A second major cause of tooth wear is acid erosion. Erosion of the tooth structures by acid occurs when the acid demineralizes the enamel and dentin and then the demineralized and weakened tooth surfaces are rubbed away by the toothbrush, the tongue, the cheek, the opposing teeth, and food.

Erosion of tooth structure is preventable and the dental team can advise patients on how to slow down and stop the erosion process. (For more dental info, visit my website at www.lajolldental.com)

The two sources of acid that causes erosion of the teeth are ingested acids in food and drinks and internal digestive acids that are regurgitated into the mouth. The position on the teeth of the erosion will tell us if it is ingested acid or internal acid. Ingested acid, coming into the mouth from the front, will erode away the fronts of the teeth and the biting surfaces of the teeth. Internal acids by comparison, enter the mouth from the esophagus and cause erosion on the back side of the front teeth and the biting surfaces of the teeth.

To minimize and control attrition (tooth-tooth wear) we need to keep the teeth apart during sleeping hours and create a daytime bite that is comfortable and well balanced.
For nighttime control of attrition a night guard (also called occlusal guard, biteguard, or splint) can be used. They are custom-made hard acrylic mouth pieces fabricated to order by the dental office. They can be made to fit over the upper or lower teeth, can cover two teeth or all the teeth in that arch. In extreme cases, they can also be worn during the day. Without the mouthpiece in place, the teeth worn by attrition will continue their destructive process.
To overcome this, an individualized treatment plan is indicated. The plan must realign the biting position of the upper and lower jaws to be in harmony with each other, with the muscles, and with the jaw joints. To accomplish this, we take impressions for study models as well as wax registrations to determine the best course of treatment. The more common treatments include bite adjustment, restoring the worn teeth, orthodontics to realign the upper and lower teeth, jaw surgery to reposition and realign the two arches, joint surgery, or a combination of several of these. The most common treatment in our office is bite adjustment and restoration of some or all of the teeth. Orthodontics is another common treatment. (For more dental information, see my website at www.lajolladental.com)
It is important to note, many dentists don’t understand attrition and how to realign the upper and lower arches and restore the teeth in harmony with each other, with the muscles, and with the jaw joints. Too many crowns get placed on worn teeth without correcting the cause of the attrition. No surprise, then, the wear continues on the new crown(s)!

One of the three major causes of tooth wear is attrition. Attrition is caused by tooth to tooth contact. The back teeth become flatter while the front teeth become shorter. In a healthy well-balanced bite the rate of attrition is minimal throughout life. When that rate is dramatically increased, wear will appear on some or all of the teeth. (See my website at www.lajolladental.com)
One of the conditions that accelerate the attrition or wear is bruxism. Bruxism is an involuntary clenching-grinding of the teeth. It is believed to be caused by stress, anxiety, and an imbalance in the biting position of the upper and lower jaws – malocclusion. Bruxism can occur subconsciously during the day or while sleeping.
Moderate to severe attrition of the front teeth can leave a patient with short and unpleasant looking teeth and an aged smile. It is possible to have attrition accompanied by acid erosion and/or abrasion.

We are saving more teeth these days through gum treatments, root canals, and better patient awareness. As such, with more teeth in patient’s mouths than we saw 20 years ago, we are finding more wear on the teeth. The wear is not simply a sign of age, it is an indication of other conditions.
Wear has three causes, and it is important for the dental team to identify which of the three causes has affected your teeth, because the treatments will differ. (See my website for more dental information)
The three causes are:
1. Attrition – which is true tooth-to-tooth grinding.
2. Erosion – which causes tooth wear by demineralizing the tooth structure with acid and demineralized tooth areas getting rubbed away.
3. Abrasion – which is when a person aggressively brushes his or her teeth over a period of time and that abrades portions of the teeth. Another abrasion cause is when older over-contoured porcelain crowns abrade the opposing teeth, wearing them away.

Prevention should serve as a lifestyle pattern for total health, not the least of which is dental health. Prevention in dentistry leads to improved long-term oral health and reduced dental costs. It encourages a bright smile, fresh breath, and an overall good feeling of personal security. Prevention is your insurance policy toward a healthier, pain-free, debt free lifestyle.

Our dental hygienists can provide an excellent service to assist you in the maintenance of your overall dental health. Your cooperation with her can serve to increase your knowledge of your present oral condition. When you keep your appointment with your hygienist, the following benefits will result:

* Your hygienist will customize a personal home care and preventive maintenance program for you and inform you of those dental products that are appropriate for your particular needs. You will be instructed in the proper methods of tooth brushing, flossing and adjunctive dental health devices.

* Your entire mouth will be thoroughly and carefully examined for gum disease, growths, lesions, and any abnormalities that would affect your general health.

* Your teeth will be cleaned and polished to remove plaque and tartar both above and below the gum line, eliminating bacteria that lead to cavities, bad breath, and gum disease.

* Fluoride will be applied to teeth to prevent decay (for children), and root sensitivity / root cavities for adults.

* Sealants can be easily applied to the chewing surfaces of children’s teeth as a protection against future decay.

For our periodontal maintenance patients, your hygienist will use her specialized cleaning instrument, the Cavitron, to not only remove tartar, but also flush bacteria and debris from the periodontal pockets. She will also irrigate and medicate those same pockets with Chlorohexidine Gluconate.

Dental disease is a silent invader, presenting itself in various forms (puffy, bleeding gums, cavities, oral cancer, and abscesses). Although your mouth may appear to be in good health at this time, stresses, body changes, life changes, medications, illness, and age can tax your immune system. Maintaining regular re-care appointments with your hygienist and follow-ups with Dr. Briscoe offer you the assurance that any problems in regard to your oral care will be addressed immediately.

Taking care of tomorrow’s problems today will give you tremendous peace of mind. If you have postponed or missed your last hygiene maintenance appointment, remember: it’s not just a cleaning, it’s an INVESTMENT in your overall health.

See my website for more information www.lajolladental.com

Variables that may compromise periodontal therapy or have an effect on you may include:

Systemic Health
Nutritional Intake
Ability to Absorb Nutrients
Alcohol
Caffeine
Smoking
Medications or Drugs
Stress Levels
Hormonal Therapy
Trauma from Malocclusion
Faulty Dentistry
Food Impaction
Mouth Breathing
Calculus
Body Chemistry

For more information see my website at www.lajolladental.com

1. Always brush your tongue or use a tongue scraper daily. Your tongue retains approximately 80% of the bacteria in your mouth.
2. Replace your toothbrush or other home care products if they appear worn out. Toothbrushes should not look flattened or spread out. They should be replaced every six to eight weeks.
3. Toothpastes for sensitive teeth or fluorides are very useful for sensitive root surfaces. Use as directed.
4. Prescription fluoride gels are used to prevent decay, reduce sensitivity and decrease microbial (bacteria) count. After brushing, place gel on a dry toothbrush, proxabrush, or rubber tip and use for one minute, followed by swishing remaining gel for one minute. Do not swallow the fluoride as it may upset your stomach. Fluoride rinses (non-alcohol) you can purchase over the counter such as Act, can also help decrease sensitivity and strengthen teeth. Use one to two times a day. Do not eat or drink for thirty minutes after using.

Home Care Instructions:
1. Floss twice a day (morning and night). Wrap the dental floss around your middle finger and guide the floss with your index fingers and/or your thumbs as instructed in a “C” shape and scrap up and down.
2. Brush three times a day (morning, lunch, and bedtime). Hold the toothbrush at a 45 degree angle toward the gum line and direct the toothbrush under the gums using a small circular stroke. DO NOT RUSH! Spend 3 to 5 minutes brushing. Dry brushing is fine if it is more convenient. Rinse with water and expectorate.
3. Rubber tip one or two times a day. Using the tip of the stimulator, trace around the gum line of the teeth. Place the rubber tip between the teeth from the inside and outside surfaces and use gentle pressure to massage the gum tissue.
4. Proxabrush one or two times a day if recommended by your dental hygienist. Work the brush between open spaces and around bridgework.
5. If using a water pik, fill the tank with warm water and use medium speed directing the water at the right angle to the long axis of the tooth (never angle the waterjet down into the gum tissue). If you have a heart murmur, heart disease, or an artificial joint, check with your physician before using a water jet device.
6. Use fluoride rinses or desensitizing toothpastes daily if recommended.

For more information visit my website at www.lajolladental.com

Periodontal Disease Facts and Reminders
1. Plaque forms 20 seconds after eating and 20 minutes after brushing. It hardens into tartar in 24 hours and stays on your teeth.
2. Healthy gums DO NOT BLEED. If you have bleeding gums, pay more attention to your home care instructions. Salt water rinses can help sensitive and swollen gums (1 tsp. salt dissolved into one cup water). If your gums continue to bleed after a thorough home care routine, please contact our office. Go to www.lajolladental.com
3. Experiencing a bad taste or odor is a sign of gum disease/infection.
4. Mouthwashes have no effect on periodontitis. Some mouthwashes can reduce gingivitis.
5. When subgingival plaque reaches a certain threshold level, it produces periodontal disease. Periodontal Disease, therefore, occurs in episodes of activity and quiescenece. That is why daily removal of the bacteria in your mouth is important in reducing your risk of periodontal disease.

Six weeks after Active Periodontal Therapy (APT), we have our patients back for re-evaluation. We reprobe every tooth in the mouth, evaluate the tissue tone and texture and take intra-oral photos to show you the results. This is our report card. How well did we do with our clinical treatment, with our homecare instructions to you, and with our emotional appeal and motivation to you to save your teeth? (For more information go to www.lajolladental.com)
We may have been totally successful, or only partially successful. If we are totally successful and all the pockets have shrunk to 3mm or less, the tissue tone pink and firm, and you are religiously cleaning your mouth, then we celebrate! If we were only partially successful, we need to identify what is going on – or in some cases, what is not happening (i.e. daily) through homecare. We may be able to make some corrections and reconvene in another 6 weeks for re-evaluation, or we may need a referral to a gum specialist for evaluation of one or more sites. Often, the treatment of gum disease is not all or nothing. We may be successful in 60, 70, 80 or even 90% of the areas, and unsuccessful in just a few spots. Those few spots may need treatment by a gum specialist, and often involve surgery.
http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisease.htm