Worn Down and Sensitive Teeth from Acid Erosion
There are many reasons that teeth are sensitive to stimuli like touching, sweet, sour, hot and cold. They can be due to gum recession, toothbrush abrasion, root exposure, worn down teeth, chipped teeth, fractured teeth, tooth decay, pulpitis, injured teeth and gum (periodontal) disease.
Recently, I saw a patient whose teeth are extremely sensitive to all external stimuli. Upon medical history, dental history and intraoral examinations, I diagnosed her condition was caused by acid erosion that had dissolved most of her enamel away from her teeth over a period of time, exposing the underlying dentine to stimuli like sweet and cold etc.
We all know that the enamel is hard and non-permeable to most environmental stimulants. However, the dentin is softer and permeable. Once it is exposed, the nerve inside a tooth will feel the obnoxious stimuli and generate severe, excruciating pain.
In her case, the acid that dissolved her enamel away was from her stomach. She was suffering from a common disease called gastroesophageal reflux disease, GERD. The prevalence of this disease is about 20% of adults in western culture. People who have the disease suffering from gastric acid coming out of their stomachs through the opened or loose oesophageal sphincters into their mouths. The acid is mainly hydrochloric acid at pH between 1.5 to 3.5. Human enamel will start to be demineralized at pH 5.5 and so at pH 3.5 or below, the enamel starts to dissolve away.
The situation can be worse if the patient who has uncontrolled GERD also grinds the teeth during sleep. The acid will pool at the back of the upper front teeth if the patient sleeps on the back and causing excessive loss of enamel at the back of the upper front teeth. If the patient sleeps on the side for most of the time then the teeth on the same side will get erode away from the lingual (starting from the side closer to the palate first).
Those patients should be referred to their family doctors to find out their causes and provide the appropriate treatments and medications. Patients should also be questioned about their habits as eating heavily late at night and/or high on fatty diets also can promote GERD.
Night guard with fluoride paste inside should be worn during sleep as a way to prevent acid erosion.
In her case, a more conservative and effective way to restore her teeth is composite resin onlays. Onlays were made on the stone cast of her teeth first, then they were bonded onto her teeth. Onlays are far better option than crowns in her situation because there is no need to shave down her already eroded, weakened teeth. Onlays are better than fillings because it is already difficult to fill large area of a severely worn-down tooth with no tooth support and anatomy, it is ever harder to do multiple worn-down teeth in the same segment.
Soon after the restorations were done, patient was having a lot less sensitivity and was able to chew regular food with them.
In order to prevent further erosion and destruction of the restorations, a night guard is to be made to protect the teeth from clenching and grinding. Patient will also be instructed to place pH neural sodium fluoride paste inside the night guard before wearing the night guard. The effects of the neutral sodium fluoride are to neutralize the gastric acid and to remineralize the teeth throughout the night.