Acid Erosion and Abrasion: the Dynamic Duo of Tooth Problems
We have previously dealt with the loss off tooth structure and gum recession caused by toothbrushing’s mechanical abrasion, addressing the amount of pressure, the type of tooth brush, and the abrasiveness of toothpaste. Tooth structure loss and gum recession can also be caused by chemical erosion. An acidic environment in the mouth can cause melting of the tooth structure by itself but often times we find that both processes abrasion and erosion work together. Often times overzealous brushing is blamed completely for receeding gums, loss of root surface and sensitive teeth when actually it is acid that is accelerating the problem. After years of observation I think the acid weakens the gum attachment to the tooth causing recession as well as the loss of root surface.
This is an example of a young woman with an extremely acid mouth who brushed hard in an attempt to get her teeth white. Unfortunately the more she brushed the more the acid softened enamel wore off and the more yellow her teeth became. Acid softens the tooth structure making it wear away more quickly. All is not lost.
We resurfaced the front of her teeth with bonding covering the softer part and whitening her smile. Next time I will focus the camera better.
Where Does Acid Come From?
The acid can come from three sources: 1. acid produced by bacteria when they metabolize the food/drink, 2. the acidity of the food / drink while in the mouth, or 3. from your own body. Although I have seen patients who seem to have more “acid” systems controversy surrounds the cause or our ability to control the total acidity of our bodies. More often than not the acid from our own body is the result of acid reflux from our stomach.
How Can I Tell If Acid is Damaging My Teeth?
Before we address the different causes of erosion lets look at the symptoms and signs that we see indicating that acid is contributing to gum recession and tooth structure loss.
The easiest sign of course is decay created by bacterial acid and invasion. If you are getting numerous cavaties that are dark and soft along the the gum line as well as numerous cavaties on other surfaces of the teeth with dark staining most likely bacteria are the major source of acid. The cause of tooth decay is well known, sugar plus bacteria plus poor oral hygiene equals acid. Teeth sensitive to hot and cold and touch along the gum line are some of the other not so “silent” indications of acid erosion.
The more subtle and “silent” signs of acid caused erosion result not from bacteria but from the actual acidity of what we eat of drink or our body chemistry. The signs are often confused with the destruction created by grinding our teeth or excessive toothbrushing and as previously noted the abrasive process and erosion often work together. Without bacteria the tooth loss appears as a clean depression. When acid is contributing to gum recession we also see recession in the back of the mouth where tooth brushing abrasion does not normally cause recession.
When acid combines with abrasion caused by grinding we see a different pattern of tooth loss on the biting surfaces of the teeth. If you see rounded smooth depressions on the tips of the cusp( mountains) of your teeth or , if the edges of your front teeth are depressed in the middle and sharp on on the sides the tooth loss is not just from grinding. Grinding by itself causes flat wear facets not rounded depressions. If your front teeth look very thin, almost translucent and see through(grey) and chip very easily acid erosion has probably contributed to the problem. The defects created purely by acid often are not soft or extremely dark because bacteria have not actually invaded the tooth structure.
Some claim there is an intimate connection between your diet and the acidity of your body. As many of you know I am not a health food nut, far from it , my favorite health food is peanut mm’s since they have all the different colored food groups. I am not a real doctor or nutritionsist but I have researched the correlation between diet and total body acid and been totally confused by the different theories and data. What I do know is that you are what you eat and the acididty of the foods and drinks you put in your mouth can directly effect your dental health. We will start our next blog with an easy one and one of the biggest causes of erosion and decay; sugary drinks especially those with a sour taste.