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.
Chipped, Fractured, or Broken Teeth
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 tooth 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 in-line skating or skiing can result in damage to teeth.
What you can do: If you have fillings in your back molars, it's wise to avoid biting down on hard foods such as bones, hard candies, and ice. Wear a mouth guard if you play sports that pose a risk of injury, and get them for your kids that play sports, too. 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.
A dentist can repair chipped teeth. Fractures are harder to fix, especially if the crack extends below your gum line. If you have a badly fractured tooth, your dentist may remove it.
Bruxism: Grinding Your Teeth
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 checkup every six months, Iacopino says.
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 you can do: Stress management techniques may help. “I tell my patients who have signs of tooth grinding to find ways to relax,” Declan Devereux, DDS, says. “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.
Acid and Tooth Enamel Erosion
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, or frequent vomiting related to pregnancy. Researchers have recently recognized another threat: gastroesophageal reflux disease (GERD).
GERD causes the highly acidic contents of the stomach to back up into the esophagus, sometimes even into the mouth, where it can erode teeth. Anyone who suffers 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 you can do: Ask your doctor for support and referrals to treat bulimia or alcoholism. If you’re pregnant and vomiting a lot, it might be a good time for you to get a dental checkup (one is recommended during pregnancy).
If your dentist notices signs of enamel erosion and suspects that the problem may be GERD, she is likely to recommend you see your doctor. The only way to prevent further damage is to control your GERD. In addition to taking a prescription acid-blocker medicine, make some changes to what and when you eat to reduce the frequency of reflux. Start by avoiding foods that make GERD worse: chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Eating smaller meals helps prevent GERD. Also, don’t eat for at least two hours before bed so your stomach has time to partially empty before you lie down.
David L. Kitchen, DDS
La Jolla, CA 92037