drilling) to the tooth; so the procedure is very conservative. The surface is prepared by micro-etching ( roughening slightly) with a mild acid solution. The quartz composite material is then bonded ( ‘glued’/attached) to this surface. It is shaped, contoured, smoothed and finally polished. Often this procedure can be carried out without even the need for a local anaesthetic. There is usually instantaneous relief of temperature sensitivity. Generally, such restorations stay on for quite a few years. If one ‘pops off’, it is simple to replace it.
  • Traditionally, dentists have either recommended a desensitising toothpaste ( e.g. ‘Sensodyne’) or applied a stronger desensitising solution to such ‘areas’ in the surgery. Obviously, this leaves the ditches as they are and the success of such toothpaste/ solutions is very variable at best!

 

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