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Section Questions and Answers

Tooth Wear in Infants and Children

  1. What is Tooth Wear?
  2. Erosion: How acid in food and drink can affect teeth.
  3. How acid from the stomach can damage teeth.
  4. Overfeeding may affect baby teeth.
  5. Attrition: How teeth can be worn down by other teeth.
  6. Abrasion: Teeth can be worn away by brushing.
  7. Illnesses which predispose teeth to wear.
  8. How can Tooth Wear be prevented in children?
  9. What is the treatment for Tooth Wear?

 
1. What is Tooth Wear?

  • Tooth Wear is the loss of tooth surface, which is not caused by decay or injury.
  • Abnormal Tooth Wear can affect not only the enamel, but also the dentine, nerves and blood vessels of teeth.
  • The 3 causes of Tooth Wear are:
    • Erosion
    • Attrition
    • Abrasion

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2. Erosion: How acid in food and drink can affect teeth.

  • Erosion is the wearing away of tooth surface by an acid, which dissolves the enamel and dentine.
  • Erosion is a common cause of Tooth Wear and is usually preventable.
  • The two sources of acid in the mouth are dietary and gastric. Baby teeth are at risk from the acid in fruit juices.
    Older children will be exposed to a larger variety of acidic foods and drinks.
  • Foods with a high acid content cause erosion by dissolving the calcium in the enamel and dentine of the tooth. Foods which have a high acid content are:
    • All soft drinks. This includes the carbonated, diet and sports varieties, as well as sparkling mineral water.
    • Soft drinks are a major cause of tooth erosion. The quantity and frequency of drinking is directly related to the degree of erosion.
    • Citrus fruits: oranges, lemons and grapefruit.
    • Fruit juices.
    • Pickles and vinegar.
    • Yoghurt.

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3. How acid from the stomach can damage teeth.

  • The acid produced in the stomach is sufficiently powerful to dissolve any food, including bone.
    • When the contents of the stomach are regurgitated the acid comes into contact with the teeth.
    • Any condition that causes repetitive regurgitation or vomiting will result in erosion of teeth.
    • The dentist if often the first to notice the problem. The enamel on the back surfaces of front teeth are the first to be affected.
    • The erosion is seen as a light yellow patch on the tooth. This indicates that the enamel has been dissolved and the dentine under the enamel has been exposed.

Click to enlarge
Erosion of enamel
Yellow dentine visible

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4. Overfeeding may affect baby teeth.

  • Infant overfeeding can result in the regurgitation of acidic stomach contents.
  • Constant overfeeding over a long period can lead to the erosion of the enamel surfaces of baby teeth.

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5. Attrition: How teeth can be worn down by other teeth.

  • Attrition is the mechanical wearing down of the biting and chewing surfaces of teeth. This takes place in all children and is normal.
    • The tooth to tooth contact during chewing grinds down the surfaces.
    • The front teeth become shorter and the back teeth become flatter.
    • Attrition of baby teeth does not usually present a problem. It is a slow process, and the baby teeth are gradually replaced by permanent teeth.

See Bruxism

Click to enlarge
Attrition of baby teeth
Dentine showing
Click to enlarge
Wear of upper teeth

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6. Abrasion: Teeth can be worn away by brushing.

  • Abrasion is the wearing away of tooth surface caused by friction.
    • Permanent teeth can be worn away by brushing too vigorously. Long sweeping strokes in a horizontal direction can cause the damage.
    • It is evident on the outer surface of the back teeth, near the gum line.
    • Abrasion of baby teeth is not common.

See Toothbrushing

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7. Illnesses which predispose teeth to wear.

  • Tooth Wear is seen in children with certain ailments:
    • Problems of the oesophagus
    • Anorexia or bulimia in adolescents.
    • Conditions related to learning disabilities.

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8. How can Tooth Wear be prevented in children?

  • For infants:
    • If overfeeding is taking place, consult your doctor for advice on baby feeding.
    • Do not put your baby to bed with a bottle of juice or milk. Plain water is preferable.
    • Limit the frequency of drinking fruit juices and ensure that they do not contain added sugar. The acid content can be reduced by diluting the juice with water.
    • Do not bottle feed for long periods. A bottle of plain water between feeds is healthy and acts as a pacifier.
    • Always wipe the baby teeth with a muslin or soft cloth after feeding. This is to remove the plaque.
  • For older children:
    • Reduce or avoid the soft drink treats, as these are one of the main dietary causes of erosion and decay of teeth.
    • Oranges and lemons must not be sucked.
    • Toothbrushing after meals with a fluoride toothpaste should become a regular daily habit.
    • Sugarless chewing gum is recommended to neutralise the acid by increasing the salivary flow.

See Oral Hygiene and Diet and decay

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9. What is the treatment for Tooth Wear?

  • Loss of enamel and the sensitivity this causes can be treated in the following ways:
    • Small areas of erosion can be desensitised by the dentist.
    • Larger areas of exposed dentine can be restored with a tooth-coloured plastic filling.
    • Where the erosion has led to a large breakdown of tooth structure, a stainless steel or plastic replacement crown can be fitted over the entire tooth.

Click to enlarge
4 stainless steel
crowns
Click to enlarge
6 steel crowns
4 plastic crowns

See Repair of Teeth

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