Louise Chang, MD
Teeth are built tough. With regular care they can last a lifetime. Still, the daily grind of chewing, brushing, and grinding, along with accidental injuries, can take a toll. Here are three of the biggest threats, and what you can do to avoid them.
Teeth can sometimes chip or fracture when you bite down on something hard, such as a popcorn kernel or stale bread. “But that kind of injury is actually quite uncommon,” says Steven E. Schonfeld, DDS, PhD, a dentist in private practice and spokesman for the American Dental Association.
Teeth that have fillings or root canals are at highest risk, because they aren't as strong as intact teeth. “But even intact teeth can chip or fracture if you happen to bite down in just the wrong way on something hard,” Schonfeld says.
More often, teeth are damaged as a result of accidents or sports injuries. When researchers surveyed athletes competing in the Pan American World Games recently, they found that almost half showed signs of fractures believed to have occurred over time during training or competing. In that study, sports most commonly associated with tooth injuries included wrestling, boxing, basketball, and karate. But even non-contact sports such as roller-blading or skiing can result in damage to teeth.
What can be done: If you have fillings in your back molars, it's wise to avoid biting down hard on foods such as bones, hard candies, and ice. Wear a mouth guard if you or the kids play sports that pose a risk of injury. A 2002 survey of college basketball players found that mouth guard wearers significantly reduced their risk of dental injuries. Simple mouth guards are available at most sporting goods stores. Your dentist can also make a custom-fitted mouth guard.
Chipped teeth can be repaired. Fractures are harder to fix, especially if the crack extends below the gum line. Badly fractured teeth may have to be removed.
Teeth are built to chew and grind food. But unconscious grinding or clenching of teeth, over time, can damage the chewing surfaces. “Chronic tooth grinding, called bruxism, can cause micro-cracks in the enamel, making teeth more susceptible to decay, and even wear down the pointed surfaces of molars,” says Anthony M. Iacopino, DMD, PhD, dean of the University of Manitoba Faculty of Dentistry.
Tooth grinding can also cause headaches, muscle pain, and jaw injury. In many cases, people with bruxism don't realize they have a problem until a dentist notices tell-tale signs on their tooth surfaces. That's one more good reason to get a semi-annual check-up, says Iacopino.
Researchers suspect that stress or anger may lead to tooth grinding. A 2010 study found that people with sleep bruxism were more likely than people who don't grind their teeth to report trouble at work, daily problems, and physical problems.
What can be done: Stress management techniques may help. “I tell my patients who have signs of tooth grinding to find ways to relax,” Declan Devereux, DDS, a dentist in private practice in Hawaii, tells WebMD. “Take a walk. Learn to meditate. Avoid stressful or frustrating situations if possible.” For some patients, that may be enough to ease tooth grinding. If not, dentists may prescribe a mouth guard or splint, which fits over the upper or lower teeth, protecting them from becoming damaged.
As tough as teeth are, they become vulnerable when acid levels in the mouth are too high. Acid erodes enamel, making teeth more susceptible to decay. Acidic foods and drinks, and acid-producing bacteria in the mouth are prime culprits. Enamel erosion may also be due to other conditions such as bulimia, chronic gastritis related to alcoholism, and recurrent vomiting related to pregnancy. Researchers have recently recognized another threat: chronic gastroesophageal reflux disease (GERD).
GERD causes the highly acidic contents of the stomach to escape up into the esophagus, sometimes even into the mouth, where it can erode teeth. Anyone who suffers chronic GERD is at risk. In a study of 117 patients with GERD, 28 had dental erosion. Another study of 20 patients found evidence in about half of the patients.
What can be done: The only way to prevent further damage is to control GERD. If your dentist notices signs of enamel erosion and suspects that the problem may be GERD, he or she is likely to refer you to a gastroenterologist. A variety of antacids are available, over-the-counter and by prescription. In addition to taking medication, some experts recommend raising the head of the bed several inches. That allows gravity to help keep stomach contents from refluxing at night. Walking after a big meal may reduce heartburn for the same reason. Chewing sugarless gum can also help by increasing saliva production, which rinses out the mouth.
SOURCES:Steven E. Schonfeld, DDS, PhD, spokesman for the American Dental Association.Anthony M. Iacopino, DMD, PhD, dean of the University of Manitoba Faculty of Dentistry.Declan Devereux, DDS, private practice dentistry; Andrade, R. Dental Traumatology, June 2010, vol 26: pp 248-53.Labella, C. Medicine and Science in Sports and Exercise, January 2002, vol 34: pp 41-44.Huynh, M. Journal of the Canadian Dental Association, October 2007, vol 73, pp 727-30.Giraki, M. Head and Face Medicine, March 5, 2010; vol 6: Epub.Barron, R. Journal of the Canadian Dental Association, February 2003, vol 69: pp 84-89.
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