Chipping or wear of teeth: Healthy, well functioning teeth do not exhibit damage and deterioration with normal use. Teeth will wear if there is parafunctional activity such as daytime clenching or nighttime grinding. Daytime clenching can be stopped through heightened awareness (reminding one’s self not to clench) while teeth can be protected at night with the use of a nightguard. Teeth will also wear if they are not in a favorable position. Examples include teeth in crossbite or an edge-to-edge bite. The best option is to move the teeth into their proper position via orthodontic treatment. It can become very expensive to repair worn teeth. Furthermore, shortened teeth are very unaesthetic.

Accelerated movement of teeth: Most of us will experience some tooth movement throughout our lifetime. A bigger concern is when teeth appear to displace at an accelerated rate. This is typically seen in the lower arch—in particular with the incisors. Commonly, one or more of the mandibular incisors will begin to move either outward or inward, then the shifting incisor will then cross over an adjacent tooth. If you notice movement of your teeth, see an orthodontist for either a retainer (to stop the movement) or for retreatment with Invisalign. If crowding becomes too great, it may require the extraction of a tooth in order to achieve ideal alignment.

Increased gum recession: Gum recession under any circumstance is a sign of gingival distress and/or an unhealthy oral environment. Proper home care and regular dental check ups will minimize gum loss and maintain optimal gingival health. Remember, the gums or gingiva are the covering for the important bony housing of the roots of the teeth. Therefore, gum recession = bone loss. And too much bone resorption puts one’s tooth or teeth at risk for increased mobility and possible loss. It is especially important to catch gum recession early on, because once the recession develops, it cannot be easily repaired—even with a graft. Rapid gum recession is usually due to different reasons than poor oral hygiene. Possible causes include overly aggressive tooth brushing (especially with a stiff bristled toothbrush), a high frenum attachment, traumatic occlusion (teeth coming into early contact) or teeth in crossbite (usually seen when a lower incisor is displaced forward). Tooth related issues that are causing recession can be addressed with orthodontic intervention.

Palatal Impingement: Palatal impingement is when the incisal (top) edges of the lower incisors bite into the palatal tissue behind the upper incisors. This is the most severe form of vertical overbite. Over time, damage to the gum tissue in the palate can cause stripping of the gingiva, which may ultimately result in loss of the upper front teeth. It can also be very uncomfortable or painful—the tissue directly behind the maxillary central incisors is very sensitive. This tissue is called the incisive papilla and can easily become irritated or inflamed with trauma (think pizza burn). Since palatal impingement involves a significant overlap of the front teeth, the other consequences of the “deep bite” are wear on the anterior teeth and lower incisor crowding. This situation can be temporarily corrected with a retainer (to protect the palate) or more permanently with orthodontic intervention.

Abractions: Abractions are a dental term for teeth that lose tooth structure where the teeth and gum come together (along the gum line). The damage is typically wedge or “V”-shaped and is not related to cavities, bacteria or infection. One usually notices abfractions when food begins to get caught in the wedge or the teeth develop sensitivity to hot and cold. Over time, the loss of enamel can make the teeth vulnerable to tooth decay and ultimately affect their structural integrity. Abfractions are due to long-term stress on the teeth and common causes are bruxing (teeth grinding), mal-aligned teeth (especially tipped-in posterior teeth), acid reflux, eating disorders or dry mouth. Options for treatment include fillings, a mouthguard (if bruxing), special toothpaste (like Sensodyne for sensitivity) and orthodontics that can be helpful if the occlusion is the cause of the abfractions.

Discoloration of teeth: Unfortunately, teeth generally darken or yellow with age. This is due to the fact that enamel thins, dentin (yellow inner layer) thickens and translucency diminishes. Other factors that darken teeth are environmental such as smoking, eating certain foods and drinking red wine/coffee and taking some medications. A bigger concern is when a tooth suddenly changes color with or without associated pain. This situation is uncommon but not rare. It usually occurs when the tooth has had trauma and it is the result of the tooth “dying”. It may happen shortly after the trauma or quite some time later — long after the injury. The tooth likely will need to have a root canal to remove the infected nerve. If there is a crack in the root from the trauma, the tooth may need to be removed and an implant placed.