Toothbrush Abrasion
Written by Dr. Ronald Birnbaum
One of the most common types of damage that occurs in the mouth is called Toothbrush Abrasion. I see it in about 8 out of 10 people. Toothbrush abrasion is an innocuous problem stemming from a bad habit that can lead to receded gums, sensitive teeth, holes cut into teeth, strange esthetics and tooth loss.
Introduction
For starters, take your toothbrush and move it back and forth along your skin. If you rub it like this enough times in the same area and with enough pressure, you will cause your skin to turn red and it may hurt. If you kept up this pace, your brush may eventually cause damage to your skin, cause a little bleeding, and hurt a lot. Now, please don’t try this for real, but you get the idea.
Fortunately, brushing the skin is not something most of us do, even though the outer skin is a tough layer of protection and will stand up pretty well against a toothbrush.
However, brushing the teeth is a daily exercise that all of us must do. When you take your toothbrush and carry it to the mouth, it is going to meet two things: something very hard (your teeth) and other things very soft (your gums, your tongue, etc.).
The enamel of teeth is the hardest substance in the human body, almost like rock, and very hard to break or otherwise do damage to. Enamel in adult teeth has years to form, which partly explains where this strength comes from. Enamel makes up the outermost layer of teeth when you look in the mirror.
Teeth are encircled by a fragile, thin, easy to damage layer of skin called the gums. Their most fragile spot than at that junction where the teeth meet the pink of the gums (called the gumline). It is at this point that toothbrush abrasion comes into the picture, because this is precisely the area in your mouth that is most vulnerable to damage from brushing one’s teeth too hard, leading to what is called toothbrush abrasion.
The Cause of Toothbrush Abrasion
We all brush our teeth every day. The goal of brushing is to remove food particles from around the teeth to render them clean and our breath feeling fresh. Food usually collects in the form of “plaque”, which is that whitish material that likes to hang around the gumline. So when you take your toothbrush, you are carrying it around the teeth, but often also against the gumline and maybe a little bit higher onto the gums themselves. So you brush and you brush and you brush and you’re done, great.
However, if you put too much force on the toothbrush as you go around, your gums don’t like it (remember the skin example). Keeping in mind that the gums are very fragile and weak, they really can’t stand up to this excessive force for too long. What happens over time is that the gums will actually recede- (in protest?) and you will have given yourself a receded gumline.
Gum Recession from Toothbrush Abrasion
Gum recession caused by toothbrushing is not the same thing gum disease, which is caused by bacteria and infection. This recession is caused by you. You have brushed too hard, too frequently, with too much force, too much on the gums, for too long, and now it is too late, your gum has disappeared. Maybe you pushed too hard because you were stressed or not paying attention. No matter what the reason, once the gum is gone, it is gone and it “‘aint ever gonna grow back”. You have receded gums and- you’re (gasp!) only 25, or 30 or 35 or whatever and you thought all your life that gum recession was only a problem for “old people”. As you can see, if the cause of the recession is toothbrushing, it can occur at any age, young and old.
Sensitivity in The Teeth
If a recession of the gumline has occurred, most people will first take notice of a sensitivity when something cold or sweet touches the side of the affected tooth while eating, drinking or breathing air. Sometimes also a pain occurs during toothbrushing as the bristles move across the side of the tooth. Why is this related?
As the gumline recedes due to excessive toothbrushing forces, it begins to expose a part of the tooth which is normally kept covered up by the gums. This part of the tooth is called the dentin, which is where the nerve endings are. As a result of the dentin being exposed, the nerve endings contained within also become exposed and the result is the sensitivity to cold, sweet or touching of the area.
The dentin is a layer underneath the enamel, but as you go down into the root of the tooth, the enamel slowly gets thinner and thinner until it stops about 1/3 of the way down. This is where the underlying dentin starts to show through and takes it the rest of the way down the root to the tip of the tooth. Where the enamel has stopped and the dentin takes over is called the dentin-enamel junction, which usually happens to be just below the gumline. If the gumline has receded, however, this junction becomes exposed and the dentin sensitivity becomes apparent.
If the gumline recession is minor, de-sensitizing materials can be placed over the exposed dentin to seal the nerve endings and make the patient comfortable. One popular material is potassium nitrate, contained in “sensitivity” toothpastes. Upon using a toothpaste containing it, it blocks the nerve endings, but it takes two weeks for enough to build up to give a noticeable result. Indeed if the person stops using the product, the material goes away and they are sensitive again. The other downside is that the toothpaste itself may not be what is needed in the rest of the mouth (maybe the person needs a tartar control toothpaste, or an anti-gingivitis formula), so it means a lot of toothpaste in the house. Finally, the overzealous person will attempt to brush the sensitivity toothpaste into the tooth vigorously, causing further gumline recession and worsening the problem.
A better solution is a desensitizing solution that is applied in the dental office directly to exposed sensitive dentin areas only. The chemical is then sealed into place, completely blocking the nerve endings. It is invisible, works instantly, offers long-lasting protection and is cheaper than buying tube after tube of special toothpaste.
Holes cut into teeth
As the gumline recedes and the dentin is exposed, not only does sensitivity become a problem, but the dentin itself can be literally cut away by the toothbrush if a bad forceful brushing technique is continued to be used.
The dentin is softer compared to enamel. While toothbrushing cannot easily cause harm to enamel, the dentin however, is quite easily damaged. Once a receded gumline has exposed enough dentin, the toothbrush can easily start to cut a hole into the tooth at this point. After a months of abuse, the hole will have grown to resemble a notch.
A smaller notch, if caught early, may not need any treatment other than desensitizer to keep the patient comfortable from the exposed dentin. However, a deeper notch will always require treatment to fill in the notch.
If the notch is left exposed, food and bacteria become trapped in hidden corners and this will lead to tooth decay (a cavity). Decay that occurs in the dentin notch will quickly eat away and destroy the tooth, resulting in pain and more complicated treatment like a root canal becoming necessary.
To treat a deeper notch, the treatment consists of a filling, usually of tooth-colored filling material applied directly to the notch to fill it in. This not only gives the tooth its correct contour back, but it covers up all exposed dentin, shutting off any sensitivity. This is a very common treatment.
Tooth Loss
A deeper notch, sometimes cutting as much as halfway into the tooth like a lumberjack saws a tree before it is about to be felled, will eventually weaken the tooth so much that just like the tree, the tooth will break, cracking out of the mouth when the person bites hard.
Yet even continued brushing too hard, with continuing recession of the gumline without necessarily any notching, will cause more and more of the tooth to be exposed. As the gum shrinks towards the tip of the root, the tooth loses support from the gums. Eventually the tooth may get loose and fall out due to simply not having enough gum around it to hold it up.
Esthetics due to Toothbrush Abrasion
Patients often ask why there is a yellow part of the tooth at the gumline. That is the dentin, it is always yellow. If the patient has brushed too hard and gumline has receded due to toothbrush abrasion, more of the dentin will be exposed, causing a “yellow teeth” esthetic problem. Sometimes tooth-colored filling material can be placed as a “patch” to cover up the yellow areas.
Treatment for Toothbrush abrasion
First and foremost is to stop the bad brushing habit. Keep brushing, but do so with a soft toothbrush, a light touch and with an up and down motion against the teeth to minimize destruction. It doesn’t matter if the toothbrush is manual or electric, both types can cause the same problem.
Since the gum doesn’t grow back, as long as the patient is comfortable, without sensitivity or deep notches, it can be left like that.
Some patients with high esthetic requirements opt to have plastic surgery on the gums to reposition the gums back into place or to cut out gum from another part of the mouth in order to cover up the teeth where the gumline has receded.
Information contained is generalized. Sensitivity of any kind may be an indicator of more a serious dental and/or overall health condition. This advice is not intended to be self-diagnostic nor may it be relevant to your particular condition and cannot be used to replace a dental examination.
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