What is tooth wear?
Enamel is the hard outer layer. Dentin, underneath, is softer and yellower. Once wear reaches dentin it speeds up: teeth get shorter and more sensitive, edges chip, and the bite can lose height. Some wear over a lifetime is normal. It is a problem when it is faster than the years explain.
What causes teeth to wear down?
- Erosion: acid dissolving enamel. From food and drink (citrus, soda, sports and energy drinks, wine) or from inside (reflux, frequent vomiting). Erosion leaves smooth, cupped, glassy surfaces.
- Attrition: tooth against tooth. Clenching and grinding (bruxism), often in sleep, flatten the biting edges and chewing cusps (the raised points on back teeth) until upper and lower teeth fit together like puzzle pieces (bruxism at our office).
- Abrasion: something else against the tooth. A hard brush, an abrasive paste, nail biting. A typical sign is a notch at the gum line.
An uneven bite, or missing back teeth that shift the load to the front, makes attrition worse. Temporomandibular disorders (TMD: pain or dysfunction of the jaw joint and chewing muscles) often coexist with grinding, but the joint does not wear the teeth. The grinding does.
How can I tell if my teeth are wearing?
- Front teeth look shorter, flatter, or see-through at the edges.
- Chewing surfaces look shiny, flat or cupped; old fillings stand above the tooth around them.
- Sensitivity to cold, sweet or sour, yellow patches of dentin with dark stain settling into them, chipped edges, cracked teeth, or a jaw that is tired in the morning.
We record it with photographs and models of your teeth and compare them over time, which is how slow wear is told from fast.
How are worn teeth treated?
- Find the cause. A diet history, questions about reflux (sometimes a conversation with your physician), a look at how you brush, and a bite examination that includes the jaw joints and muscles.
- Stop the damage. Change the acid exposure, soften the brushing, and, for grinders, a night guard (an occlusal splint: a custom plastic appliance worn over the teeth in sleep) that takes the wear instead of the enamel.
- Restore what is lost, matched to how much is lost. Mild wear: often monitoring, or composite bonding (tooth-colored resin added to the worn edges), quick and repairable but less durable than ceramic (fillings and bonding). Moderate wear: veneers (thin porcelain facings bonded to the front of the tooth) on front teeth that have lost length; onlays (partial ceramic coverings) on back teeth that have lost cusps (inlays and onlays). Severe wear with a collapsed bite: crowns or onlays on most teeth, planned together around one even bite height, which is full-mouth rehabilitation. The new height is usually tested first, in temporary restorations or a removable appliance, before anything is made in ceramic (occlusion and planning).
Orthodontic treatment (moving the teeth with aligners or braces) comes in when the bite itself, not only the surfaces, needs correcting. Veneers over a bad bite wear out too.
What happens if worn teeth are left alone?
Sensitivity, chipping, lost fillings, decay in the exposed dentin, and a bite that keeps collapsing, which makes later restoration larger and costlier. Slow wear can be watched for years; we say this to inform the decision, not to rush it.
How can I prevent tooth wear?
- Keep acidic drinks to mealtimes, rinse with water afterward, and wait about an hour before brushing.
- Use a soft brush and a low-abrasion fluoride toothpaste.
- Wear your night guard if you grind, and replace it when it wears through.
- Sugarless gum after meals raises saliva, which neutralizes acid.
When to call us
Call if a front tooth chips, teeth suddenly feel sensitive or shorter, or you have been told you grind and have no guard.
Questions patients ask
Will restoring my teeth change my face?
Rebuilding lost bite height can modestly change how the lower face sits in patients who have lost a lot of height. We do not plan restorations for facial effect, and we do not promise one.
Can I see the planned shape before you start?
Yes. We plan the new tooth shapes digitally and try them in your mouth as a mock-up (a temporary overlay) before any tooth is prepared (smile design).