Toothbrush Abraision and Sensitive Teeth
November 7, 2000

Dear Dr. Mady: I recently noticed that my teeth are starting to look long and they appear notched by the gum line. Also, I can catch the edges by the gums with my fingernails and they are very sensitive. What do you think this is and what is causing it? -J. B.

Dear J. B.: It sounds like you are suffering from a classic case of what is known as toothbrush abrasion. It is a specific clinical disease that has been well-defined for many years. It is usually described as a mechanical reduction of tooth tissue usually occurring over a long period of time.

It is also called cervical abrasion and most often results from faulty toothbrushing techniques. As well, the gums wear away at the same time as the tooth structure.

As in your case, abrasion is characterized by gingival recession, more commonly known as receding gums. This is what causes the teeth to appear longer and esthetically unappealing. Also, recession often breeds sensitivity and pain due to exposure and wear of the cementum layer over the roots.

This layer is softer than the enamel layer and more prone to decay, erosion and additional abrasion. In fact this does not mean that you have poor oral hygiene. Often individuals with this condition have better oral home care habits than others. It is true that people who do not brush often have less incidence of cervical abrasion.

After moderate wear of the tooth surface has occurred, sensitivity may be intermittent and may occur from cold or hot food and beverages, breathing in cold air, brushing and flossing and from certain foods, especially acidic ones. The recession is not reversible but can be halted with proper toothbrushing techniques, and proper restorative treatment by your dentist can stop further wear.

Not only is improper brushing technique to blame, but also using the wrong kind of toothbrush. I recommend that only a soft or ultra-soft bristle type brush should be used when brushing. The medium or hard type bristle brushes definitely promote unnecessary wear of the teeth, especially if you are a heavy-handed brusher.

Even more important than the type of brush is the brushing method, and force used in the process. A key to successful brushing is to use a gentle touch, and if the brush has soft, polished bristles, they are less likely to injure gum tissue or tooth.

Your dentist or hygienist will recommend and demonstrate various methods of brushing but it is important to remember that during brushing, let the brush do the work instead of your hand or your arm. Many make the mistake of feeling that their teeth are not clean if they don't brush hard. This is untrue and the worst type of brushing is the rugged back and forth style similar to the way that young children brush their teeth. The many methods taught include a circular scrub or an up and down method.

My best advice is to see your dentist immediately. He or she will recommend treatment and habit changes based on your particular condition and stage.

If you have lost considerable amounts of tooth structure, a cosmetic/protective bonding procedure may help. If a significant amount of gingival or gum tissue has been worn away in the process, you may be referred to a Periodontist (gum specialist) to see if you are a candidate for a gingival graft procedure. This is a surgery where gum tissue is taken from the roof of your mouth or somewhere else and grafted over the exposed root surfaces to improve appearance and reduce tooth sensitivity. The periodontist will also be able to discuss toothbrushing habits with you and demonstrate different techniques that are non-destructive.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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