Enamel Explorations: Understanding Tooth Wear

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Welcome to today's show. Everyone with me, I have my great friend for many years and amazing prosthodontist, Dr. Nikki Magami. Welcome to the show.

Glad to be here. We've been waiting to do this for a long time.

Yes. And a lot of you might not know what a prosthodontist is. And we have such a great topic today is really understanding how your teeth wear down. Especially those of you that are probably looking at your teeth and you see, oh, my God, my teeth are half the size they used to be. What happened? Stay tuned and you'll learn how to prevent this and how to reconstruct it. So, Nikki, a lot of us don't know what a prosthodontist is. Of course we do. But tell us, what is a prosthodontist?

That's a really good question. So I get that a lot. What we do is basically look at the full mouth, not just on a single tooth, to kind of learn about how the patient bites, how they function, what's the health of their overall teeth. Because, you know, a tooth may not look like it has cavity or needs a new crown, but someone like me can look at it and be like, this patient really needs to have more of a comprehensive treatment done. And as some of the images for some of our audience that gets to see it, you'll see it's a very complicated case, and we need to really understand what's going on and not just dealing with individual tooth that has, let's say, a fracture. I mean, we have to treat the source of the problem. And usually prosthodontists are trained three to four years after dentistry, after they get their dental degree, to study and to learn and to recognize these issues and try to overall help with the overall health of the oral dentition.

Yeah. And you and I met in residency. I remember I was a periodontal resident.

Yes.

And you were going through your residency at the Lava Hospital, West Lava, I think that's the right name for it. And we had implant classes together, dental implant classes together. And the nice thing is that, you know, as residents, we get to understand each other's trait or each other's work. So I can build a better foundation for you, and you can build a good structure on top of the foundation that we set up as periodontists. So you're a maxillofacial prosthodontist, correct?

That's right.

How do you become one of those?

So after you become a prosthodontist, you do another year of training. And basically this training focuses on patients that have, unfortunately, traumas. It could be cancer, or it could be an accident where they kind of lose part of their mouth and we have to make them prosthesis to basically allow them to function again. There could be patients that had some kind of an oral cancer and their palate is removed. And now we need to kind of create something in a removable form or even a fix if we have enough bone, heart tissue to separate between, let's say, their nasal cavity with their oral cavity. So it's not everyday dentistry. It's more like hospital dentistry or patients with accidents that, again, lost part of their heart tissue and teeth and bone and.

Yeah, they lost part of their face, essentially. They lost part of their face. And you have to kind of rebuild it back. That that requires you to really understand the facial and neck structures.

Right. And. And function as, you know, and you both. We, both of us, like, you know, deal even with that part of dentistry where patients come in and we have to deal with the teeth and the joint and the muscles. I mean, it's not just like teeth function by themselves. So it gets really complicated, especially if you have issues where surgically there has been damage that's been done on these, you know, other systems, and to have to replace and create an harmony again, it becomes complicated. So. So you really do have to understand how these systems or how, like, your joint, your muscles, your mouth, they all play together in order to be able to create, to balance someone's function back into health and, you know, harmony.

Absolutely right. So with all this knowledge, it's so important with some of the things we're going to be talking about today, tooth wear. And I know for those of you listening, you won't be able to see some of the images that Dr. Nikki wants to share with us, just so you understand, you know, the tooth wear. But you can go to my YouTube channel, Ask Dr. Sondha, and really look at the podcast episodes, and you will be able to see the images that she has to share with us today.

So let's get started here. Well, we're talking about teeth wear, and it's usually combination of many processes. We're looking at Just to simplify it, chemical wear of the teeth versus mechanical wear of the teeth. And of course, there's some specific terminology that's given to these processes that really is not the focus here.

Now, can I ask a question?

Of course, of course.

What do you mean by chemical? Some people might be thinking, oh, these are people, like, taking in hydrogen peroxide or drinking Listerine. Like, what do you mean by chemical? What kind of chemical?

Right, exactly. So I'm going to get into that in more detail. Chemical, basically, can be many things, can be either things we consume. So they are, you know, coming from outside our body to our mouth. I mean, a lot of our patients drink lemon water. That can be considered chemical.

What about vinegar? You know, some people actually drink vinegar.

Anything, anything that's acidic can be a harm, a chemical harm to the teeth. And usually these things happen so slowly that most patients don't even recognize what's happening to their teeth. And as a matter of fact, I.

Know we actually have some patients that are eating lemons. Basically, they take the lemon and they take bites out out of it.

Right, exactly. And that comes across, if a dentist sees it right away, can tell that that patient is doing that because the wear facets in the front teeth are very specific for that kind of a function. So it's interesting because, I mean, most people. And you know what Sanda makes me think about sometime and let me just say something else about another kind of chemical, and I'll tie this to that is gerd, which is like gastroesophageal reflux disease that a lot of people experience or, you know, people with, you know, acid reflux. And, you know, they see their medical doctors, but they don't even bother to look at teeth. And that, that always really bothers me that generally you and I send the patient to their doctor where I would say I would like the primary doctor to also look at teeth to be able to tell, oh, you know, this person probably has an active acid reflux. Like, teeth are not looked at as much in a, you know, medical community. And that's kind of a sore topic.

For me, but hopefully we have some gastroenterologists listening to this podcast. And please, if you have people with gerd, send them to a prosthodontist, send them to a dentist who understands tooth wear so we can help your patients prevent their teeth from wearing down.

I think that's interesting, this chemical where, like you said, like, patients who bite into something sour, it could even be oranges, they start wearing their front teeth. People who have gerd, which is acid reflux. You see the wear on, like, their back teeth and behind some of their upper teeth. So just the way the wear present itself gives us a diagnosis. Sometimes patients, I've heard that they actually drink soda and they swish it around in their mouth before they swallow it. I know like, a lot of crazy stuff I've heard. And they wear just the top of their back teeth and not the front. So it's interesting how the presentation of the wear gives you a history. And you can, you know, patients, sometimes they don't even know they open up their mouth. And I'm like, do you do this? It's like, oh, yeah, we do. And it's very specific, the wear to specific behavior. So.

But you have to be a good detective.

In other words, sometimes it's hard, like you will see in a picture. And I can't describe it. The early stages of it. It's very subtle. It's very subtle. And even it can go undiagnosed with a dentist that's just started to, you know, like a new dentist, you know, just something that you really have to actively look for. Because as we get older, too, is a matter of wear and tear. We also, as we get older, we wear down our teeth. But to recognize what's a normal wear versus something that's more accelerated, it takes a little wisdom there. But clearly, in some of the images you'll see, it's more like as it kind of as we wear down the enamel. So with chemical, what happened is it's like acid. You slowly demineralize the surface of the tooth. And so you go from a tooth that's super white to slightly getting a little bit less white as we lose more enamel and we see more of the dentin underneath of it.

Yeah, so this makes me think of the, you know, the Coca Cola, which is pretty acidic. Like, I know there were studies done. Basically, you take a tooth removed from someone's mouth, put it in Coca Cola, and essentially the whole tooth can be dissolved if you wait long enough.

That's right, yeah.

So those of you that love sodas, and nowadays we have so many natural sodas out there, they're still acidic. You know, there's prebiotic sodas, which I also love, by the way. But, you know, you have to be careful. Don't take the soda and start swishing it between your teeth, or don't let it sit on your teeth. Try to drink it through a straw or lemon water the same way you brought in a good point. A lot of, you know, health habits can be dangerous for your teeth like this erosion. So try to use a straw. That would be my recommendation.

So also, let me just mention, other than GERD sometime we see patients with eating disorder like bulimia, that you can also see that presentation, the wearing down of the teeth behind their upper teeth.

So a lot of people don't admit their bulimic, especially to their family, and the first person to diagnose them is a dentist.

Other than themselves.

Other than themselves. Of course they know they are, but they. It's a condition that you can't just stop. So it's really important for bulimia to understand that acid coming from the stomach can really destroy the teeth.

Right, Right.

Yeah. Anything people can do to prevent from acid erosion of the stomach. What do you recommend? Typically?

There are many things. I mean, I obviously prefer holistic prevention as opposed to starting taking medication. There's a lot that can be done. You know, patients who have like obesity is one big cause of it. The pressure, extra pressure on the stomach can push on the acid to come up. There could be some mechanical issues. That, that needs to be something that has to be diagnosed. But let me just take this back because I kind of do like to talk about it. With acid reflux, sometime patient can actually have not so much your typical acid reflux symptom and still, still have this problem which is called like silent acid reflux. It's important for them to get tested by their GI doctor or go to their primary doctor and get a referral to see a gastroenterologist to do some testing. And the way they do some testing, it could be an endoscopy which they send a little flexible tube down the esophagus and kind of take a look. And even they can take like, you know, tissue biopsy because if you have this chronic issue, it can lead actually to cancer because, you know, the acid doesn't bother the stomach, but it does bother the tube that connects the stomach to the mouth, which is. We call it esophagus. And the lining of that tube is very sensitive to this acid. So if you have a patient that doesn't have the valve working well between the esophagus and the stomach, and they get this cross chronic acid inside the esophagus, they start seeing this sort of ulceration, Then endoscopy can pick up and they can just do biopsy, like I said. And they can also do measure, I believe the ph, which they can, you know, basically couldn't probe. And they can measure the pH for amount of certain amount of time and see how much, how acidic esophagus is. So I think first of all, before prevention, you have to get a definitive, I say, diagnosis. Make sure that you either have this issue or you don't. Because if you're just trying to prevent and not really get to the source of it, I think ultimately you're going to be on this pathological path. To me, you have to first. And the most important thing is to get it diagnosed. And then from that point, there are a lot of things that we can do with preventing this. I mean, not eating right before going to bed, you know, you kind of want to give it time between your dinner and food, because when you lay flat, some of that acid can get pushed up into the esophagus. Again, weight is another issue. When patients start losing weight, sometimes that extra pressure from the stomach gets reduced. I mean, it is so multifactorious on the, that you have to see everybody's situation is slightly different. You know, maybe when you sleep, have your head raised a little bit just so that you don't allow for the acid to come up. And if it's a mechanical issue, sometimes they recommend even doing surgery to try to correct for that. You know, I don't like taking chronic, like taking, you know, medication on long term before really getting kind of like a diagnosis. Because taking those medications, I'm not a expert in that, but I know taking medication for a long time is also not a healthy way to go about it. So I really think changing lifestyle, not drinking alcohol, because alcohol also loosens up that tightness and it can relaxes that valve just to kind of simplify it. And it's like, as for that acid to come up. So there are a lot of things we can do to prevent acid reflux. And you know, I think the primary doctor, whoever is going to be diagnosing it, can go over some of these issues to be able to direct the patient. What's the best way to kind of try to prevent it. Prevention is the key.

Always. Yes, I like that. Goes straight to the root of the problem. Not just that topical.

Yeah. And bulimia is a hard one because patient is already sensitive. They are kind of aware of what's going on. And that's another hard topic to deal with. As a dentist, I've had many patients that did not share that. And even at the end of the treatment, I kept referring to it and they knew that kind of, I'm aware of it, but it never came up fully. And it's really hard. I mean, I have in the past said. I mean, you have to verbalize it. But there are patients that may never say that they do that, because bulimia people think of individuals that throw up all the time. And it doesn't have to be that way. It could be just occasional, you know.

Yes.

But it's a very sensitive topic, so it's really hard to open that conversation with the patients. Of course.

Yeah.

So I like to kind of just talk a little bit about what we see. If I can move on.

For those of you that are just listening in, if you go to the YouTube channel, you can actually see the images, but we'll try our best to describe them in depth.

So what you would see see on teeth, the slide shows an earlier stage versus a later stage. In an earlier stage, you kind of start seeing these small craters on top of your molars. Your back teeth kind of looks like a hole, almost like cheek dimples. It does, it does. It's kind of a circular erosion type of, you know, wear. And it's not sharp. You know, initially, everything is kind of round. And teeth kind of get this sort of a glassy look to them because as they lose mineral, they become more transparent, almost like you see through them. So if you look in the mirror and you see your front teeth that you kind of see, it's kind of glass, like that is not white enough. You should mention that to your dentist. There is a possibility that your teeth are going through erosion. So before you start seeing. Seeing major changes, those are generally things I would look for on the back teeth. Look for the holes. It's almost like little circular, round holes. Sanda, can you add anything to that, or am I describing it?

No, I think that that's perfect. Yes. And basically, for, you know, if you're going into your dentist office and they have a camera that they take pictures of your teeth with, we call it an intraoral camera. That's a great way to see these kind of initial stages aware. And this is when you can do something about it, like start adding calcium hydroxyapatite, toothpaste, or tooth powder to your daily routine in order to start building some of this mineral back.

Right. And there are some professional products that we prescribe to our patients all the time, like MI case, that allows for calcium and phosphate to bond to the surface of the tooth to kind of help with, to remineralize. And what I. What I really like to actually focus on, a lot of our patients on that they drink coffee and they want to just brush their teeth right away in order to stop the teeth from staining and what they're doing. Actually, when we drink something with the lower ph or something acidic, that's a very sensitive time for teeth not to brush our teeth because. Because that's where the teeth become. The surfaces sort of gets kind of soft from this acidic exposure and it's best to allow the mouth to remineralize the teeth back and then brush it. So if someone is worried about staining their teeth, it's best just to go and rinse their mouth with water and not pick up a brush to start brushing their teeth because they just speed it up. You know, you drink your lemon water, you soften your teeth and then you take a toothbrush, do it and you know, brush away the soft tooth structure. So that is, I think if any from this podcast, that's probably my only pearl that I and your listeners, you know, basically can remember because we all do, you know, like patients who drink red wine or coffee or something. It's like, let's go brush, get the stain off the teeth. And that's the worst time to do it. Just allow for the mouth for the tooth to harden up and then you can kind of go ahead and brush as usual, but just rinse with water. But coming back even like the front teeth, if you look in a mirror and you see like the front teeth kind of gets this glassy see through look to it. So that's an early sign of erosion. And you know, as they get kind of these lesions get, as you go into the, you know, more severe phase of it, you're going to definitely start seeing bigger sign and it's easier to see because now the yellow part of the tooth that we call dentin is starting to kind of show through. And that's kind of easy even for someone who's not a professional to pick that up. But what's the key here is to prevent this process before it gets to that point.

So once it's gotten this bad, right, that you wore all your enamel off, especially on the backside of the front teeth, like you have here on the lower left, what is the treatment for that?

So in the early phase, clearly we want to prevent it with, you know, like, like you said. Exactly. Then the second, like when it gets a little bit more advanced, where you lost some tooth structure, then we like to just bond some composite tooth color material to the area to again replace the tooth structure that was lost and prevent basically from. Because let me just take it one step back. Once the Enamel is gone. Dentin doesn't have as much mineral, so it's easier for it to kind of wear down. So we kind of want to create a layer. So again, try to prevent more of a two structure getting lost. So it's like when the enamel is gone, the wear goes a lot faster because dentin is a lot softer than enamel. So by bonding some tooth color material to just replace the tooth structure that was lost, we are again preventing from this to get worse.

Yeah, and this is more of a biomimetic approach, like you're mimicking nature. You're just replacing the tooth structure that's gone. Would you ever like shave these teeth down and put a crown on them?

Unfortunately, as you will see in the next image, sometimes things gets really kind of to a point that we even lose teeth. Right. Because you know, the teeth when it just, you start getting a lot of the dentin getting lost. And we're dealing with tooth becoming, needing maybe sometime even root canal, because it's just unfortunately wasn't prevented and there's not a whole lot that we can save. So initially you start with the pace, then you're thinking bonding. Then when a lot of the two structures lost and you're looking at partial procedure crown. Now, those partial crowns or full crowns can be done directly in the mouth. So we kind of can do this in a different way or ultimately can be done in a ceramic. Basically we can make a crown for the patient. But again, depends on how far this erosion the wear has gone. And as you know, we talk about it later on. Unfortunately, when you start having erosion, then the bite kind of becomes unhealthy and then other processes starts to play into it. Meaning teeth starts to wear each other down because you're losing tooth structure. So it becomes a multifactorial issue.

Does this affect in any way the tmj once your bite wears down?

Of course, of course. I mean, once you lose a lot of your tooth structure, clearly the joint is compensating for that and it's the stress that's put on. And even your muscles, your facial muscles, instead of it being in a more relaxed phase, they're going to probably, if you measure how the contractions of these muscles, they're going to be in a more of an hyperactive, not always sometime. Again, every patient is different. You know, mouth is incredible in a sense that sometimes when we lose tooth structure, the mouth tries to correct itself by kind of sort of pushes those teeth up. So you may never look at a patient and feel like their face is looking shorter because the mouth is constantly trying to heal itself. So these are really complicated issues. It's hard to cover them in like just a conversation. But unfortunately it's not a, like a black and white answer for me to just give it to you like that. But every individual is unique and really you need to do a comprehensive exam to know if the joint is still in the right position and muscles are still relaxed. But all of these, once the bite is compromised, the other parts, meaning your joint, your muscles, they start to actually react to that. And now how they react to it comes down to the patient's biology and their anatomy, clearly. Right?

Yeah, absolutely.

So the next slide, you can see this is a lot more progress. So let me.

Can I start by sharing a little bit this patient's story? Basically, he came to us because he was in a lot of pain. And, and if you actually are watching our, our YouTube channel, you can see that half of the tooth was gone. But that's really not what he came in paying for. It was his jaw that was really hurting. He was getting headaches every single day and he couldn't take it anymore. What really happened to this patient is that he was actually throwing up every day because of stomach problems. And that acid from that throwing up is what caused this tooth wear. So how did you approach somebody like this? How do you start to work on someone like this?

So this patient, clearly, you know, we talked about acid reflux, all that he felt, he never had that history. So we believe that he got tested for acid reflux by his doctor and it tested negative. So we started from there like we talked about earlier. And as far as the treatment, clearly at this point, prevention is not, you know, we have to go into full on treatment. Unfortunately, we couldn't restore some of the teeth and it became a little bit of a bigger treatment. But we, due to certain concerns that we had, we basically replaced the missing tooth structure because this patient never had cavity. Like these lesions are not infected lesions. So we have this talented lab that we work with and they kind of basically made these restorations for us to basically bond to the areas that the teeth were missing. And so this was done in a very conservative way. And we're actually kind of halfway through it. I think Sandha and patient is right now very comfortable. So happy that I have actually not even seen him lately. I'm. I, you know, I. He came in with a lot of issues, but, you know, just a simple bonding and bonding can be done directly. What I mean by that, a dentist can just Add completely deposit on the day of treatment on the teeth just to give it some thickness to allow for some of that sensitivity to go down, to allow for basically to build the bite back up again. I mean, this patient, if you recall, Sanda, this is one patient that he really got closed down. Like, if you look at his face, it was a lot shorter than what it should have been for someone who is pretty young. So by just adding these bonding, we were able to actually restore his youthfulness. His face looked full again. And his muscles actually kind of, when patients, you know, lose T structure, their muscles also are not able to function the way they're supposed to. So it was just incredible to see that transformation that can be done, like I mentioned, directly by the dentist, or it can be done indirectly, where you just kind of just clean up things a little bit. You can see some of these edges are kind of sharp because, like I said, it's not. When we lose a lot of tooth structure. Now teeth are touching each other, they're interfering. So now teeth starts to break because they don't have enough substance. So it becomes a multifactorial where as we'll get into the other factors later on. But basically, we just had our lab make some indirect resin restoration. We bonded in place, and it was immediately an improvement in his health and his presentation. If you look at his bottom, the bottom part of this image, you see the wear facets on the front teeth. And that's what I kind of wanted to just point out for our audience who's going to be seeing some of these images. So you can see the wear on the front part of the teeth. But let's move on. But 25% of patients that get diagnosed with GERD, they also. You start seeing these dental erosions. So that's a pretty high percentage.

Yes.

All right, so I think we're moving on to the next kind of wear. I like this photo because you can see how, like, with this kind of. We call it attrition, but basically it just stands for how teeth starts to wear each other down. And basically, if you look at these lesions, they're kind of sharper, they're not brown, like erosion type of lesion. And it's like teeth, basically, when we lose some teeth in the back, like in this image, the front teeth are starting to take on a lot more forces, and the front top teeth are wearing down the bottom teeth. So you can kind of see, sort of, if you look at the wear facets, they kind of match. So that's kind of the difference between erosion versus like a teeth, you know, we call it attrition and patients who grind. We all know people are friends that grind. And you can start seeing their teeth are looked flat. Right?

Yeah.

That's like a classic picture of someone who's wearing down their teeth. Like their teeth are wearing them down either through a parafunction, brux grinding. But that's another kind of aware facets you see. I don't know if you want.

Do you see normal wear happening? Just as we age, there's some mechanical wear that happens. Correct. Like there's no way we can keep that same anatomy. But I think a matter of prevention of this, what we call mechanical wear, basically the teeth rubbing together. Would you recommend a night guard?

Absolutely, absolutely. Again, prevention is always the key. I mean, when it gets to be this bad, sometimes we have to even reconsider. And this is where prosthodontics come into play. Sometimes teeth, when we see the patients, is already so late into the game that we have to actually rebuild the teeth because there's no way of replacing the tooth structure that it's lost. Except for us changing, redesigning some of these teeth to be able to create that space again to rebuild the tooth structure that was lost.

Yes. So basically, for those of you listening, when you actually look at your teeth and you start seeing the yellow part of inside of the tooth starting to show, especially as you're checking out the chewing surfaces of your teeth, that's not a good sign. It means you're starting to wear off your enamel. So that enamel typically is whiter in color. And on the underneath layer, which shouldn't be exposed to the environment, is more yellow.

Right, right. And it's like teeth starts to look sharp.

Yes.

You know, you're going to see sharp corners. Oftentimes when it goes undiagnosed, you start seeing fractures. So, you know, these are really some classic clear indication that you're experiencing these kind of.

So how would you treat someone like this?

Well, you know, again, you can't just look at those individual teeth that present with the wear. You want to look at the full mouth. Is this patient wearing their teeth down because they don't have enough teeth support in the back? I mean, how often do you and I see patients that don't have molars in the back and their front teeth are getting all the beating a lot. Right. So there's nothing we can do except to rebuild those teeth in the back.

Yeah.

And gain that space in the front. Sometimes, you know, we send our patients to our orthodontic colleagues just to kind of move things around for us to be able to create that space. Because I can't tell you how many people come to us just to do the front right for esthetics, right? Just like, let's get the front teeth done. And it's like we look and see the bottom teeth and we look at it and where it becomes a much bigger of an issue. And then by educating our patients, sometimes some of them even go through a year of just like, you know, treatment with an orthodontist to just create the space, correct the bite, then get the new sets of restorations, because you just can't, unfortunately, when it gets to this point, you need to kind of do more than just fillings.

So, you know, we have patients that, as you said, they. Without back teeth. And what would you say to them when they tell you, that's okay, I'm just going to chew with my front teeth? I can chew just fine. So what would you say?

I generally love to spend time on those appointments just showing the patients that, oh, look, do you see why this tooth looks like this? And by you showing it and they go through function, they kind of see right away that, oh, yes, the teeth are wearing themselves down. If I had more teeth in the back, it won't be doing it. Sometimes, Sanda, I put a cotton roll in the back. Just show them what a volume in the back can do to the spacing to the front of the teeth. And immediately they see it, you know, so it's not even about, like explaining it. I demonstrate it to them, and they can even look at their face afterwards and see, okay, okay, this is what it was lost. That's how they used to look before. And the changes, I mean, it's kind of like instantly you see a difference when patients come in. I mean, we can just change everything. And just showing them that by increasing the length of some of these teeth or putting something in the back of their mouth that it's going to represent, like, you know, a molar or something. You open up their bike, they close. Clearly see the issue at that moment.

Yes.

It's not difficult. It's very.

It is, yeah. And it's so important for just to kind of recap, we talked about acidic wear of the teeth. We talked about wear from grinding, what we call mechanical wear. Ways to prevent it. Any last words that you want to share about tooth wear?

If I can just go quickly over two other things and we can just describe it very fast, because I know we did speak spent a lot of time on the other two kinds of wear. So another mechanical wear that our patients sometimes we see is like basically what we call abrasion. It's where like sometimes patients, they like to brush hard. Especially patients who have periodontal disease. They're really meticulous about cleaning their teeth and gum, and they start wearing their teeth down on the side of it. And it's kind of a recipe for disaster. They already have bone loss and the gum is already receded. So their roots are kind of exposed, which, as we know, roots don't have enamel. And they start brushing really hard just to kind of clean the area, and they start wearing those teeth down. So you usually see that on the sides of the teeth there. Some patients that use really abrasive toothpaste, you know, you have to be really mindful of the toothpaste you're using not to be to abrasive because it looks like it would work like a sandpaper, right? So as they're brushing, you can wear things down. Some people have just really like their diet allows for that kind of wear. So this is what we mean by abrasion type of wear. And you see a lot on the sides. I don't know if you want to add anything to that.

I'm really advising people not to, you know, use their whole force to brush sideways and really scrub the teeth, you know, from tooth wear. Very, very important to use a soft brush and be gentle. In other words, thorough but gentle.

So on this image, you would see the upper teeth, there's this broad wear of the root of those teeth because this patient does such a meticulous job trying to clean things. But unfortunately, also it's wearing down.

And with the tooth wear also comes gum recession. If you're brushing too hard. You have one more thing to share with us.

And this is our favorite topic. Abfraction, Right. So unfortunately, again, this is something we experience with patients who have lost some bone around their teeth. And they're more susceptible with to this type of lesion because teeth, as they lose the bony support around them, they kind of unfortunately go through more like different kind of forces, compressive forces, and you start getting this sort of like a V looking deep lesion on the side of the tooth. And in combination of brushing hard and all that, you can really damage the teeth structure.

So for those of you listening and you cannot see the image, basically abstractions almost looks like cracks in the teeth horizontally. You won't see them vertically, but it's horizontally, usually in areas of the exposed root surface that have now being receded or right at the edge of the gum, you start seeing these channels that could be pretty sharp, meaning loss of tooth structure. Are these areas sensitive?

They can be very sensitive, yeah.

So how do we prevent such, you know, tooth word from happening? Would a night guard be 100% preventing?

These are absolutely, yeah. Again, the same type of prevention helps with all of these. Again, the thing with these lesions, unfortunately, when it's on the early phase, I don't generally like to restore them because you haven't lost a lot of tooth structure. I mean, so prevention using mi pace, again, night guard. Those are the key factors in our early phase that needs to be done in order to prevent it. Again, educating the patient. Because let's say a patient have this kind of lesion and they're brushing again, aggressively, again becomes a combination of wears. Right. So educating them, try to prevent it from getting worse. And when it gets to this point, then you have to do a filling. Ultimate bonding to prevent it from getting worse.

Yeah. All right, awesome. So there you have it, everyone. Pretty much everything about tooth wear, what it is, how to prevent it, how to treat it, and when it's time to see a prosthodontist. Dr. Nikki, thank you very much. It's been very enlightening. And where can people find you? At Beverly Hills Dental Health and Wellness, the Beverly Hills location. You know, we've been working together for quite a few years now. I'm not going to say how many. Yes, we do a lot of advanced treatment in Beverly Hills using biological principles. See you next time.

See you next time. Thank you.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. Doctorsanda. This is Dr. Sanda. And remember, your mouth is the gateway to your health. So take care of it in the most natural and best way possible.