9-15 July is TOFS awareness week! Find out about TOFS and why we’re supporting the work of the charity here at Rhiwbina Dental.

TOF stands for trachea-oesophageal fistula – which is when there is an abnormal connection between the trachea (the breathing tube that connects to our lungs) and the oesophagus (the tube used for swallowing, connecting with the stomach). Along with oesophageal atresia (OA – a condition in which the oesophagus does not develop fully), TOF/OA prevents the ability to swallow.

TOF/OA is a condition that usually becomes apparent at birth – and with increasing awareness, there is a good prognosis for many children born with TOF/OA. However, many adults live with TOF/OA and dental health is one of the many challenges they face. The charity TOFS works to raise awareness and our dentist, Alison Lewis, recently contributed to the TOFS magazine with advice about dental health. Check out her article below – and visit the TOFS website for more information.

Tooth wear in Adult TOFs by Dentist Alison Lewis

This article aims to give an overview of tooth wear, a common condition affecting many Adult TOFs.

What is tooth wear?

Tooth wear is a term used to describe the progressive loss of a tooth’s surface due to actions other than those that cause tooth decay or dental trauma. It is becoming more widespread, as people keep their teeth longer, and because of modern dietary habits. There are three main types: erosion; abrasion; and attrition. Although one type can exacerbate the other, it is erosion, which generally affects TOFs.

How are TOFs affected?

Adult TOFs are at high risk of tooth wear due to the gastro-oesophageal reflux that often goes hand in hand with the TOF condition. Acid from the reflux causes the surface of the tooth enamel to ‘dissolve’. When this happens repeatedly, the damage starts to become noticeable. It can range from a mild 'glassiness’ of the enamel surface to a full-blown stripping-off the enamel down to the dentine, which can then be affected in the same way. It classically affects the back of the upper front teeth (the palatal aspect), as this is the surface that the reflux acid contacts first.

If left unchecked tooth wear can lead to unsightly teeth, chipping and sensitivity. In severe cases, it can result in death of the nerve within the tooth, with the possibility of associated infection.

What you can do to help reduce the likelihood of tooth wear

  • Try to keep reflux under control, with medication if necessary. Your GP will be able to prescribe something appropriate.
  • Avoid foods that makes your reflux worse.
  • Reduce intake of fizzy drinks and fruit juices. Drink plenty of water (but not sparkling!). If you do drink something acidic, use a straw.
  • Avoid tooth brushing for 20 to 30 minutes after consuming acidic food or drink. This gives the saliva time to 'lock down’ the top layer of enamel that has been softened by the acid. Brushing too soon can wash this top layer down the plughole, thus speeding up the effects of the acid erosion.
  • Use a fluoride mouthwash. This will help strengthen susceptible enamel.
  • Use a desensitising toothpaste, eg Sensodyne Repair and Protect, or ProEnamel. This will help reduce any sensitivity.
  • Avoid scrubbing with your toothbrush. Studies have shown electric toothbrushes to be more effective at removing plaque, and can be less damaging if used correctly.
  • Chewing sugar free gum helps stimulate saliva flow – important for washing away and buffering any food acids.

Treatment available if tooth wear is present

The first priority is to address the causes of tooth wear as above. If tooth wear is already present, there is a range of treatments that can help. Sometimes management of sensitivity and addressing dietary habits are all that is needed.

If tooth wear is more severe, it may be possible to rebuild the lost tooth tissue with composite. This is a tooth-coloured filling material, which is bonded to the teeth. It doesn’t involve any drilling or anaesthetic and is thus a 'tooth-friendly’ treatment, not involving the removal of any more precious tooth tissue.

Another option is porcelain crowns. This is a more complicated and expensive treatment. Damage from tooth erosion is usually widespread, and treatment can involve several, if not all of the teeth. This needs to be done with much planning and care by someone with a lot of experience. Many dentists are happy to do this in general practice, though others prefer to refer to a specialist. Certain cases may be available for NHS treatment, but this would need individual assessment. NHS Direct or your Local Health Board may be able to help you find an NHS dentist.

If you live near a Dental Teaching Hospital, it might be possible to get specific treatment there, if your general practice cannot provide it.

There is a lot of information about reflux, diet and teeth online. Being well informed, helps you to make healthy choices that will minimise any damage that TOF-related gastro-oesophageal reflux can cause.

ref: British Health Foundation Ireland

Alison N Lewis BDS DPDS

Alison is a General Dental Practitioner working in a specialist practice in Cardiff. www.rhiwbinadental.com