By: Anna Giacalone, DMD

One might expect to see severely worn teeth in the elderly. Unfortunately I see a great number of patients far from being considered elderly with short, discolored, worn teeth. Some don’t show teeth at all when they smile. The loss of tooth structure ages these patients.
In addition to the cosmetic impact of tooth wear, there are health issues. Patients may experience sensitivity, fractures of teeth, jaw joint and facial muscle pain. Severe rapid wear may even wear through enough hard tooth structure to expose the nerve of the tooth!
The outermost layer of tooth structure known as enamel is the hardest substance in the human body. Once this enamel is worn through the next layer, dentin, is exposed. Dentin has about the same hardness as bone and is much darker than enamel. The exposure of the darker dentin is why teeth get darker as they wear. Also, since the dentin is softer than enamel the wear of teeth accelerates. Sometimes wear is vertical, making teeth shorter. At times the wear is front to back making teeth thin, almost transparent.
Severe wear isn’t the result of the normal function of chewing. It is, rather, the result of parafunction, habits such as grinding, clenching, nail biting. A special type of tooth wear known as erosion occurs as a result of acid attack on teeth. Stomach acids come in contact with the teeth when patients suffer from acid reflux diseases or bulimia. A highly acidic diet can also cause erosion of the teeth.

What can be done?
First, have regular dental check –ups so that your dentist can detect the early signs of abnormal tooth contact and help you either eliminate the cause or limit the damage.
When erosion is the type of wear, a change of diet or referral to a medical specialist is appropriate. If attrition of vertical height of teeth is noted, then grinding or clenching is most often the cause. Improper tooth/jaw position can trigger these habits. Your dentist might recommend orthodontics or tooth reshaping to remedy this. At times stress initiates the grinding and clenching habit. Ideally stress reduction is the best solution. Sometimes counseling, medication or biofeedback help. Most often stress can not be eliminated and our ability to deal with it is less than perfect. In this case a “damage control” appliance known as an occlusal guard can be worn. There are many designs of occlusal guards. Some are worn at night when most people parafunction without even knowing they do.
When the loss of tooth structure has already occurred, we need to restore the lost tooth structure as well as prevent reoccurrence. We have many ways of restoring the natural length and shape of teeth including bonding, veneers, crowns and bridges. Tooth structure can be restored while restoring harmony and balance to the jaw joint and muscles. Tooth sensitivity is often eliminated.

Our goal is to give our patients the smile
of their youth, a comfortable healthy mouth,
and the self confidence of a beautiful smile.

Dr. Giacalone attended Chestnut Hill College earning a B.S. in biology in 1978. In 1982 she graduated from the University of Pennsylvania School of Dental Medicine, receiving the Pennsylvania Dental Association Award of Excellence. After graduation, she served four years in the U.S. Public Health Service, providing dental care to the underserved. Since that time, she has been working in private practice providing a wide range of dental services to the people of Delaware County. In December Dr. Giacalone celebrated a milestone, 20 years of dental practice in the Olde Ridge Village.
Dr. Giacalone puts a good deal of effort into continuing dental education. She earned Fellowship status in the Academy of General Dentistry after completing the required five hundred hours of specified education and passing the national exam. Currently she is pursuing the next level, mastership. Other scholarly pursuits include publication of an article in a major dental journal, lecturing and teaching. In 1993 she completed the program in Complete Dentistry at the prestigious Dawson Institute for Advanced Dental Studies, an experience which had a major impact on the way she practices dentistry.

Dr. Giacalone has been honored by patients, peers, and consumer groups with the following awards:
• “Top Cosmetic Dentist Main Line Today 2007 (chosen by  peers)
• “Top Dentists Delaware Valley 2008, Delaware Consumers’ Checkbook (chosen by patients)
• “America’s Top Dentists 2010, Consumer Research Council of America

To learn more about the dental practice of
Anna C. Giacalone, DMD, Inc. visit her web site:
www.agiacalonedmd.com