Getting to the Root of Sensitivity

Professor Andrew Eder considers the interplay between dietary acid intake, toothbrushing, tooth surface loss and patients reporting tooth sensitivity, and how to address these challenges, read the article below:

Dentistry-Jan-2020

Professor Andrew Eder presents an overview of some of the more recent research related to tooth wear to help dentists stay current in his article for The Probe, read the article below:

The-Probe-Sept-2019

Read Professor Andrew Eders advice in the article below:

dentaltownuk_2019JuneJuly

Professor Andrew Eder presents an overview of Tooth Wear and offers practical advice for supporting pathological effects in their tracks, read more…

The-Dentist-April-2019

Professor Andrew Eder explores the growing body of evidence linking tooth wear and general health, read the article below as published on The Probe:

The-Probe-March-2019

With dentists ideally placed to recognise eating disorders, to raise awareness of the effect on the dentition and to mark Eating Disorders Awareness Week, taking place from 25 February to 3 March 2019, Professor Andrew Eder considers the oral health challenges and offers preventive advice.

According to the UK eating disorders charity BEAT, around 1.25 million people in the UK have an eating disorder, with about 40% of those suffering with bulimia (www.beateatingdisorders.org.uk, 2018). Yet, in a Yougov survey conducted for Eating Disorders Awareness Week in 2018, more than one in three adults in the UK who took part could not name any signs or symptoms of eating disorders (www.beateatingdisorders.org.uk/edaw, 2018).

To give it its full medical name, bulimia nervosa is defined by The Oxford Dictionary of Dentistry as: ‘An eating disorder in which large amounts of food are eaten followed by self-induced vomiting.’

The definition continues: ‘The vomiting can lead to severe dental erosion. Patients are often fanatical about oral hygiene, which can lead to toothbrush abrasion and gingival recession.’

Oral signs and symptoms

Therefore, it is clearly important the dental profession is able to recognise the signs and symptoms of bulimia in their patients.

Extended periods of intentional vomiting causes acid erosion, which may result in:

  • The teeth becoming rounded, smooth and shiny and losing their surface characteristics
  • Incisal edges appearing translucent
  • Cupping forms in the dentine
  • Shallow and rounded cervical lesions
  • Restorations standing proud of the surrounding tooth tissue, because they tend to be unaffected by erosion.

In addition, abrasion such as that potentially caused by overzealous toothbrushing may manifest as:

  • Teeth becoming less white as some of the outer surface is lost
  • Chewing surfaces wearing flat and taking on a shiny, pitted appearance
  • Restorations such as crowns and bridges may stand proud of the natural teeth (as is also found with erosion).

Alongside this, attrition as a result of tooth grinding may present with:

  • Front teeth becoming short, sharp or chipped
  • Back teeth becoming shorter and opposing chewing surfaces wearing flat
  • Failing and fractured restorations.

This brings up an interesting point that tooth wear is multi-factorial – dentists will not see the dentition affected just by erosion, abrasion or attrition alone or, indeed, any other recognised mechanism of tooth surface loss in isolation. This then requires a multi-factorial clinical response and, since we are dealing with a mental health disorder, dentists and their teams must approach the issue with great sensitivity.

Taking preventive action

Bulimia sufferers do tend to react with embarrassment and deny there is a problem when the issue is raised with them, so if there is a concern that needs to be addressed in dental practice, try to make them feel at ease beforehand.

You can do this, in part, by telling them you have time to talk things through, communicating on their level and asking questions in a non-judgmental manner aimed at encouraging the patient to identify the cause of their oral health problems. It may help if you share your examination findings with the patient and explain how their symptoms are linked.

At this stage, it is not about offering treatment but rather preventive advice. It may be helpful to:

  • Issue a fluoride rinse or gel and prescribe a high-fluoride toothpaste for daily use
  • Advise the patient not to brush immediately after vomiting or consuming acidic foodstuffs, and to rinse with a fluoridated mouthwash and chew sugar-free, xylitol-sweetened gum afterwards.

As for abrasion caused by a rough brushing technique, an important preventive message to share with patients is the need for gentle but effective brushing. Experience has shown that many people mistake brushing hard for brushing well. If properly explained to a bulimic patient, they might be able to alter their brushing habits, as long as they are reassured their oral health will not suffer – and, in fact, improve. It may also be appropriate for the dentist or hygienist to demonstrate the best brushing technique for the patient, and to recommend the use of a soft toothbrush and non-abrasive toothpaste.

In addition, extra protection may be provided via calcium and phosphate ions, to help restore the mineral balance, neutralise acid in the mouth and increase salivary flow.

Protecting the remaining dentition

Of course, getting a bulimic patient to take preventive action is easier said than done, given the nature of the disease. It may also, therefore, be necessary to protect the remaining dentition, for example direct application of a glass ionomer or composite to sensitive areas, an occlusal guard to protect the teeth during purging, and/or an alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling.

Once any treatment has been completed, it is important that the patient attends for regular check-ups. This will allow monitoring of the rate of wear with models and photographs if the patient is agreeable and, when appropriate, further guidance and encouragement can be provided, together with any adjustments to lifestyle being made.

Much of what a bulimic patient goes through is, of course, beyond the scope of the dental professional and they may already be under the care of various agencies. Consequently, it may be sensible (with the patient’s consent) to contact their GP or other healthcare professional overseeing their care before beginning any course of treatment. This will facilitate a team approach, to help decide upon a course of action that will offer the best possible outcomes given the patient’s circumstances.


The London Tooth Wear Centre offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and a holistic approach in a professional and friendly environment. If you have any concerns about your patient’s tooth wear, please visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

References

www.beateatingdisorders.org.uk/media-centre/eating-disorder-statistics (2018) accessed 21 December 2018

www.beateatingdisorders.org.uk/edaw (2018) accessed 21 December 2018

As placed on www.dentistry.co.uk

Professor Andrew Eder considers some of the risks associated with the identification and management of tooth wear and how to handle them.

Read the article below:

Summer is here at last and despite the idiosyncrasies of British weather (or perhaps because of it) there will be hot days where the clink of ice in a glass, as well as the odd ice lolly or ice cream will offer blessed relief from the heat.

For some, however, tooth sensitivity puts the happy idea of these things in the shade.

Read more in Andrew’s guest post on Compare The Treatment here.

With the Oral Health Foundation’s research into the UK population’s dietary habits revealing that 43% of adults are consuming one or more fruit juices or smoothies every day, Professor Andrew Eder considers the effect of such acidic beverages on the dentition.

Read the full article in Private Dentistry here:

Download (PDF, 418KB)

Professor Andrew Eder explores the difference between physiological or pathological tooth wear, and considers why being able to differentiate between the two is so important for the long-term care of patients.

See the full article in BDJ In Practice here:

Download (PDF, 233KB)

 

Tooth wear has hit the headlines at an almost unprecedent level, thanks to the efforts of a team at King’s College London, whose study into sipping acidic drinks such as fruit teas and flavoured water has shown they can damage the enamel.1

Commenting on the research, Professor Andrew Eder, a Specialist in Restorative Dentistry and Prosthodontics and Clinical Director of the London Tooth Wear Centre®, said, ‘This will come as little, if any surprise, to dentists. However, the fact that it has brought the issue into the public eye via media outlets such as the BBC2 and the Daily Mail3 is potentially of great benefit to the oral health of the nation, if dental teams can capitalise on this raised awareness in a timely manner.

‘It is an easy enough topic to bring up in conversation and may open up a further discussion about what patients can do to minimise such damage to the teeth. A suggested in the British Dental Journal article, asking a number of carefully framed questions may help to ascertain the extent of any given patient’s susceptibility to erosion.’

In this regard, O’Toole and Mullan suggest asking the following questions:
1. How many dietary acids are being consumed daily, including fruits, anything with a fruit flavouring, acidic drinks, acidic sweets and medications?
2. How many of these are between meals?
3. Is greater than 10 minutes being spent consuming any dietary acid at a single sitting?
4. Do they sip, swish, hold or rinse the dietary acid in their mouths prior to swallowing?
5. Do they consume dietary acids at an increased temperature, e.g. hot water with lemon, stewed fruits, fruit teas?1

If you consider that a patient may benefit from prevention-led intervention, simple steps that may help include:
• Limit the intake of acidic drinks to meal times
• Rinse the mouth with water for 15 to 30 seconds after consuming acidic drinks
• Chew sugarfree gum or eat a piece of cheese after consuming an acidic drink
• Wait at least an hour to brush teeth after consuming any acidic drinks
• Use a toothpaste that contains fluoride and a non-abrasive toothbrush to clean the teeth at least twice a day
• Use a fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after acidic drinks, to help limit the erosive potential.

If you are concerned about any of your patients, the London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

For further information on the work of the London Tooth Wear Centre®, please visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

References
1.O’Tooole S, Mullan F. The role of the diet in tooth wear. British Dental Journal 2018: doi:10.1038/sj.bdj.2018.127
2. http://www.bbc.co.uk/news/health-43141587. Accessed 23 February 2018
3. http://www.dailymail.co.uk/news/article-5424729/Drinking-trendy-fruit-teas-ruin-smile.html. Accessed 23 February 2018

ENDS

The public at large are relatively well informed about the importance of brushing and flossing to maintain a satisfactory level of oral health, embracing that message to various degrees.

What appears to be much less well known is that there can be tooth wear challenges posed by what one might call over-exuberant toothbrushing, in the form of abrasion.

Clinical signs that abrasion may be occurring include:

• Teeth may become less white as some of the outer surface is lost
• Front teeth may become sharp or chipped
• Chewing surfaces may wear flat and take on a shiny, pitted appearance.
• Restorations such as crowns and bridges may stand proud of the natural teeth.

 
An important preventive message to share with our patients, therefore, is the need for gentle but effective brushing. Experience has shown that many people mistake brushing hard for brushing well! It may also be appropriate for the dentist or hygienist to demonstrate the best brushing technique for the patient, and to recommend the use of a soft toothbrush and non-abrasive toothpaste.

If you would like help tackling this growing problem, The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

Earlier this year, a group of key opinion leaders published European Consensus guidelines on the management of severe tooth wear, focusing, in part, on the difference between physiological and pathological wear.1

As Loomans and colleagues (2017) wrote, it is important to be able to differentiate between these two types of tooth wear, since physiological surface loss is to be expected with age, while pathological describes ‘unacceptable levels of progressive wear’.1

To help dentists recognise which is which, the group merged the results of a number of studies into physiological tooth wear, revealing that over a time span of six decades the molars show the greatest level of wear (1740 μm), the mandibular incisors come next (1460 μm), then the maxillary incisors (1010 μm), and, lastly, the premolars (900 μm).1

For dental professionals, the signs that indicate pathological tooth wear may be occurring and preventive action is, therefore, needed include:

• Tooth sensitivity
• Discolouration, including yellowing and loss of shine (where some of the outer enamel layer has been lost)
• Sharp or chipped anterior teeth
• Occlusal surfaces wearing flat and taking on a shiny, pitted appearance
• Altered occlusion as vertical height changes
• Restorations standing proud of the teeth
• Abfraction lesions developing cervically
• V-shaped notches or shallower cupping present cervically

 

Reference

Loomans B et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent 2017; 19: 111-119

 

The Oral Health Foundation recently raised concerns about teenagers bruxing in their sleep, because it can be a sign of being bullied.

According to a recent study (Serra-Negra et al, 2017), 65% of adolescents who were subjected to verbal bullying in school suffered from sleep bruxism, compared to just 17% in those who were not.

It would seem imperative, therefore, that dentists raise awareness of this indicator with parents, as well as offering advice on how what preventive measures can be taken to minimise damage to the dentition, whilst other parties address the social issues of the problem, to help maintain and build self-esteem.

If a patient presents with pain and/or tooth wear that can be attributed to bruxism, a three-step treatment plan may be appropriate:
1. Prescription of short term muscle relaxants, particularly if an acute situation
2. Treatment with a physiotherapist or osteopath with specialist knowledge of the temporomandibular joint
3. Nightly use of a mouthguard, primarily of the Michigan Splint design

It may also be a good idea to ensure patients are brushing effectively but gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity where there is clear evidence of tooth wear, as well as suggesting they do something relaxing before bed such as reading or having a bath.

Reference
Serra-Negra J et al. Is there an association between verbal school bullying and possible sleep bruxism in adolescents? J Oral Rehabil. 2017; 44(5): 347-53

In anticipation of the first phase of the sugar tax, Professor Andrew Eder looks beyond the more commonly-associated topics of obesity and caries, and considers the effect of sugary drinks in terms of tooth surface loss.

Trends in relation to tooth surface loss, revealed by the most recent Adult Dental Health Survey (2009), suggest that erosion, abrasion and attrition are on the increase. Indeed, comparison between the 1998 and 2009 surveys reveal an increase of 10% in the incidence of tooth wear; when extrapolated, this is very concerning for the future.1

The good news is that some help is around the corner in the form of the so-called ‘sugar tax’, but it has predominantly been promoted as a tool in the fight against obesity and, to a lesser extent, caries. But in truth it also has a role to play in reducing the incidence of tooth wear, as the inherent acids have acidogenic potential, possibly resulting in erosion over time.

So, whilst this outcome is not directly linked to sugar, if the tax could be used as a tool to encourage patients to drink fewer carbonated beverages and high-sugar fruit juices, tooth surface loss beyond that expected as we age may be reduced, or even prevented.

Taking steps

It is anticipated that the tax on sugary beverages will come into being in April 2018,2 in form of a tiered tax on the drinks industry as follows:
• A high tax for drinks with >8 g of sugar per 100ml
• A moderate tax for 5g to 8g of sugar per 100ml
• No tax for <5g of sugar per 100ml.3

As Jeremy Rees, Professor of Restorative Dentistry at Cardiff University, told the British Dental Journal in 2015 regarding what was – at that time – a campaign to tax sugary drinks, ‘I believe that would be a step in the right direction because the average consumption of carbonated drinks in the UK (particularly for young people in their twenties and younger) is half a litre a day per person.’4

Responding to a question about what milestone he would like to see in preventive dentistry, he responded: ‘I think it’s making people more aware of the issues relating to acid erosion.’4

This is the key; educating patients about tooth surface loss. The public has been told repeatedly about the detrimental effect of sugar consumption on their oral health, and many have responded to this call to action by switching to sugar-free carbonated drinks and fruit juices. They genuinely think this is a healthy move, and, of course, in some ways it is.

Undeniably, telling a patient that they are suffering from tooth wear can come as something of a shock, especially for those in their 20s, 30s and 40s who are well educated and try to live a healthy lifestyle.

Whatever their age and status, patients need to be made aware that ill-considered drink choices can cause damage to the enamel and dentine. If you would like support in doing this, The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

References
1. Adult Dental Health Survey 2009. Health and Social Care Information Centre 2011
2. https://www.gov.uk/government/news/soft-drinks-industry-levy-12-things-you-should-know. Accessed 1 June 2017
3. Briggs ADM et al. Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study. The Lancet Public Health 2017; 2(1): e15–e22
4. Rees J. ‘We ned to make people more aware of the issues relating to acid erosion.’ BDJ 2015; 219(4): 157-158

Did you know that missing teeth can contribute to excessive tooth wear of your remaining teeth?

So, not only might you be upset by the unsightliness of such a gap or gaps where teeth have been lost, you may also experience tooth sensitivity, as well as problems chewing. Your teeth may also begin to look shorter on smiling or when speaking. In addition:
• Teeth may become less white as some of the outer enamel surface is lost
• Front teeth may become sharp or chipped
• Chewing surfaces may wear flat and take on a shiny, pitted appearance.
• Restorations such as crowns and bridges may stand proud of the natural teeth.

One possible solution is that of dental implants, a permanent method of replacing missing teeth by inserting an artificial root – an implant – into the jaw to then support a new tooth on top. The issue is a simple one to understand; if you have a gap or gaps in your mouth where a tooth or teeth used to be, there is a possibility that the remaining teeth will come into greater contact than they would have before, when there was that extra ‘barrier’ in place.

If you want to know more about your personal suitability for dental implants, I would be delighted to offer advice if your own dentist is unable to assist and, in the meantime, I am happy to offer some further insight on tooth wear itself, because, as the adage goes, prevention is better than cure.

The good news is that there are some simple steps we can all incorporate into our everyday lives to reduce the risks, such as:
• Drinking still water or low-fat milk between meals
• Limiting fruit juice to once per day and avoiding fizzy drinks
• Rinsing the mouth with water for 15 to 30 seconds after consuming acidic foods or drinks
• Chewing sugar free gum or eating a piece of cheese after consuming acidic food or drink
• Waiting at least an hour to brush teeth after consuming any acidic foods or drinks
• Using toothpaste that contains fluoride but is low in abrasivity, with a relatively soft toothbrush.
• Using a fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after acidic foods and drinks, to help limit the erosive potential.

If you are suffering from excessive tooth wear and no preventive action is taken, somewhere down the road you will be facing the possibility of extensive and expensive restorative treatment. You may think you are not affected by tooth wear but there is no doubt that it is on the increase; over three-quarters of adults and at least half of children show signs of tooth surface loss.

We are ideally placed to offer you tailored advice on dental implants and tooth wear. Please contact the London Tooth Wear Centre® which offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

Professor Andrew Eder explores a handful of the most recently published research related to tooth wear, to help dental professionals stay ahead of this growing challenge being faced in everyday practice.

With the challenges posed by pathological tooth wear poised to affect many of our patients’ oral health if not addressed promptly, it is incumbent upon dental professionals to gather as much information as possible to help them take preventive steps before the problem becomes so bad that only restorative treatment offers an answer to their discomfort and aesthetic issues.

There is a growing body of evidence exploring the signs, symptoms and implications of tooth wear beyond that which we would expect as we age, ranging from exploration of the accuracy of various methods for assessing erosion to using CAD/CAM technology to monitor tooth wear in a clinical setting.

Physiological versus pathological

Loomans and colleagues (2017) recently published European expert consensus guidelines on the management of severe tooth wear, focusing on defining the difference between physiological and pathological damage, as well as recommending, ‘[…] diagnosis, prevention, counselling,
and monitoring aimed at elucidating the aetiology, nature, rate and means of controlling pathological tooth wear.’1

In terms of physiological tooth wear, one suggested scale is that a loss of around 15 μm per year for premolars and 29 μm per year for molars is ‘typical’, although others offer alternative indicators so it is important to consider a cross-section of the proposed measurements.1

The panel offered the following definition for pathological tooth wear: ‘Tooth wear which is atypical for the age of the patient, causing pain or discomfort, functional problems, or deterioration of aesthetic appearance, which, if it progresses, may give rise to undesirable complications of increasing complexity.’1

They also created a separate definition for ‘severe tooth wear’, relating to the level of tooth surface lost: ‘Tooth wear with substantial loss of tooth structure, with dentine exposure and significant loss (≥ 1/3) of the clinical crown.’1

The following guidelines were issued for the treatment of patients with severe tooth wear:
• ‘Priority should be given to the diagnosis of the aetiology of the wear and instigating appropriate preventive measures
• ‘Patients with moderate or severe tooth wear but without (functional or aesthetical) complaints should be advised to monitor the situation first to determine whether the tooth wear is progressive or not
• ‘Restorative treatment should be as conservative as possible, employing minimally invasive treatment strategies according to a dynamic restorative treatment concept
• ‘Direct and indirect minimally invasive techniques can be employed using adhesive materials. Traditional, invasive restorations remain an option in selected cases and under certain circumstances
• ‘Explanation of the possible treatment options and expected complications should be included in the informed consent.’1

Assessing erosive tooth wear

In 2016, Bliggenstorfer and Lussi reported on the accuracy of different methods for assessing erosive tooth wear, having acknowledged limitations in detection using the naked eye alone.2

They wrote: ‘[…] the aim of this study was to investigate if the accuracy of assessing exposed dentine by the naked eye could be improved by using a microscope, dyeing, or a combination of both. The collected data were compared with the assessment of histological sections, which was considered the gold standard.’2

Following assessment 4 times by 17 examiners of a total of 70 teeth demonstrating various levels of erosion, they concluded: ‘[…] the differentiation between enamel and exposed dentine of erosive tooth lesions was best performed using microscope magnification alone. The use of a dyeing agent alone provided no improvement in the visual assessment of the measured parameters. Even the combination of microscope magnification and dyeing did not show any further improvement compared with the microscope magnification alone. Therefore, the usage of an additional dye is superfluous for the detection of exposed dentine in teeth showing erosive tooth wear.’2

CAD/CAM assessment

Ahmed and colleagues (2017) wrote about the clinical monitoring of tooth wear over a period of one year using CAD/CAM technology. Given the idea that current tooth wear indices offer only a subjective way of evaluating tooth surface loss, the authors of this study sought to assess CAD/CAM scanning as an objective assessment tool.3

They found: ‘[…] all patients presented anterior tooth wear ≥ 140 μm in depth. The most commonly and severely affected teeth were the maxillary central incisors. The clinical feasibility and applicability of the developed CAD/CAM methodology in monitoring tooth wear was demonstrated.’3

As the researchers admitted themselves, this study involved a small sample size, so the ability of statistical analysis was limited, and it would seem prudent, given the results, that further research is undertaken in the area in order to achieve more robust outcomes.3

Dentine hypersensitivity

Dental Update published guidelines for general dental practice, offering a new perspective on tooth sensitivity (Gillam A, 2017).

It was written: ‘[…] several investigators have suggested that DH [dentine hypersensitivity] may be a tooth-wear phenomenon characterized predominantly by erosion, which may subsequently expose the dentine surface and initiate the tooth wear lesions.’4

The guidelines continue: ‘[…] the treatment for tooth wear and DH may be more complex in restoring lost enamel and dentine than patients with DH associated with a well maintained dentition with relatively little tooth surface loss.’4

Offering overall management strategies for tooth sensitivity caused by tooth wear, in terms of clinical evaluation, Gillam (2017) suggests:
• ‘Identify cause of tooth wear (enamel loss)
• ‘Record severity of lesions, if possible, using a recognised index
• ‘Take study casts and clinical photographs to monitor condition over time
• ‘Check and monitor periodontal health.
• ‘Use of pain scores to assess and monitor DH (e.g., Visual Analogue Scores).’4

In relation to patient education and offering preventive advice:
• ‘Show patient the site(s) and explain probable cause of the tooth wear lesion(s)
• ‘Recommend an oral hygiene regimen to minimise risk of further tooth wear.
• ‘Where appropriate recommend reducing frequency of consumption of acidic food & drink.’4

Meanwhile, corrective treatment may involve:
• Provide high fluoride remineralising treatment (pre-emptive phase)
• ‘Provide professional desensitising treatment to relieve DH
• ‘Encourage patient to seek advice from medical practitioner, if tooth wear caused by working environment or reflux/excessive vomiting (Psychiatric evaluation may also be appropriate)
• ‘Restorative correction in the form of composite build up, crowns may also be appropriate.’4

The timing of acid intake

O’Toole and colleagues (2017) investigated the extent to which the timing of consuming acidic foods and drinks may affects erosive tooth wear, given that, as yet, there is no clinical threshold of what may be considered ‘safe’.5

Following completion of this single-centre, frequency-matched, case-control study, the authors offered the following summary: ‘In this large cohort of hospital-based patients, the predominant risk factors in the development of severe erosive tooth wear in this study were acid intake between meals, an alternate drinking method such as sipping, swishing or holding acidic drinks in the mouth prior to swallowing and eating fruit over an extended time period. Brushing after meals was not associated with erosive tooth wear suggesting universal preventive advice to delay brushing after meals is not substantiated.’5

Building on our knowledge

As with all areas of dentistry in the ever-changing and developing 21st century, new evidence, materials and methods are continuously coming to light and it is so important for us as dental professionals to remain up to date, if we are to succeed in safeguarding our patients from the potentially devastating effects of pathological tooth wear looming ahead in the not too distant future.

References

1. Loomans B et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent 2017; 19: 111–119
2. Bliggenstorfer SE, Lussi A. Accuracy of different methods for assessing erosive tooth wear. JDR Clinical & Translational Research 2016; 1(3): 218-225
3. Ahmed K et al. Clinical monitoring of tooth wear progression in patients over a period of one year using CAD/CAM technology. The International Journal of Prosthodontics 2016; 30(2): 153-155
4. Gillam A. A new perspective on dentine hypersensitivity – guidelines for general dental practice. Dental Update 2017; 44(1): 33-42
5. O’Toole S et al. Timing of dietary acid intake and erosive tooth wear: A case-control study. Journal of Dentistry 2017; 56: 99-104

Many people would be surprised to learn that being stressed out may be affecting not only the health of their teeth but also how they look.

A type of tooth wear, known as ‘attrition’, involves contact between the teeth over and above normal use, as seen in patients who generally grind and clench their teeth at night (also known as bruxing), that has been linked to a stressful lifestyle.

To add insult to injury, when patients suffer from sensitivity as a result of tooth wear, how they react has the potential to make matters worse. For example, sufferers may avoid toothbrushing and flossing, plus make poor food and drink choices, in an attempt to avoid the pain these everyday tasks can cause.

Statistics gathered by the NHS suggest that over three-quarters of adults (permanent teeth) and more than half of children (primary teeth) are suffering from some type of tooth wear and, if we continue as we are, this is set to get worse.

 

Signs and symptoms

Those who do suffer from such grinding and/or clenching activity may experience tooth sensitivity, problems chewing, headaches and neck ache. If a dentist examined a bruxer’s mouth, they might find teeth that are:

• Sharp or chipped
• Broken
• Shortened
• Loose
• Wearing flat, and looking shiny and pitted

 

The dentist can help

Dentists are there to help, and will be able to make a diagnosis of attrition, provide preventive advice and care, or refer the sufferer on, if appropriate.

Possible treatment options include prescribing muscle relaxants, fabricating a suitable mouthguard to be worn at night to relieve pressure on the jaw, or recommending care from a physiotherapist or osteopath with specialist knowledge of the muscles involved.

If there was one piece of advice above all others I would offer, it would be this – don’t delay in seeking help. If damage resulting from tooth wear is diagnosed and addressed in its early stages, tooth grinders can avoid the extensive and expensive dental treatment that would otherwise be necessary to correct the situation.

 

Making changes

The good news is that making a few simple lifestyle changes can be a big help, such as:

• Doing something relaxing before bed, such as yoga, reading or having a bath
• Learning to brush effectively yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity (dentists can offer advice on this).

 
In addition, if someone is suffering from tooth sensitivity (which should be diagnosed by a dentist to ensure there is no underlying condition that needs treatment), using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste can also be helpful in alleviating the pain caused by sensitivity.

Read the recent article on Toothbrushing below as published on Dental Supplies Magazine

“In this article, Professor Andrew Eder considers the damage that can be caused to the teeth if patients are too heavy-handed with their toothbrushing, as well as exploring other potential causes of abrasion and offering preventive advice to be passed on to patients.

The Oxford Dictionary of Dentistry defines ‘abrasion’ as: ‘The non-bacterial loss of tooth tissue due to frictional tooth wear by extrinsic agents. Common causes are toothbrushing, particularly with abrasive pastes, pipe smoking, and pencil chewing. The lesions produced by toothbrush abrasion are typically wedge-shaped and are most commonly associated with the labial and buccal surfaces of the premolars, canines, and incisors of the permanent dentition.’

These are not the only cause of abrasion – you can add to the list a diet rough in texture or using the teeth for a purpose other than nature intended, such as biting tags off new purchases, or cleaning between the teeth with tools not created for that purpose, for instance earring posts, keys and credit cards!

A patient suffering from tooth wear may report sensitivity, as well as problems chewing. Their teeth may also look shorter on smiling or when speaking. In addition:

• Teeth may become less white as some of the outer surface is lost

• Front teeth may become sharp or chipped

• Chewing surfaces may wear flat and take on a shiny, pitted appearance.

• Restorations such as crowns and bridges may stand proud of the natural teeth.

Patient awareness and education

Raising awareness and educating our patients about the potential for abrasive tooth wear is essential if we are to prevent further damage. Thus, for example, an important message to share is the importance of gentle but effective brushing – in my experience, many people mistake brushing hard for brushing well! It may be appropriate for the dentist or hygienist to demonstrate the best technique for the patient, and to recommend the use of a soft toothbrush and non-abrasive toothpaste.

Meanwhile, as already mentioned, foods with a rough texture will make matters worse, so it is worth having a discussion with patients about their diet. As a rule of thumb to share with them, if it’s tough to chew and/or fibrous, it may well be abrasive. Some of the more commonly consumed foods that can contribute to abrasion include celery, carrots, broccoli, apples, seeds and nuts.

It is also very important to make sure patients understand their teeth are not a handy tool, for example to tear labels off newly bought items or to rip open packets of sweets when their hands fail them! In addition, many people chew foreign objects such as pens and pencils, very often without realising. If a discussion with your patient brings such an issue to the fore, it might be worth suggesting they coat their chew-item of choice with a bitter-tasting solution designed for nail biters.

The reality of wear

As Wiegand and Schlueter (2014) wrote: ‘Although toothbrushing is considered a prerequisite for maintaining good oral health, it also has the potential to have an impact on tooth wear, particularly with regard to dental erosion. Experimental studies have demonstrated that tooth abrasion can be influenced by a number of factors, including not only the physical properties of the toothpaste and toothbrush used but also patient-related factors such as toothbrushing frequency and force of brushing. While abrasion resulting from routine oral hygiene can be considered as physiological wear over time, intensive brushing might further harm eroded surfaces by removing the demineralised enamel surface layer.’

Added to this, there is no doubt that tooth wear is on the increase; over three-quarters of adults show signs of tooth wear. Comparing the most recent Adult Dental Health Survey (ADHS) with its predecessor, figures suggest that in just 11 years the incidence of tooth wear in England has increased by 10%.

Our awareness of these issues – combined with proactive patient care – is key to helping the UK population achieve dental longevity, as well as keeping them pain-free. In addition, while this article has focused on abrasion, it is important to note that tooth wear is multi-factorial and should not be considered in isolation – abrasion, erosion, attrition and abfraction are rarely seen in isolation (if ever), and may affect people from all walks of life at any age.

The stark truth is that if patients remain unaware and uneducated about the potential for tooth damage through tooth wear, patients will continue with their destructive habits, which will have serious implications for their oral health in years to come.”

Professor Andrew Eder explores the significance of continuing education in relation to tooth wear to build on undergraduate knowledge, in order to meet the growing needs of patients suffering from pathological surface loss. The article was published in issue 42 of Dental Supplies Magazine below:

Read the full article below:

Professor Andrew Eder explores the significance of continuing education in relation to tooth wear to build on undergraduate knowledge, in order to meet the growing needs of patients suffering from pathological surface loss.

Professor Andrew Eder is a Specialist in Restorative Dentistry and Prosthodontics and Clinical Director of the London Tooth Wear Centre®, a specialist referral practice in central London. He is also Professor/ Honorary Consultant at the UCL Eastman Dental Institute and Pro-Vice-Provost and Director of Life Learning at UCL.

We’ve all been there. After five years of hard work (and some fun), there’s little to match the sense of achievement when you receive word that you’ve passed your final examinations and are ready to be let loose on the world, to contribute to the improvement of the nation’s oral health. For most of us, the next step came in the form of dental foundation training (DFT) and vocational training (VT) (or the equivalent at the time of your graduation), which is a steep learning curve to says the least!

It is at this point that reality of our patients’ needs really hit home and, whilst we all learned so much as undergraduates, there is still more to knowledge to absorb and apply in practice if we are truly to meet our career goals.

For me that, in part, came in the form of specialisation in restorative dentistry and prosthodontics, with a particular interest in tooth wear. You may ask – why? Because over the years, I have noticed an increase in tooth wear beyond that which would be expected in relation to my patients’ ages, and it’s something that needs to be addressed not only because it causes pain and an unsightly dentition, but also because the NHS can in no way can afford to meet the growing needs of these patients if left unchecked – with restorative treatment both extensive and expensive.

The facts and figures

Recognising that tooth wear has the potential to be a serious issue, its incidence and significance was recorded in the Adult Dental Health Survey (ADHS) for the first time in 1998, and repeated in the 2009 edition. In each, tooth wear was assessed at three stages:

1. Any wear
2. Moderate wear – wear that has exposed a large area of dentine on any surface
3. Severe wear – wear resulting in exposed pulp or secondary dentine.

Comparison of the two surveys shows that in just 11 years the incidence of tooth wear in England increased by 15% in those aged 16 to 24, 10% in the 25 to 34 cohort, and 13% between the ages of 35 and 44.

The trends identified in the last two surveys strongly suggest that those in the younger age groups need preventive treatment beyond what is generally already being offered if their dental health is to be secured over the long term.

This idea was further reinforced by the results of the 2013 Children’s Dental Health Survey, which indicated that just over a quarter of children in the UK aged 12 have tooth wear on their molars and on the buccal surfaces of their incisors. What’s more, by 15, 31% of children had tooth wear on the occlusal surfaces of molars (compared to 25% at 12 years old).

What needs to be done?

As a group of professionals dedicated to caring for our patients, clearly the increasing relevance of tooth wear does need to be addressed – preferably in its earliest stages. To be successful, preventive care and the ability to communicate effectively with patients – so that they can understand their responsibilities and be motivated to meet them – are essential.

For dental professionals, the key is to build on our undergraduate knowledge, not only to understand fully the care and treatment that these types of patients need, but also to be able to overcome any psychosocial impediments to patients acting on their own behalf to improve the situation.

There are online resources – both paid for and free of charge – such as GSK’s distance learner module on tooth wear and the Basic Erosive Wear Examination (BEWE), offering a valuable foundation.

To build upon this, check out what NHS Health Education England has to offer in your area. As just one example, Kent, Surrey
and Sussex offers a module entitled ‘BDA Clinical Management of Pathological Tooth Wear in General Dental Practice’, offering delegates the opportunity to ‘…attain a better understanding of tooth wear and will learn strategies to achieve a conservative solution avoiding further loss of healthy tooth structure in order to achieve a functional and predictable outcome.’

Also invaluable are hands-on courses, some privately run and others catered for by some NHS Health Education England providers, including HEKSS, with its day long event looking at the restoration of teeth worn down due to various types of erosion and attrition, using a range of techniques applicable to general practice. Not only that, but the psychology of care is also addressed, alongside record keeping, teamwork and when to refer.

Professor Andrew Eder explores the current situation regarding tooth wear in the UK in a recent interview with Private Dentistry. Andrew discusses the rise in tooth wear, its potential causes and offers advice to dentists dealing with patients who present with tooth wear.

Read the full interview with Professor Andrew Eder below:

Speaking exclusively to Private Dentistry, Professor Andrew Eder explores the current situation regarding tooth wear in the UK.

PD: In your view, what do the Adult and Children’s Dental Surveys indicate in terms of the situation regarding tooth wear in the UK?

Andrew Eder: In very broad terms, it’s two fold. If you look at the last two surveys, with 10 years between, they essentially demonstrate that tooth wear is on the increase in both adults and children.
Conversely, when considering tooth wear alongside tooth decay and gum disease, these have not shown the same increase and, in some cases, have even decreased.

PD: In real terms, what are you seeing in practice in relation to tooth wear?

AE: There are two elements of greatest concern to me at the moment. One is older patients who are living longer, and keeping their teeth for longer, but who are having problems with tooth wear. Some of their teeth are sharp, others are crumbling, fillings are falling out, and the dentition isn’t as effective as it used to be. Managing those sorts of problems is quite challenging. I’m also seeing younger patients with a lot of enamel loss due to attrition or erosion; the latter due mainly to the consumption of carbonated drinks and alcohol, as well as stomach acid regurgitation in patients with eating disorders.

PD: Is there anything about the pattern of tooth wear in the UK that surprises you?

AE: There is an issue that I’m keen to look into, so I don’t have all the answers yet. Some reports have suggested that thereis less erosive tooth wear in the US than in the UK. There is a suggestion that people in the US prefer their soft drinks much colder than we do in the in UK, normally putting ice in drinks or having them straight out of the fridge. When you do that, it may have a positive effect on the pH, in that it becomes less acidic. It’s early days on this but something that I’m keen to explore to see how we might be able to influence the potentially damaging effects of acidic drinks.

PD: Are you seeing anything new in practice that dentists might not yet be very aware about when it comes to tooth wear?

AE: One thing that I’m seeing more of in recent years is tooth wear related to recreational drug use. That’s most definitely something I’d like to make people more aware of. You’ll often see unusual patterns of tooth wear, particularly attrition as a result of grinding and clenching, because users may hold their mouth and face in what appears to be a very strained position. Finger application of drugs can also cause significant ulceration of the soft tissues.
If an unusual case of tooth wear presents, colleagues should explore all options, and a frank and open discussion with the patient may be required. However, if they are under the age of consent sometimes it can be more tricky. There is obviously preventive advice to share regarding drug use, but if there is tooth grinding then a mouthguard may be helpful although compliance is questionable.
Involving other healthcare providers where appropriate will also be critical to provide comprehensive assistance.

PD: In general terms, what can dentists do to help their patients prevent further wear damage going forward?

AE: The most important elements are the professional awareness and the ability to diagnose the various types of tooth wear based on the presentation. It isn’t uncommon for me to see a patient referred for an opinion and, on examination, it is clear that they present with a high level of tooth wear and yet no-one at their dental practice has mentioned this previously.
Early diagnosis is key because the sooner you diagnose any tooth wear, the sooner you can offer preventive advice and limit further progression. Also, at this point and where appropriate, patients can often be provided with simple, adhesively retained restorations to protect areas of tooth wear without further removal of otherwise healthy enamel or dentine.
Building on this approach, we – the profession – need to encourage and foster a conservative approach to management.

PD: What might the future hold for people susceptible to tooth wear if this challenge is not addressed appropriately and quickly?

AE: If tooth wear is not managed at the most optimal time and allowed to deteriorate, we may be limited in the treatment options available to help these patients. As a result, this might impact negatively on the quality of life experienced by, particularly, our older patients. If the wear progresses deep into the tooth, then patients can suffer from sensitivity and pain leading, possibly, to root canal problems and even tooth loss. In summary, we must do everything possible to avoid reaching the point where only extensive and complex treatment at one end or extractions at the other remain as viable options. Looking to a healthier future, it’s all about professional awareness, patient education, tackling the challenges of erosion in the young, and addressing wear and tear in the elderly.
It’s certainly an area in which the dental profession can make a big difference, and the sooner the better.

Professor Andrew Eder explores the effects of eating disorder bulimia on oral health, most specifically in terms of erosion as a result of self-induced vomiting, and how patients may be helped.

The piece as featured in Dental Nursing is shown below:

Read the article here:

With The Costs of Eating Disorders – Social, Health and Economic Impacts report estimating that more than 725,000 people in the UK are affected by an eating disorder, there is a very good chance that more than a few of your patients may need help in this area. The eating disorder that tends to have the greatest effect on oral health is bulimia nervosa, which involves the sufferer caught in a cycle of eating large quantities of food and then vomiting (known as purging), in order to prevent weight gain. This can result in severe damage to the teeth in the form of erosion, so it is certainly something that we, as dental care profesisonals, should be keeping an eye out for. Indeed, the extended periods of intentional vomiting suffered by bulimics can have considerable impact on the dentition and result in substantial oral health complications, including:

– The teeth can become rounded, smooth and shiny and lose their surface characteristics
– Incisal edges appear translucent
– Cupping forms in the dentine
– Cervical lesions are shallow and rounded
– Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

Advice is the first step

This can, of course, be a challenging issue to raise with a patient, as shame and denial are common features of an eating disorder. To
try to overcome such barriers, it is essential we do our very best to make the patient feel comfortable and not intimidated. Assure
them you have time to talk things through and ask questions in a non-judgemental way aimed at encouraging the patient to identify the origin of their oral health problems. One way that can help in this endeavour is to share your examination findings with the patient and explain how their symptoms may be linked. Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general guidance on how to reduce the effect of acidic food and drinks should be
given, such as:

– Drinking water or low fat milk in preference to other liquids
– Using a straw positioned toward the back of the mouth when drinking acidic beverages
– Avoiding swishing acidic drinks around the mouth
– Rinsing the mouth with water or fluoridated mouthwash after consuming acidic foodstuffs.

In addition, oral health advice for a patient whose dentition is compromised by bulimia includes:

– Issuing a fluoride rinse or gel and prescribing a highly-fluoridated toothpaste and a soft toothbrush for daily use
– Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.

Extra protection can be provided via calcium and phosphate ions, such as those found in GC Tooth Mousse, helping to restore the mineral balance, neutralise acidic challenges and stimulate saliva flow.

Extra protection

It will come as no surprise that patients with bulimia can find it extremely hard to overcome the disorder, which may mean that, ultimately, preventive oral care may not be enough to save the dentition. In such a situation, action beyond preventive advice alone may need to be taken to protect the remaining tooth structure. This may include the direct application of composite resin if at least an enamel halo exists or glass ionomer to sensitive areas, an occlusal guard to protect the teeth during purging, and an alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling. Such mouthguards should not be worn
for prolonged periods without any such protective gels and when acids are present in the mouth to avoid these acids being held in direct contact with the teeth. Once any treatment has been completed, it is imperative that the patient attends for very regular check-ups so that the rate of wear can be monitored, further guidance provided, adjustments to lifestyle made, and motivation provided. As an aside, if you believe from a patient or their dentition that they may be bulimic, it may be prudent (with the patient’s permission) to make contact with their GP or other healthcare professional overseeing their care before beginning any course of treatment, as a team approach will normally help facilitate a course of action that will offer the best possible outcomes in the given circumstances.

Professor Andrew Eder explores the effect of bulimia on the dentition during Eating Disorders Awareness Week.

The piece as featured in the British Dental Journal outlines the impact bulimia has on dentition and oral health as well as suggest advice to offer patients on prevention and protection.

Read the full article below:

The Effect of Bulimia on the Dentition

During this year’s Eating Disorders Awareness Week, Andrew Eder explores the effects of bulimia on oral health, most specifically in terms of erosion as a result of self-induced vomiting, and how patients may be helped.

Eating Disorders Awareness Week took place between 27 February and 5 March 2017, focusing, in part, on early intervention. A leading charity in this area, BEAT (www.b-eat.co.uk) is looking to educate both healthcare professionals and the wider public about eating disorders, so that they are equipped to help if a patient or someone they know may be suffering.

Dental professionals are no exception, and with ‘The Costs of Eating Disorders – Social, Health and Economic Impacts’ report estimating that more than 725,000 people in the UK are affected by an eating disorder, there is a very good chance that more than a few of your patients may need help in this area.

The eating disorder that tends to have the greatest effect on oral health is bulimia nervosa, which involves the sufferer caught in a cycle of eating large quantities of food and then vomiting (known as purging), in order to prevent weight gain. This can result in severe damage to the teeth in the form of erosion, so it is certainly something that we, as dental professionals, should be keeping an eye out for. Indeed, the extended periods of intentional vomiting suffered by bulimics can have considerable impact on the dentition and result in substantial oral health complications, including:

– The teeth can become rounded, smooth and shiny and lose their surface characteristics
– Incisal edges appear translucent
– Cupping forms in the dentine
– Cervical lesions are shallow and rounded
– Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

Advice is the first step

This can, of course, be a challenging issue to raise with a patient, as shame and denial are common features of an eating disorder. To try and overcome such barriers, it is essential that we do our very best to make the patient feel comfortable and not intimidated. Assure them you have time to talk things through and ask questions in a non-judgemental way aimed at encouraging the patient to identify the origin of their oral health problems. One way that can help in this endeavour is to share your examination findings with the patient and explain how their symptoms may be linked.

Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general guidance on how to reduce the effect of acidic food and drinks should be given, such as:

– Drinking water or low fat milk in preference to other liquids
– Using a straw positioned toward the back of the mouth when drinking acidic beverages
– Avoiding swishing acidic drinks around the mouth
– Rinsing the mouth with water or fluoridated mouthwash after consuming acidic foodstuffs.

In addition, oral health advice for a patient whose dentition is compromised by bulimia includes:

– Issuing a fluoride rinse or gel and prescribing a highly-fluoridated toothpaste and a soft toothbrush for daily use
– Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.

Extra protection can be provided via calcium and phosphate ions, such as those found in GC Tooth Mousse, helping to restore the mineral balance, neutralise acidic challenges and stimulate salivary flow.

Extra protection

It will come as no surprise to dental professionals that patients with bulimia can find it extremely hard to overcome the disorder, which may mean that, ultimately, preventive oral care may not be enough to save the dentition.
In such a situation, action beyond preventive advice alone may need to be taken to protect the remaining tooth structure. This may include the direct application of composite resin if at least an enamel halo exists or glass ionomer to sensitive areas, an occlusal guard to protect the teeth during purging, and an alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling.

Such mouthguards should not be worn for prolonged periods without any such protective gels and when acids are present in the mouth to avoid these acids being held in direct contact with the teeth. Once any treatment has been completed, it is imperative that the patient attends for very regular check-ups so that the rate of wear can be monitored, further guidance provided, adjustments to lifestyle made, and motivation provided.

As an aside, if you believe from a patient or their dentition that they may be bulimic, it may be prudent (with the patient’s permission) to make contact with their GP or other healthcare professional overseeing their care before beginning any course of treatment, as a team approach will normally help facilitate a course of action that will offer the best possible outcomes in the given
circumstances.

Professor Andrew Eder explores the current situation regarding tooth wear in the UK. Read below as featured in Private Dentistry:

This month Professor Andrew Eder’s article ‘Key to wearing well whatever your age’ features in The Jewish Chronicle. The piece looks at how Tooth Wear is increasingly affecting people of all ages, the affect it has on our teeth, it’s causes and what can be done limit tooth wear.

Read the full article below:

Tooth Wear is no respecter of age; in fact, it is increasing across the UK among both the young and the old. But why does it matter? After all, it is a natural part of ageing. True — but lifestyle can accelerate and exacerbate this process. The result may be tooth sensitivity and an unsightly smile due to teeth becoming short and unattractive, while rough tooth edges can harm the lips, tongue and inside of the cheeks.

More than three-quarters of adults and more than half of children show signs of tooth wear. What is more, sadly, 35 per cent of 12-year-olds and 28 per cent of 15-yearolds are too embarrassed to smile or laugh due to the condition of their teeth.
Without doubt, tooth wear has the potential to affect a person’s self-esteem for life. And that is not something any of us want for ourselves or for our children. What can be done to minimise and prevent tooth wear that might otherwise require expensive and extensive dental treatment further down the line?

Particularly common among children and young adults, tooth erosion is caused by consuming acidic foods and drinks; the acid attacks the outer surface of the teeth. Culprits include fruit juices, smoothies, sports beverages and fizzy drinks (including sugar-free). Where possible, drink still water or low-fat milk between meals, limit fruit juice to once per day and avoid fizzy drinks.

Another significant cause of tooth erosion is bulimia nervosa, which involves eating large quantities of food and then deliberately vomiting, bringing up stomach acid that can damage the teeth.

Young women, particularly those aged 12 to 20, are the most likely to develop an eating disorder but older women and men of all ages can also have an eating disorder.

Where acid is damaging teeth, you can use these preventative measures following consumption of something acidic or an episode of vomiting:

– Rinse the mouth with water for 15 to 30 seconds.
– Chew sugar-free gum or eat a piece of cheese.
– Wait at least an hour to brush teeth.
– Use a toothpaste that contains at least 1,400ppm fluoride and a non abrasive toothbrush.
– Use a fluoridated mouthwash every day at a different time from tooth brushing, as well as before or after an acidic event

In addition, if wear is linked to tooth grinding brought on by stress, it may help to do something relaxing before bed, such as yoga, reading or having a bath. In addition, if you are worried that you may be brushing your teeth too hard — which can also lead to tooth wear — ask your dentist or hygienist to demonstrate how to brush your teeth without being too vigorous and perhaps use a softer toothbrush and a minimally abrasive toothpaste. If you have any concerns about your oral health, or that of your children, call your dental practice without delay. Do not suffer in silence; dentists and hygienists are here to help.

Professor Andrew Eder comments on the increase in Tooth Wear across the young and old. Read below as featured in the Jewish Chronicle:

This month Professor Andrew Eder features in Dental Practice Magazine with his article ‘Facing the Future of Tooth Wear’. The piece looks at what we mean by Tooth Wear and its increasing occurrence among both adults and children. He also discusses the signs and symptoms and considers the future of tooth wear and its prevention.

Read the full article below:

Read the recent blog post on Eating Disorders Awareness Week below as published on the British Society of Dental Hygiene and Therapy website:

“Eating Disorders Awareness Week will take place between 27th February and 5th March 2017, focusing, in part, on early intervention. A leading charity in this area, BEAT (www.b-eat.co.uk) is looking to educate both healthcare professionals and the wider public about eating disorders, so that they are equipped to help if a patient or someone they know may be suffering.

Dental professionals are no exception, and with The Costs of Eating Disorders – Social, Health and Economic Impacts report estimating that more than 725,000 people in the UK are affected by an eating disorder, there is a very good chance that more than a few of your patients may need help in this area.

The eating disorder that tends to have the greatest effect on oral health is bulimia nervosa, which involves the sufferer caught in a cycle of eating large quantities of food and then vomiting (known as purging), in order to prevent weight gain. This can result in severe damage to the teeth in the form of erosion, so it is certainly something that we, as dental care professionals, should be keeping an eye out for.

Indeed, the extended periods of intentional vomiting suffered by bulimics can have considerable impact on the dentition and result in substantial oral health complications, including:
– The teeth can become rounded, smooth and shiny and lose their surface characteristics;
– Incisal edges appear translucent;
– Cupping forms in the dentine;
– Cervical lesions are shallow and rounded;
– Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

ADVICE IS THE FIRST STEP

This can, of course, be a challenging issue to raise with a patient, as shame and denial are common features of an eating disorder. To try and overcome such barriers, it is essential that we do our very best to make the patient feel comfortable and not intimidated. Assure them you have time to talk things through and ask questions in a non-judgmental way aimed at encouraging the patient to identify the origin of their oral health problems. One way that can help in this endeavour is to share your examination findings with the patient and explain how their symptoms may be linked.

Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general guidance on how to reduce the effect of acidic food and drinks should be given, such as:
– Drinking water or low fat milk in preference to other liquids;
– Using a straw positioned toward the back of the mouth when drinking acidic beverages;
– Avoiding swishing acidic drinks around the mouth;
– Rinsing the mouth with water or fluoridated mouthwash after consuming acidic foodstuffs.

In addition, oral health advice for a patient whose dentition is compromised by bulimia includes:
– Issuing a fluoride rinse or gel and prescribing a highly-fluoridated toothpaste and a soft toothbrush for daily use;
– Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.

EXTRA PROTECTION

It will come as no surprise to dental professionals that patients with bulimia can find it extremely hard to overcome the disorder, which may mean that, ultimately, preventive oral care may not be enough to save the dentition.

In such a situation, action beyond preventive advice alone may need to be taken to protect the remaining tooth structure. This may include the direct application of composite resin if at least an enamel halo exists or glass ionomer to sensitive areas, an occlusal guard to protect the teeth during purging, and an alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling. Such mouthguards should not be worn for prolonged periods without any such protective gels and when acids are present in the mouth to avoid these acids being held in direct contact with the teeth.

Once any treatment has been completed, it is imperative that the patient attends for very regular check-ups so that the rate of wear can be monitored, further guidance provided, adjustments to lifestyle made, and motivation provided.

As an aside, if you believe from a patient or their dentition that they may be bulimic, it may be prudent (with the patient’s permission) to make contact with their GP or other healthcare professional overseeing their care before beginning any course of treatment, as a team approach will normally help facilitate a course of action that will offer the best possible outcomes in the given circumstances.

Pathological Tooth Wear (also known as tooth surface loss) is on the increase, as indicated by the most recent Adult and Children’s Dental Health Surveys.

Recognising that tooth wear has the potential to be a serious issue in the UK in the future if preventative action is not fully embraced, its incidence and significance was recorded in the Adult Dental Survey (ADHS) for the first time in 1998, and this exercise was repeated in the latest offering. Comparison of the two surveys shows that in just 11 years the incidence of pathological tooth wear in England has increased by 10%.
As for the Children’s Dental Health Survey, it tells us, for example, that 33% of five-year-olds demonstrated tooth surface loss (TSL) on one or more of the buccal surfaces of the primary upper incisors, while a quarter of 12-year-olds were reported to have TSL on the molars and the buccal surface of the incisors. In addition, 15-year-olds were shown to be more adversely affected than 12-year-olds when TSL on the occlusal surface of molars was measured (31% compared to 25%).

LOOKING AHEAD

Commenting on this worrying trend, Professor Andrew Eder, clinical director of the London Tooth Wear Centre, said, ‘Irrespective of age and circumstance, patients need to be aware that, amongst other issues, poor drink and food choices, eating disorders, stress-related bruxism and traumatic oral hygiene measures can all cause considerable tooth wear.

If we are to have any chance of subverting the oral health outcome that the statistics indicate, it is incumbent upon all dental professionals to meet this challenge head-on.’

The London Tooth Wear Centre offers an evidence-based and comprehensive approach to managing pathological tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

 

This article was published in Private Dentistry, December 2016.

With New Year’s Eve and its associated celebrations fast approaching, Professor Andrew Eder considers the erosive potential of alcohol, and offers both preventive and treatment solutions.

As we prepare to chink glasses and celebrate the New Year with a kiss from our nearest and dearest, it is important that our patients realise there’s a ‘hidden’ danger from too much imbibing of the merry stuff! I write ‘hidden’ because there appears to be a worrying lack of public awareness when it comes to tooth wear, which we dentists know has the potential to wreak havoc, resulting in pain, sensitivity and, ultimately, expensive and extensive restorative treatment if not prevented as early on as possible.

Alcohol, of course, tends to be high in sugar – an ingredient that many of our patients will associate with causing tooth decay and resulting in fillings. But it’s also acidic (and excessive drinking leading to vomiting contributes additionally, of course) – with long-term consumption contributing to tooth erosion; and that’s what many patients fail to realise.

Read preventive advice and how to remedy the damage in the full article on the erosive potential of alcohol below:

Read the recent blog post on the future of tooth surface loss (TSL) below as published on GDPUK:

“Pathological tooth wear (also known as tooth surface loss) is on the increase, as indicated by the most recent Adult and Children’s Dental Health Surveys.

Recognising that tooth wear has the potential to be a serious issue in the UK in the future if preventive action is not fully embraced, its incidence and significance was recorded in the Adult Dental Health Survey (ADHS) for the first time in 1998, and this exercise was repeated in the latest offering. Comparison of the two surveys shows that in just 11 years the incidence of tooth wear in England has increased by 10%.

As for the Children’s Dental Health Survey, it tells us, for example, that 33% of 5-year-olds demonstrated tooth surface loss (TSL) on one or more of the buccal surfaces of the primary upper incisors, while a quarter of 12-year-olds were reported to have TSL on the molars and the buccal surface of the incisors. In addition, 15-year-olds were shown to be more adversely affected than the 12-year-olds when TSL on the occlusal surface of molars was measured (31% compared to 25%).

So, what does this mean in reality for dental professionals and patients looking to the future? As Poyser and colleagues (2015) so succinctly stated: ‘The prevalence of tooth wear is likely to escalate as life expectancy continues to increase. As people expect to retain their teeth throughout life this has important implications on the type of preventative and restorative care that the profession will need to provide in the future. This also has an implication for training and funding for dental services. The management of TSL and the eventual failure of restorations placed to manage this problem are likely to be a significant issue in future years.’

Commenting on this worrying trend, Prof. Andrew Eder, said: ‘Irrespective of age and circumstance, patients need to be aware that, amongst other issues, poor drink and food choices, eating disorders, stress-related bruxism and traumatic oral hygiene measures can all cause considerable tooth wear.

‘Once the first signs of tooth wear are recognised, a partnership approach offers the most effective way in which to prevent further damage. Left in the dark, patients – especially those in the younger age groups – are likely to continue in ignorance with their destructive habits, which will have nationwide dental health repercussions for many years to come if the figures published in the most recent surveys are anything to go by.

‘So, if we are to have any chance of subverting the oral health outcome that the statistics indicate, it is incumbent upon all dental professionals to meet this challenge head-on.’

The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

References

1. Adult Dental Health Survey 2009. Report 2: Disease and related disorders. Health and Social Care Information Centre 2011

2. Children’s Dental Health Survey 2013. Report 2: Dental disease and damage in children: England, Wales and Northern Ireland. Health and Social Care Information Centre 2015

3. Poyser NJ et al. The Dahl Concept: past, present and future. BDJ 2005; 198: 669-676″

Halloween Oral Health – Are parents aware this Halloween of the dangers of fruit juices, smoothies, sports drinks and fizzy drinks on their children’s teeth? Professor Andrew Eder discusses the issues and offers some helpful tips in Private Dentistry this month.

Read the full article below:

Grinding your teeth? A new ear plug could help with teeth grinding and clenching (Bruxism). The device, Cerezen, is currently being trialled and helps with problems associated with bruxism by absorbing the pressure created when you grind or clench your back teeth.

The grinding and clenching of teeth can cause jaw and ear ache as well as the tightening of back and neck muscles leading to tension headaches.

In addition the additional contact of teeth over normal use (attrition) results in tooth wear.

Read the full article on the Cerezen device below:

As part of National Smile Month (16th May to 16th June), the Oral Health Foundation has released some fun but nonetheless impactful facts and figures about how we treat our teeth and its links to growing cases of tooth wear. Read the article on the Dental Supplies Magazine Website. See the magazine clippings below:

With National Smile Month fast approaching (16th May to 16th June), the Oral Health Foundation has released some fun but nonetheless impactful facts and figures. Did you know, for example, that earrings, business cards, keys, matchsticks and screwdrivers are just a few of the somewhat inexplicable objects patients admit to using to remove food particles from between their teeth?

If we put to one side the hygiene aspect of putting any one of these objects into our mouths, their use is particularly worrying when it comes to the issue of tooth wear, which is a growing problem. Comparing the most recent Adult Dental Health Survey with its predecessor, figures suggest that in just 11 years the incidence of tooth wear in England increased by 10%.

Alongside over-zealous tooth brushing and consuming a diet rough in texture, using utensils not specifically designed for the job of removing food debris interdentally contributes to abrasion.

Patients suffering from tooth wear often experience sensitive teeth, which may look shorter on smiling or when speaking. Patients also often report that chewing may have become a problem. In addition:

• Teeth may become less white as some of the outer surface is lost

• Front teeth may become sharp or chipped

• Chewing surfaces may wear flat and take on a shiny, pitted appearance.

• Restorations such as crowns and bridges may stand proud of the natural teeth.

Since over-enthusiastic tooth brushing can result in abrasion, it is a good idea for the dentist or hygienist to demonstrate how to brush the teeth without being too vigorous and, where appropriate, to recommend the use of a soft toothbrush and non-abrasive toothpaste. It is also worth mentioning to patients that foods with a rough texture will make matters worse. Finally, making patients aware of the damage inflicted by ‘handy’ tools for cleaning between the teeth is imperative to stop further damage to the enamel and dentine.

The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear. To request advice, make a referral or for further information on the work of the London Tooth Wear Centre® email info@toothwear.co.uk or call 020 7486 7180.

Professor Andrew Eder comments on stress contributing to tooth loss in recent articles on GDPUK. Read it here:

Almost half of British adults say they feel stressed every day, according to the Mental Health Foundation.

It is generally well-known that stress can contribute to health problems such as depression and heart disease. What is less well known, but imperative to address for emotional and physical wellbeing, is that it can also damage your teeth.

One of the more common signs of stress is tooth grinding, but there’s a good chance you don’t even know you’re doing it, as it often happens in your sleep. However, its effects cannot be underestimated, often resulting in physical symptoms such as tooth sensitivity, gum problems, difficulty chewing, headaches and neck ache, as well as the possibility of ultimately losing teeth, which can have a devastating emotional effect.

If a dentist examined your mouth, they might find teeth that are:

Harp or chipped
Broken
Shortened
Loose
Wearing flat and looking shiny and pitted.

The good news is that making a few simple lifestyle changes can be a big help, such as:

Doing something relaxing before bed, such as yoga, reading or having a bath

Learning to brush effectively, yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity (ask your dentist for advice on this if you’re not sure).

In addition, if you’re suffering from sensitivity (which should be diagnosed by a dentist to ensure there is no underlying condition that needs treatment), using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste used when brushing or applied directly onto a sensitive tooth can also be helpful to calm any sensitivity.

Commenting on this growing problem, Professor Andrew Eder, an expert in tooth wear and clinical director of the London Tooth Wear Centre®, said: “If you’re worried that your teeth may be wearing, tell your dentist. They are, after all, there to help and will be able to make a diagnosis, provide guidance or refer you, if appropriate.

“Possible treatment options include the provision of a suitable mouthguard to be worn at night to relieve pressure on the teeth and jaw, prescribing muscle relaxants or recommending care from a physiotherapist or osteopath with specialist knowledge of the muscles involved.

“If there was one piece of advice above all others I’d offer, it would be to not delay seeking help. If damage resulting from tooth wear is diagnosed and addressed in its early stages, you can avoid extensive and expensive dental treatment that might otherwise be necessary to correct the situation. The bottom line is that you needn’t suffer alone or long-term.”

There is a rise of Tooth Wear in Children caused by the increased consumption of acidic food and drinks such as sports and fizzy drinks and fruit juices and smoothies.
In a recent Jewish Chronicle article ‘Rethink that acid drink’ Professor Andrew Eder helps to raise awareness of tooth wear in Children.
Read the article below…

Tooth Worries? Have your teeth become more sensitive? Are they sharp or chipping at the edges? Have you stopped smiling?

This could be related to acidic foods and drinks in your diet, stomach acid reflux or even grinding and clenching which often takes place at night.

Most often, it is a combination of problems and, as we all keep our teeth longer, such problems of tooth wear are on the increase.

There are many ways we can help you to protect your teeth.

Please do contact us for further information.

No-one can have failed to notice the big push towards reducing sugar in our diet, especially among children. The reason for this is twofold – firstly that there is an obesity epidemic, and secondly because our children are losing their teeth to decay and acid erosion at an alarming rate and unnecessarily.

Indeed, the latest figures from the Government indicate that nearly half of 15-year-olds and a third of 12-year-olds have untreated decay or fillings, or have lost teeth to decay – and this is affecting their adult teeth. Meanwhile, at age 12 a quarter of children in the UK have suffered acid erosion of teeth beyond that which you would expect for their years, increasing to 31% by age 15.

High-profile figures such as Jamie Oliver are working hard to promote the idea of reduced sugar intake and are doing great work educating families about decay and obesity. Jamie’s ‘tax’ on sugary drinks has been well publicised, but little has been said about how many of those sugar-laden beverages also contribute to dental erosion; yet frequent consumption can lead to an equally damaging outcome.

Over time, acid erosion may result in short and unattractive teeth which may also become rough and sensitive. If left to continue its damaging course, teeth may require extensive and expensive restorative treatment further down the line.

Dental erosion is caused by consuming acidic foods and drinks; the acid attacking the outer enamel surface of the teeth. Culprits include fruit juices, smoothies, sports beverages and fizzy drinks (including sugar-free, as it happens), as well as foods otherwise considered to be healthy like citrus fruits, yoghurt and honey.

The good news is that there are lots of simple steps you can incorporate into your family’s lifestyle without too much effort on your part. While they won’t reverse any damage already done, they can make sure things don’t get any worse. To help prevent dental erosion, try to:

• Drink still water or low fat milk between meals

• Limit fruit juice to once per day and avoid fizzy drinks

• Rinse the mouth with water for 15 to 30 seconds after consuming acidic foods or drinks

• Chew sugar-free gum or eat a piece of cheese after consuming acidic food or drink

• Wait at least an hour to brush teeth after consuming any acidic foods or drinks

• Use an age-appropriate toothpaste that contains fluoride and a non-abrasive toothbrush

• Use an age-appropriate fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after acidic foods and drinks, to help limit the erosive potential.

Focusing on this important but often overlooked issue, Professor Andrew Eder, an expert in tooth wear and Clinical Director of the London Tooth Wear Centre®, said, ‘With more than a third of 12-year-olds and over a quarter of 15-year-olds reported as being embarrassed to smile or laugh due to the condition of their teeth, this problem has the potential for far-reaching consequences beyond the physical.

‘To provide some guidance on healthier options, sugar-free squash has erosive potential, but with a lower acidic level than fruit juice it may be a practical alternative and far less damaging than fizzy drinks particularly when diluted. Milk can also be a good option, but perhaps not suitable for drinking throughout the day.

‘Now widely available in the UK is coconut water. It has an acceptable acidic level, is hydrating, entirely natural and isotonic, which means it is similar in composition to that of the fluid in the human body. There are several flavours available but because fruit juice has been added to these, drinking the plain version is best. If you really can’t see a way to eliminate acidic soft drinks from your diet, limiting them to meal times is greatly beneficial.

‘Finally, if you’re worried about tooth wear, tell your dentist. They are, after all, there to help and will be able to make a diagnosis, provide guidance or refer you on, if appropriate.’

Alternatively, the London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.

For further information on the work of the London Tooth Wear Centre®, please email info@toothwear.co.uk or call 020 7486 7180.

Professor Andrew Eder comments on stress contributing to tooth loss in recent articles on Dental Republic, Health Care News and Dentistry. Read it here:

Almost half of British adults say they feel stressed every day, according to the Mental Health Foundation.

It is generally well-known that stress can contribute to health problems such as depression and heart disease. What is less well known, but imperative to address for emotional and physical wellbeing, is that it can also damage your teeth.

One of the more common signs of stress is tooth grinding, but there’s a good chance you don’t even know you’re doing it, as it often happens in your sleep. However, its effects cannot be underestimated, often resulting in physical symptoms such as tooth sensitivity, gum problems, difficulty chewing, headaches and neck ache, as well as the possibility of ultimately losing teeth, which can have a devastating emotional effect.

If a dentist examined your mouth, they might find teeth that are:

Harp or chipped
Broken
Shortened
Loose
Wearing flat and looking shiny and pitted.

The good news is that making a few simple lifestyle changes can be a big help, such as:

Doing something relaxing before bed, such as yoga, reading or having a bath

Learning to brush effectively, yet gently with a relatively soft toothbrush and a toothpaste that is low in abrasivity (ask your dentist for advice on this if you’re not sure).

In addition, if you’re suffering from sensitivity (which should be diagnosed by a dentist to ensure there is no underlying condition that needs treatment), using a fluoridated mouthrinse every day at a different time to toothbrushing is an effective first line of defence. A desensitising toothpaste used when brushing or applied directly onto a sensitive tooth can also be helpful to calm any sensitivity.

Commenting on this growing problem, Professor Andrew Eder, an expert in tooth wear and clinical director of the London Tooth Wear Centre®, said: “If you’re worried that your teeth may be wearing, tell your dentist. They are, after all, there to help and will be able to make a diagnosis, provide guidance or refer you, if appropriate.

“Possible treatment options include the provision of a suitable mouthguard to be worn at night to relieve pressure on the teeth and jaw, prescribing muscle relaxants or recommending care from a physiotherapist or osteopath with specialist knowledge of the muscles involved.

“If there was one piece of advice above all others I’d offer, it would be to not delay seeking help. If damage resulting from tooth wear is diagnosed and addressed in its early stages, you can avoid extensive and expensive dental treatment that might otherwise be necessary to correct the situation. The bottom line is that you needn’t suffer alone or long-term.”

Professor Andrew Eder speaks to The Dentist and Dental Republic about the need for dentists to focus attention on tooth erosion, read the article here:

The European Federation of Conservative Dentistry (EFCD) has called for the dental community to increase its focus on erosive tooth wear and declared it a challenge requiring co-operation with other healthcare professionals, according to a recently published consensus report (Carvalho TS et al, 2015).

The Federation further concluded that effective management includes screening for early signs of tooth erosion and evaluating all aetiological factors, including eating and drinking habits, nutritional supplements, reflux, vomiting and medications.

Speaking about this consensus, Professor Andrew Eder, a specialist in restorative dentistry and prosthodontics, and Clinical Director of the London Tooth Wear Centre, commented: “With people living longer, we need to work with our patients now to ensure their oral health does not let them down and one area that urgently needs our attention is that of erosive tooth wear.

“The Adult Dental Health Survey teaches us that more than three quarters of dentate adults show some tooth wear in their anterior teeth, while the increase in moderate tooth wear in 16 to 34 year olds is of clinical relevance as it is suggestive of rapid tooth wear.

“In my view, tooth wear is going to increase in our patients in the years to come. Poor drink choices, eating disorders like bulimia and an increased need for medication as a result of people living for longer, as well as other factors, are all going to contribute to tooth wear.

“So we as dental professionals need to keep an eye out for the tell-tale indications, take preventive action when we spot the initial signs, and make sure our patients understand that they need to make sensible choices if they want to keep their teeth for a lifetime.”

Professor Andrew Eder talks to Dentistry about the EFCD urging the dental community to increase its focus on tooth erosion. Read the article as published in Dentistry here…

Professor Andrew Eder talks to PD Essentials about the EFCDs call for the dental community to increase its focus on tooth erosion. Read the article as published in PD Essentials here…

The London Tooth Wear Centre share their top tips for preventing tooth wear this Christmas with The Dentist. Read the article here or below:

According to charity Addaction, 54 per cent of men and 41 per cent of women are expected to drink over the recommended guidelines at Christmas, and so it is important to raise our patients’ awareness of the increased potential for tooth damage at this time of year.

As we dental professionals know all too well, alcohol is acidic and therefore highly erosive, especially when consumed frequently, in large quantities over an extended period of time. It may also be that the high alcohol intake occasionally causes vomiting, which can exacerbate the damage to the dentition.

To help prevent tooth wear, advise patients to:

1. Drink still water or low fat milk between meals.

2. Limit fruit juice to once per day.

3. Avoid carbonated drinks.

4. Swallow any acidic drinks immediately to reduce contact time with the teeth.

5. Use a wide bore straw to drink acidic drinks to limit the contact time with the teeth.

6. Dilute and keep any acidic drinks chilled, as this reduces the damaging low pH potential.

7. Rinse the mouth after acidic foods and drinks with water for 15-30 seconds to dilute any remaining acids.

8. Snack on cheese or drink some milk following consumption of an acidic beverage.

9. Wait at least an hour to brush teeth after consuming any acidic drinks.

10. Use a toothpaste that is fluoridated to 1400ppm and low in abrasivity.

11. Use a fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after acidic drinks to help limit the erosive potential.

12. Chew sugar free gum, especially that containing xylitol, after drinking to help neutralise the acidic environment in the mouth.

Professor Andrew Eder speaks to Dental Supplies Magazine and Dental Republic about the need for dentists to focus attention on tooth erosion, read the article here or below as published on Dental Supplies Magazine:

“The European Federation of Conservative Dentistry (EFCD) has called for the dental community to increase its focus on erosive tooth wear and declared it a challenge requiring co-operation with other healthcare professionals, according to a recently published consensus report (Carvalho TS et al, 2015).

The Federation further concluded that effective management includes screening for early signs of tooth erosion and evaluating all aetiological factors, including eating and drinking habits, nutritional supplements, reflux, vomiting and medications.

Speaking about this consensus, Professor Andrew Eder, a specialist in restorative dentistry and Prosthodontics, and Clinical Director of the London Tooth Wear Centre, commented ‘With people living longer, we need to work with our patients now to ensure their oral health does not let them down and one area that urgently needs our attention is that of erosive tooth wear. ‘The Adult Dental Health Survey teaches us that more than three-quarters of dentate adults show some tooth wear in their anterior teeth, while the increase in moderate tooth wear in 16 to 34 year olds is of clinical relevance as it is suggestive of rapid tooth wear. ‘In my view, tooth wear is going to increase in our patients in the years to come. So we as dental professionals need to keep an eye out for the tell-tale indications, take preventive action when we spot the initial signs, and make sure our patients understand that they need to make sensible choices if they want to keep their teeth for a lifetime.’”

London Tooth Wear Centre explains why dentists should keep an eye out for stress-related symptoms of tooth wear in younger patients in a dentistry.co.uk article, read the post here

Professor Andrew Eder highlights the effect alcohol has on good oral health. He points to the erosive effect alcohol can have on our teeth and the damage it can cause to our oral health and offers advice for avoiding tooth wear. Read the full article as published in Dentistry here…

Professor Andrew Eder offers advice for dealing with some of the more common tooth wear-associated problems patients present with, to help prevent further deterioration and, perhaps, reverse some of the damage to keep a nice smile. Read the full article as published in Private Dentistry here…

Professor Andrew Eder comments in a Times article warning against the danger of fruit snacking due to it’s link with Tooth Wear, read the article below:

Professor Andrew Eder shares with Private Dentistry readers why early intervention and close monitoring are key to tackling the growing challenge of tooth wear, read the article here…

Dentistry reports high levels of Tooth surface loss amoung Children, read the post here

The Probe reports evidence of tooth surface loss and high levels of Tooth Wear among Children, read the post here or below as published on The Probe.

“A third (33 per cent) of five year olds have evidence of tooth surface loss (TSL) on one or more of the buccal surfaces of the primary upper incisors, according to the Children’s Dental Health Survey published in March.

In addition, a quarter of 12 year olds were reported to have TSL on molars and the buccal surface of incisors, while the proportion of children with any TSL at age 15 on the occlusal surface of molars was higher than at age 12 (31 per cent compared to 25 per cent).

The authors of the report state: ‘The proportions of children affected by tooth surface loss into dentine and pulp are low and consistent over time, although any such damage is a significant burden to have at the age of 15.’

Combined with figures from the latest Adult Dental Health Survey, which suggests a small increase in moderate tooth wear in 16 to 34 year olds, all of this is of clinical relevance as it is suggestive of rapid tooth wear.

It therefore seems that the dental profession needs to work harder with young patients if we are to prevent long-term damage that will require considerable remedial treatment in the future if left unchecked.

Specialist centres such as The London Tooth Wear Centre, offer an evidence-based and comprehensive approach to managing tooth wear.”

Professor Andrew Eder explores the multifactorial challenges of an increasingly common oral health issue – that of tooth wear. Read more…

Professor Andrew Eder tackles the challenging issue of discussing oral health symptoms that indicate a patient may be bulimic and explores the first stages of remedial dental treatment, read more…

Professor Andrew Eder named number 11 in the Private Dentistry Elite 20 list! Read more below..

Read London Tooth Wear Centres piece on the-dentist.co.uk, aiming to raise awareness of bruxism and attrition and offer simple solutions to the problem.

The London Tooth Wear Centre considers Bulimia and Oral Health contributing to PD Essentials with an article highlighting the effects the eating disorder can have on oral teeth. Complications can include:

• The teeth become rounded, smooth and shiny and lose their surface characteristics
• Incisal edges appear translucent
• Cupping forms in the dentine
• Cervical lesions are shallow and rounded
• Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

Read the full article below..

The London Tooth Wear Centre contributes to DH&T with an article raising awareness of the health implications of eating disorders, such as Bulimia, and offers steps on how to help minimise the damage to oral health. Read the article below..

Professor Andrew Eder shares his thoughts on potential causes and signs of tooth wear with The Jewish Chronicle.

Research from the NHS information centre suggests that up to 6.4% of adults display signs of an eating disorder and, of those, 40% are bulimic.

The extended periods of intentional vomiting instigated by bulimics have considerable impact on a patient’s dentition and can result in substantial oral health complications, including:

• The teeth become rounded, smooth and shiny and lose their surface characteristics

• Incisal edges appear translucent

• Cupping forms in the dentine

• Cervical lesions are shallow and rounded

• Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

Alongside beat (www.b-eat.co.uk), which helps sufferers in the UK beat their eating disorders and runs Eating Disorders Awareness Week (23 February – 1 March 2015) with the aim of raising awareness of the health implications of these disorders, practices like the London Tooth Wear Centre are working hard to tackle this increasingly prevalent oral health problem.

Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general guidance on how to reduce the effect of acidic foodstuffs should be given and include:

• Drinking water or low fat milk in preference to other liquids

• Using a straw positioned toward the back of the mouth when drinking acidic beverages

• Avoiding swishing drinks around the mouth

• Rinsing the mouth with water or fluoridated mouthwash after consuming acidic foodstuffs.

Oral health advice for a patient whose dentition is compromised by bulimia includes:

• Issuing a fluoride rinse or gel and prescribing a high-fluoride toothpaste for daily use

• Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.

Extra protection can be provided via calcium and phosphate ions, such as those found in GC Tooth Mousse, helping to restore the mineral balance, neutralise acidic challenges and stimulate salivary flow.

Compliance may be difficult to achieve and restorative treatment in the presence of ongoing tooth wear is considered unwise but, irrespective of this, the damage caused by erosion means it may be necessary to take action to protect and conserve the remaining tooth structure, for example:

• Direct application of a glass ionomer or composite to sensitive areas may be indicated

• An occlusal guard can protect the teeth during vomiting

• An alkali or fluoride gel placed within the fitting surface of the guard to neutralise any acid pooling may be helpful.

If you have any concerns about your patient’s tooth wear, further information is available at www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

Figures suggest that 1.6 million people in the UK are affected by an eating disorder. That’s according to beat (www.b-eat.co.uk), which helps sufferers in the UK beat their eating disorders and runs Eating Disorders Awareness Week (23 February – 1 March 2015) with the aim of raising awareness of the health implications of these disorders.

Eating disorders are by-products of the body conscious society in which we live. Bulimia nervosa is more common than anorexia nervosa; however both are sadly rising in prevalence.

The extended periods of intentional vomiting instigated by those suffering from bulimia nervosa have considerable impact on a sufferer’s teeth, causing tooth wear and sensitivity.

The good news is that there are some simple steps people can take to help reduce and prevent further damage, including:

• Rinsing the mouth after vomiting with water for 15-30 seconds to dilute any remaining acids

• Waiting at least an hour after vomiting before brushing the teeth

• Using a toothpaste low in abrasivity and fluoridated to a minimum of 1400ppm

• Using a fluoridated mouthwash every day at a different time to tooth brushing, as well as before or after vomiting to help limit the erosive potential

• Chewing sugar-free gum, especially that containing xylitol, after vomiting to help neutralise the acidic environment in the mouth.

It’s definitely a good idea to talk to your dentist as early as possible if you have any worries about your oral health so that any damaging effects can be talked about and tackled. Dentists are trained to understand the issues that affect the health of your mouth. They can help to make sure you are not in pain, your teeth work as they should and, over the longer time, to improve how your teeth look if that’s what you want.

If you have any concerns about tooth wear or would simply like some preventive advice, please contact the London Tooth Wear Centre – visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

According to NHS figures, over 7 million of us will make a New Year’s resolution to improve our health in some way. Tipping the scales on this is weight loss, but did you know that diet fizzy drinks and fruit juice, as well as some foods such as yoghurt, honey and quinoa that we consider to be healthy can damage your teeth?

What we’re talking about here is a type of tooth wear involving loss of the outer protective enamel, an increasingly common dental problem that may, over time, result in unattractive smile, with short, rough or sensitive teeth. If left to continue its damaging course, teeth may require extensive restorative treatment further down the line.

The good news is that there are some simple steps you can incorporate into your lifestyle without too much effort on your part. While they won’t reverse any damage already done, they can make sure things don’t get any worse. Here are a few dos and don’ts for everyone to try:

• Limit fruits, fruit juices, sparkling drinks, alcohol and any other acids in your diet

• Try to drink still water or low fat milk between meals, and limit acidic foods and drinks to meal times

• Use a straw for acidic drinks and avoid holding or swishing these liquids around the mouth

• After having acidic foods or drinks, wait an hour before brushing your teeth

• Choose a toothbrush that has a small head and is relatively soft

• Use a non-abrasive toothpaste that contains at least 1400ppm fluoride

• Neutralise any acids in the mouth by chewing sugar-free gum or rinsing with water or a fluoridated mouthwash .

If you are worried about your teeth, the London Tooth Wear Centre® offers a comprehensive approach to managing tooth wear in a friendly environment. For further information, visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

Every year losing weight and eating healthily feature highly on many people’s New Year resolutions’ list. For those that make it past 17th January – apparently the most common date to give up on your resolutions – there is a hidden risk that patients need to know about; enamel erosion.

Dentists are increasingly seeing young, otherwise healthy patients who are unaware of what causes tooth wear. For those following what they perceive to be a healthy diet, it is important they are educated about the risks of acidic foods and beverages such as honey, yoghurt and many salad dressings, as well as diet carbonated drinks, fruit juices, smoothies and sports drinks.

Signs that indicate tooth wear is occurring include:

• Sensitivity

• Discolouration

• Sharp or chipped anterior teeth

• Occlusal surfaces wearing flat and taking on a shiny, pitted appearance

• Altered occlusion as vertical height changes

• Restorations standing proud of the teeth

• Abfraction lesions developing cervically

• V-shaped notches or shallower cupping present cervically.

If the damage is extensive, referral to a specialist may be recommended either for treatment planning advice only or for the provision of comprehensive care. The London Tooth Wear Centre®, for example, offers an evidence-based and comprehensive approach to managing tooth wear.

For further information on keeping a healthy smile visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

Even we health professionals enjoy a little extra food and drink over the festive period, but we would be remiss not to warn our patients of the potential for tooth damage.

Tooth erosion caused by alcohol, snacking between meals and increased consumption of sugary foods has the potential to escalate over Christmas.

According to the charity Addaction, Britons consume more than 600 million units of alcohol during December and 14% drink more than they intend to over Christmas. Meanwhile, Mars has historically reported that 65% of boxed chocolates are sold in the run up to Christmas.

If advice is to be focused on limiting the damage of a lifestyle harmful to the dentition, the following can be recommended:

• Drink erosive drinks through a straw to direct liquid to the back of the mouth and avoiding swishing drinks around the mouth
• Avoid carbonated and fruit juice mixers (which may be difficult as there is little else available and wine also has a low pH at around 3.5)
• Drink water between alcoholic beverages helps buffer their acidic potential
• Chewing sugar-free, xylitol- or sorbitol-sweetened gum to help neutralise acid in the mouth
• Never brush teeth immediately after acidic exposure, but waiting at least an hour. If this is not possible, rinsing with a fluoride mouth rinse and then applying a paste containing high fluoride or calcium phosphate to the teeth without rinsing before bed is worthwhile
• Use a fluoride mouthrinse throughout the day
• Use of a toothpaste low in abrasivity and a soft toothbrush.

If you are concerned that any of your patients are showing signs tooth wear, simply visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

This October, the team at the London Tooth Wear Centre® is committed to promoting Tooth Wear Awareness Month.

The aim of Tooth Wear Awareness Month is to raise public understanding across the UK of this growing problem. Some of this is attributable to newly emerging contributors, such as one of the latest food fads – the alkaline diet.

The alkaline diet may reduce inflammation, a feature of many diseases such as heart disease and arthritis. However, in contrast to its alkalising effect on the body, some of the recommended food can have erosive effects in the mouth, either because they have an acidic pH or, when chewed, can become acidic.

The problem may then be further exacerbated by tooth brushing after eating foods with a low pH, or in addition to bruxism.

As always, it is important to consider this information in the wider context. The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing abrasion, attrition and erosion, utilising the latest clinical techniques and an holistic approach in a professional and friendly environment. It is headed up by Clinical Director Professor Andrew Eder, a Specialist in Restorative Dentistry and Prosthodontics. He is also Associate Vice-Provost and Director of Life Learning at UCL.

If you are concerned that any of your patients are showing signs tooth wear, simply visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

Professor Andrew Eder comments on the effect of Sparkling Water on teeth, read the article below.

Professor Andrew Eder comments on temporomandibular, or jaw joint disorder in The Daily Mails Good Health, read the article below.

Professor Andrew Eder explores how what we eat and drink can affect our smiles in Dental Hygiene and Therapy

Professor Andrew Eder considers some of the potential contributing factors for tooth wear and the importance of giving preventive advice in June’s issue of PD Essentials

Professor Andrew Eder looks at the effects alcohol and recreational drugs have on levels of tooth wear in May’s issue of PD Essentials

Professor Andrew Eder looks at conditions affecting tooth wear and the various treatment options available in April’s issue of PD Essentials

Easter will soon be upon us and it will be open season for chocolate lovers. It is important, therefore, to ensure patients understand what eating chocolate means for oral health.

Such consumption, of course, leads to acid attacks, which can result in cavities and may also contribute to erosion, causing the tooth tissue to be more vulnerable upon tooth-to-tooth contact.

However, there are some simple steps that can help patients to enjoy a chocolaty treat at the same time as reducing the negative impact on their oral health. For example:

• The higher the cocoa content of chocolate, the less sugar, which will be less damaging to the teeth, as well as overall health

• Avoiding chocolate with sticky centres, such as raisins or toffee, as they are not only high in sugar but the consistency also means they stick to the grooves in the biting surfaces of the teeth

• Limiting chocolate consumption to dessert time or as a snack with a drink, such as a glass of milk or water to help clear the chocolate from the teeth, rather than grazing all day

• As well as brushing their teeth at least twice per day as usual, during this ‘naughtier’ time add a fluoride mouthwash to their oral care routine, administered soon after eating chocolate and rinsed in the mouth for one minute.

It is also worth noting that cacao powder is a healthier alternative to conventional, processed cocoa powder and perfect for home baking. Cacao is full of antioxidants, magnesium and iron, as well as free from sugar and artificial additives. It can be mixed with ingredients such as nuts, coconut butter and stevia or xylitol to make delicious, nutritious and tooth-friendly treats.

There are lots of tooth friendlier, healthy alternatives to chocolate available, such as dried fruit or sweets made with fructose, the sugar naturally occurring in fruit. However, their stickiness does mean that brushing the biting surfaces of the teeth after consumption is recommended.

With National Smile Month (19 May to 19 June) also coming up, there is no better time to get your patients to contribute to their oral health.

The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear.
To request advice, make a referral or for further information on the work of the London Tooth Wear Centre®, visit www.restorative-dentistry.co.uk, email info@restorative-dentistry.co.uk or call 020 7486 7180.

Professor Andrew Eder introduces emerging terminology in his research on tooth wear in March’s issue of PD Essentials

Professor Andrew Eder considers the oral health implications of the government’s ‘five-a-day’ campaign in this months PD Essentials

In light of increasing signs of tooth wear in children Professor Andrew Eder takes a look at the effect eating disorders can have on the oral health of young people in his article for DH&T.

Professor Andrew Eder considers factors that are newly emerging as potential contributors to the increasing prevalence of tooth wear in his article for Private Dentistry.

The New Year sees an increase in people watching what they eat, which is all to the good. However, there are some for whom food can become a battle ground and develop into an eating disorder.

Eating Disorders Awareness Week (24 February – 2 March 2014) aims to raise awareness of the health implications of these disorders. One of the many impacts of an eating disorder is the potential for damage to the dentition.

For example, the extended periods of intentional vomiting instigated by bulimia can result in tooth wear, which can make dentists the first health professional to be privy to the problem.

Signs include of tooth wear as a result of an eating disorder can include one or all of the following:

• The teeth become rounded, smooth and shiny and lose their surface characteristics
• Incisal edges appear translucent
• Cupping forms in the dentine
• Cervical lesions are shallow and rounded
• Restorations tend to be unaffected by erosion and will therefore stand proud of the surrounding tooth tissue.

Advice rather than treatment features heavily during the initial stage of helping a patient suffering with bulimia. Diet analysis and general oral health guidance should be given, including:

• Issuing a fluoride rinse or gel and prescribing a high-fluoride toothpaste for daily use
• Not brushing immediately after vomiting or consuming acidic foodstuffs, but rinsing with a fluoridated mouthwash and chewing sugar-free, xylitol-sweetened gum afterwards.

In addition, it is recommended that the patient sees a doctor, who can assess their physical condition and refer them to available help. If the patient is uncomfortable seeing the doctor, in the first instance a nurse or health visitor from the same medical practice is an acceptable alternative.

To treat or manage extensive tooth wear, referral to a dental specialist may be recommended either for treatment planning advice only or for the provision of comprehensive care. London Tooth Wear Centre®, for example, offers an evidence-based and comprehensive approach to managing tooth wear.

For further information, visit www.toothwear.co.uk, email info@toothwear.co.uk or call 020 7486 7180.

Professor Andrew Eder contributes to an article in the Daily Mail on how the menopause can leave your mouth too dry to eat or talk, and what you can do to help solve the problem.

To mark Tooth Wear Awareness Month this October, Professor Andrew Eder explores the impact eating your five-a-day could have on your oral health, read the article from Mayfair Resident below.

To mark Tooth Wear Awareness Month this October, Professor Andrew Eder considers how tooth wear can affect your teeth and offers simple solutions to the problem, read the article ‘Is the daily grind getting to you?’ from The Hill Resident below.

To mark Tooth Wear Awareness Month this October, Professor Andrew Eder explores the impact eating your five-a-day could have on your oral health, read the article from SW Resident below.

This October, the London Tooth Wear Centre® is offering complimentary tooth wear consultations (while appointments last) as part of its Tooth Wear Awareness Month.

The aim of Tooth Wear Awareness Month is to raise national awareness of this growing problem. The most recent statistics from the Adult Dental Health Survey, commissioned by the NHS and published in 2009 indicate that over 75% of adults and more than 50% of children show signs of tooth wear. If we continue as we are, this is set to get worse; particularly so for adults as we are living longer and keeping our teeth longer.

Tooth wear can be caused by clenching or grinding the teeth, often whilst asleep; an action that is most frequently stress-related and can result in significant discomfort. Consuming ‘healthy’ foods and drinks can also contribute to wear due to their acidic or fibrous nature.

Intrinsic sources of acid, such as reflux, may have an erosive effect on the tooth surface, as can over-zealous tooth brushing and behaviours such as substance misuse. Sufferers may notice teeth lose their surface characteristics, become chipped, develop grooves at the gum line and darken in colour. Symptoms can include sensitivity, jaw ache, headaches and difficulty chewing.

The complimentary consultation offers a clinical examination of the teeth to ascertain whether you are suffering from tooth wear, along with holistic advice to help prevent further problems, if appropriate. The team at the Centre will also inform you should you need to consult your current dentist or require a referral. You will also need to continue to see your regular dentist for your routine dental checks and any related treatment.

The London Tooth Wear Centre® offers a comprehensive approach to managing tooth wear in a professional and friendly environment. It is headed up by Clinical Director Professor Andrew Eder, a Specialist in Restorative Dentistry and Prosthodontics. He is also Professor/Honorary Consultant at the UCL Eastman Dental Institute.

To book your complimentary appointment, simply call 0207 486 7180 or email info@toothwear.co.uk

For terms and conditions, please click here.

In this article, Professor Andrew Eder considers factors that are newly emerging as contributors to the prevalence of tooth wear – so that you can stay one step ahead!

1. Evidence indicates that patients who have had bariatric surgery may be at an increased risk of tooth wear. This is due to the acid reflux that can present, as well as regular liquidated foods of high nutritional value, such as fruit smoothies, that may be recommended post surgery.

2. The government’s five a day campaign is based on advice from the World Health Organisation, which recommends eating a minimum of 400g of fruit and vegetables a day to lower the risk of serious health problems, such as heart disease, stroke, diabetes (type II) and obesity. While this is imperative, selecting fruit more often than vegetables and especially as a snack can lead to tooth wear. In addition, faster lifestyles have incentivised the development of smoothies, thickies and ‘health’ drinks, which often include more than one of your five a day in an on-the-go formulation.

3. Anorexia Athletica is different from Anorexia Nervosa or Bulimia Nervosa. It is characterised by excessive, obsessive exercise and is therefore most commonly found in pre-professional and elite athletes where a small, lean body is considered advantageous. It can however, also present in the general population. People suffering from Anorexia Athletica may engage in both excessive workouts as well as calorie restriction.

4. Intrinsic causative factors, such as hiatus hernia which causes acid reflux are important to consider when assessing patients for tooth wear as alone they can cause tooth wear, but in addition to extrinsic factors, the rate of wear may be exacerbated.

5. Regular use of recreational drugs can result in a very specific pattern of parafunctional activity which may cause wear involving just a few teeth. It is often difficult to replicate the apparent tooth contacts which should draw attention to this as a possible cause. As part of this lifestyle, alcohol may also be consumed and a lack of home care can feature.

6. Bleachorexia is an addiction to whitening the teeth. First described by the American Dental Association, the condition features dysmorphia; an altered perception of reality, leading to an obsessive use of whitening products. Facilitating this is unrestricted access to dental bleach from non-dental professionals, both online and at unlicensed locations, such as beauty salons. There is a growing industry in “at home” whitening products, such as targeted toothpastes, many of which achieve their result through abrasion of the tooth surface. In addition, some foods have been reported to have a whitening effect, for example, strawberries. However, and similarly to dental bleach, if applied to the tooth surface very frequently, they can cause wear.

7. Increasingly popular due to the associated health benefits is a diet rich in foods and drinks that have an alkaline effect on the body. However, they can also have erosive effects in the mouth. Alkalising foodstuffs include fruits such as lemon, grapefruit and kiwi and vegetables such as beetroot, broccoli and spinach. When masticated, however, they can be acidic and one such example is spinach which releases the potentially erosive oxalic acid.

8. Remember that even carbonated water can cause enamel loss. The addition of carbon dioxide, which forms carbonic acid, lowers the pH of the water to around 3. Interestingly though, research shows that sparkling water may be safer than fruit juices as well as some still and sparkling soft drinks.

9. Extended periods of alcohol consumption, such as that seen in alcoholics can cause significant wear – often seen in association with regurgitation also. However, even low levels of alcohol can be damaging. This is particularly seen in those whose alcohol intake is frequent and spread over longer periods as part of a sociable lifestyle, especially without buffering intervals. As a result, teeth are vulnerable to erosion.

10. In broad terms, ablation describes the effects of emerging technologies – some of which may only little documentary evidence. However, it is referred to on Wikipedia as ‘the removal of material from the surface of an object by vaporisation, chipping, or other erosive processes’. In dental terms, ablation has been used to describe self-harm types of tooth wear, such as may be seen in patients with tongue piercings causing abrasion, most commonly of premolars. Other examples include online ‘home bleaching’ solutions which can bring together erosive and abrasive substances, such as strawberries or lemons and sand or salt, to form a damaging paste or recreational drug misuse causing parafunctional attrition.

Professor Andrew Eder describes the causes and symptoms of tooth wear, when and how to treat it, and when it is most appropriate to refer a patient in his article for the Young Dentist.

Professor Andrew Eder focuses on the importance of early intervention in response to the rise in tooth wear as part of his clinical focus article.

Professor Andrew Eder navigates through the best ‘tooth wear’ education tips that will help preserve the natural dentition for life in ‘Dentistry, 6th June 2013’

Download (PDF, 2.25MB)

Professor Andrew Eder reviews the findings of the latest Adult Dental Health Survey and finds greater numbers of patients are exhibiting increasingly severe tooth erosion with the largest increase of tooth wear in young people and an overall rise in England of 10% in the last 11 years.This is in part due to the fact we are living longer but there are other causes which are potentially preventive. Read more below.

Download (PDF, 68KB)

In the second in a series of three articles on tooth wear, Professor Andrew Eder shares how and
why the physiology of patients’ teeth is changing with an increase in signs of abrasion, attrition and/or
erosion.

Read Professor Andrew Eder’s piece “Tooth wear and tear” below from ‘Dentistry – 9th May 2013’

Download (PDF, 1.22MB)

Professor Andrew Eder presents the facts and figures on tooth wear that suggest greater numbers of people are exhibiting increasingly severe tooth wear.

Read Professor Andrew Eder’s piece “Wearing away oral health” in Dentistry – April 2013

Download (PDF, 2.99MB)

Professor Andrew Eder contributes to ‘How chewing gum can boost your brain power’ in the Mail Online and discusses the effect of chewing on one side. Read the article here

Read Professor Andrew Eder’s piece “My Week – Andrew Eder”

Download (PDF, 642KB)

Your teeth could be in danger from fizzy sports and energy drinks as they can cause tooth decay and dental erosion. Read more in Professor Andrew Eder’s piece “Teeth ‘at danger’ from sports drinks” as published on Yahoo Lifestyle below.

Download (PDF, 191KB)

Professor Andrew Eder highlights the rising problem of teeth wearing away, becoming sharp and sensitive and other issues associated with Tooth Wear. Read more below in Professor Andrew Eder’s piece “Bite all right?” in The Jewish Chronicle.

Download (PDF, 168KB)

In the March issue of Premium Practice Dentistry, editor Andy Myall speaks to Professor Andrew Eder about Tooth Wear. Read the interview here:

Download (PDF, 1.87MB)

Held on 12 February, the evening provided an opportunity for visitors to meet the team at the practice, discuss the support available to dentists and their patients and gain an hour of verifiable CPD via a clinical update on tooth wear.

The next two referral evenings are scheduled for:

• Tuesday 12 March 2013 at 6.30pm

• Tuesday 9 April 2013 at 6.30pm

The London Tooth Wear Centre® is a specialist referral practice in Central London offering an evidence-based approach
to managing tooth surface loss.

Led by Professor Andrew Eder, Specialist in Restorative Dentistry and Prosthodontics, the Centre was established in response to an increasing number of patients presenting with tooth wear.

Professional help is available at The London Tooth Wear Centre® for consultation and treatment planning advice only,
or for comprehensive management of patients’ tooth wear.

For further details and to book your place on a London Tooth Wear Centre referral evening, please visit the Dentists Area, email info@toothwear.co.uk or call 020 7486 7180. Spaces are offered on a first come, first served basis.

The team at the London Tooth Wear Centre® looks forward to welcoming you.

Professor Andrew Eder has been appointed Associate Vice-Provost (Enterprise) at UCL and Director of CPD and Short Course Development.

The position, with a mandate to facilitate growth of this key area across the University, follows Professor Eder’s recently completed ten year term as Director of Education and CPD at the UCL Eastman Dental Institute, for which he was recognised for his excellence and innovation in teaching and learning at UCL as a recipient of a Provost’s Teaching Award in 2010. Professor Eder will also continue to be involved in postgraduate dental education at the Eastman.

“With a background in educational entrepreneurship and leadership, I am delighted to have been invited to play a leading role in this exciting initiative at UCL,” said Professor Eder. “As the global demand for high quality lifelong learning continues to expand almost exponentially, UCL is superbly placed to be a leading provider.”

As a Specialist in Restorative Dentistry and Prosthodontics, Professor Eder also maintains a multi-disciplinary referral practice in Central London. He has a special interest in the aetiology, demographics and clinical management of patients with tooth wear. He is Co-Editor of the British Dental Journal book on Tooth Surface Loss and Clinical Director of the London Tooth Wear Centre®.

Professor Eder’s academic interests include innovative methodology and technology in teaching and learning and the impact of continuing education on patient outcomes in clinical practice. He is a past President of Alpha Omega, the British Society for Restorative Dentistry and the Royal Society of Medicine’s Odontological Section, is an examiner at UCL and the Royal College of Surgeons and serves on the Editorial Boards of several international dental journals.

Tooth wear is an increasingly common problem and getting help early on is essential to prevent teeth becoming short or sensitive. Recognising this, Professor Andrew Eder, Clinical Director of the London Tooth Wear Centre®, has launched a new website at www.toothwear.co.uk to help.

Visitors to www.toothwear.co.uk will find useful information on the different types of tooth wear, what causes it and the simple steps that can be taken to prevent significant damage.

The truth is that everyone experiences some tooth wear simply due to normal use of the teeth, but it can become a real problem if, for example, people grind their teeth, have acid reflux or an an eating disorder, brush too vigorously, or frequently consume acidic food and drink.

Indeed, with the British Soft Drinks Association’s latest figures showing an increase in the consumption of fizzy drinks and fruit juices and over 660 million litres of sports and energy drinks purchased in 2011, raising awareness of the causative factors in tooth wear is vital.

Meanwhile, figures from the latest UK Adult Dental Health Survey confirm an increase in tooth wear since the last survey. Over three quarters of adults show signs of tooth wear. An increase in moderate wear amongst younger adults is especially alarming as it is suggestive of rapid wear. This strongly suggests that preventive treatment above and beyond what is generally already being offered is needed if the UK population’s dental health is to be secured in the long term.

Irrespective of age and circumstance, it is important to recognise that, amongst other issues, poor drink and food choices, some medical conditions and stress can all cause considerable tooth wear.

If you have any concerns about tooth wear or would simply like some preventive advice, visit www.toothwear.co.uk and arrange to see your dentist or hygienist – they are there to help you!

The London Tooth Wear Centre® is delighted to open its doors to dental colleagues for a series of exclusive referral evenings.

Each evening provides an opportunity for just a few visitors to meet the team, gain an hour of verifiable CPD in an update on tooth wear and discuss how we can support you and your patients.

The London Tooth Wear Centre® is a specialist referral practice in Central London offering an evidence-based approach to managing tooth surface loss.

Led by Professor Andrew Eder, Specialist in Restorative Dentistry and Prosthodontics, the Centre was established in response to an increasing number of patients presenting with tooth wear.

Professional help is available at The London Tooth Wear Centre® for consultation and treatment planning advice only or for comprehensive management of your patients’ tooth wear.

Referral evenings are scheduled for:

• Tuesday 12 February 2013 at 6.30pm
• Tuesday 12 March 2013 at 6.30pm
• Tuesday 9 April 2013 at 6.30pm

For further details and to book onto one of our limited attendance referral evenings, please visit the Dentists Area, email info@toothwear.co.uk or call 020 7486 7180.

Spaces are offered on a first come first served basis.

We look forward to welcoming you.

Read Professor Andrew Eder’s piece “Tooth wear: Eroding trust in carbonated drinks” in The Probe – December 2012

Download (PDF, 919KB)

Read Professor Andrew Eder’s piece “Tooth wear: Worn down by drink and drugs” in The Probe – November 2012

Read Professor Andrew Eder’s piece “Toothwear: The impact of a stressful lifestyle” in The Probe – October 2012

Read Professor Andrew Eder’s piece “New generation, new challenges: Toothwear” in PDD – October 2012

Read Professor Andrew Eder’s piece “Tooth wear: The impact of an eating disorder” in The Probe – September 2012

Read Professor Andrew Eder’s piece “Tooth wear: Swimming and sensitivity” in The Probe – August 2012

Andrew Eder investigates athletes oral health and one of the most common dental conditions affecting athletes; dental erosion. Read Professor Andrew Eder’s piece on “Carrying the torch for oral health” as published in The Dentist below.

Read Professor Andrew Eder’s interview with Expert Beauty – Summer 2012

Read Professor Andrew Eder’s quotes in The Sun Health February 2012

Read Professor Andrew Eder’s quotes in The London Evening Standard November 2011

Read Professor Andrew Eder’s piece “Take Care of Your Teeth” in Choice Magazine – November 2011

Read Professor Andrew Eder’s piece “Keep your smile healthy” in The Lady Online – August 2011

Discover recommendations for tooth friendly food and drink choices and find out how what you eat can make a big difference to your teeth. Complete the quiz “How smile friendly is your diet?” as published in Top Sante below.

Read Professor Andrew Eder’s piece “What’s causing your tooth pain?” in Top Sante – March 2011

Read Professor Andrew Eder’s piece “A brush with tooth trouble” in The Jewish Chronicle – October 2010

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