Tooth wear is the gradual loss of tooth structure that is not caused by decay. It is slow, painless in its early stages, and almost always noticed too late, which is precisely why it goes unclaimed.
Enamel does not grow back. Once it is gone, the tooth is permanently weaker, more sensitive and more likely to crack.
The three kinds of wear
Attrition: tooth-on-tooth grinding. This is the classic consequence of bruxism, and the most common form seen in veterans.
Erosion: chemical loss of enamel from acid. Reflux, vomiting, high-acid diets, energy drinks and prolonged dry mouth all contribute. Gastro-oesophageal reflux is significantly more common in veterans with anxiety and PTSD, and the medications used to manage those conditions frequently reduce saliva.
Abrasion: mechanical wear from something other than teeth. Aggressive brushing, abrasive habits, and holding objects in the teeth all count.
Most veterans have a combination of all three, which is one reason the assessment needs to be done by a dentist rather than assumed.
Why service contributes
- Diet: food and drink high in acid and sugar, eaten irregularly and often without the chance to clean afterwards.
- Dehydration: heat, physical exertion and limited access to water all reduce saliva, which is the mouth’s natural acid buffer.
- Deferred treatment: dental problems that would normally have been treated early were routinely put off, and small issues became large ones.
- Grinding and clenching: see bruxism.
- Medication: many commonly prescribed psychotropic and analgesic medications cause dry mouth, which accelerates erosion sharply.
- Reflux: frequently secondary to accepted mental health conditions and to some medications.
What it looks like
- Teeth that appear shorter than they used to
- Flat, glassy or cupped biting surfaces
- Yellowing as the darker dentine shows through thinning enamel
- Thin, translucent or chipped edges on the front teeth
- Increasing sensitivity to cold, sweet or acidic food
- Fillings that appear to be standing proud of the surrounding tooth; usually the tooth has worn away around them
Claiming it
Tooth wear has its own Statement of Principles (F093). A diagnosis must be confirmed by a dental clinician, and the claim needs evidence that connects the pattern and severity of wear to the circumstances of your service or to an already accepted condition.
That evidence is the part most veterans cannot assemble on their own. Charting, imaging, clinical notes and a considered clinical opinion all need to be present and consistent. That is what we do.
