Worn Teeth

• Let’s be clear – teeth will wear down. Normal tooth wear is normal. Abnormal tooth wear is not normal. Abnormal, or higher tooth wear occurs from three main causes, often in combination:
• Attrition – a tooth to tooth wear on the biting surfaces of teeth resulting from daily grinding or clenching
• Abrasion – from excess brushing pressure, usually around the sides and necks of teeth
• Erosion – loss of tooth structure caused by long term acidic foods and drinks, e.g. juice, vinegar, or medical conditions such as acid reflux or bulimia.

Teeth become shorter as they wear. This is usually so slow that to the untrained eye it is not immediately noticeable. But look at your old school photos. Focus on the proportions of your front teeth. Have these changed in a short time?

Do your teeth feel sensitive? Often teeth with worn out enamel will allow hot and cold sensations to reach the nerve. Are you avoiding ice cream or other cold foods?

Teeth may appear more yellow. In erosion damaged teeth the inside enamel is usually dissolved from the underlying layers of tooth. Unfortunately, as the enamel is lost, the underlying softer dentine is more easily dissolved or worn out with normal chewing or grinding habits, so ongoing wear happens faster.

As with all conditions, it is important to determine the cause of your tooth wear.

High attrition may be related to an underlying temporomandibular joint disorder (TMD). The management of TMD may include behavioural therapy, night guard or occlusal splint, along with myotherapy to ease muscle tension.

Abrasion related wear needs to be identified as early as possible. Increased wear will result in severe weakening of teeth and is often associated with sensitivity to hot and cold. The use of a soft toothbrush, with a gentle technique and mild toothpaste is often necessary.

For patients consuming a large quantity of acidic food or drink, dietary change will be beneficial. Medical attention should be sought if acid reflux is suspected.

Only when the causes of tooth wear have been identified and resolved can we can consider repair options. As there are usually multiple teeth involved, a complete picture needs to be developed.

Is the state of the teeth overall worthwhile to undertake the large repair process? Are there any teeth which will require more complex dental work such as root canal treatment, or which may not be salvageable?

Large scale repairs across many teeth need to be planned. (If you have all your teeth, including wisdom teeth, this is thirty two teeth.) Often there is a loss of biting height, as worn teeth will be shorter. The remaining teeth may be repaired with material such as to cover the biting surfaces, such as direct fillings, ceramics or metals in crowns or overlay restorations.

Where possible, repair by adding to what has been lost and remove minimal further tooth structure. This will allow you further options down the track.

Tooth wear is a constant process over time which is worsened in certain individuals with lifestyle, homecare or medical factors. This wear and tear process can not only result in total tooth destruction, but as the effects of tooth wear are rarely limited to a few teeth, this usually affects the whole mouth.

Don’t wait for your teeth to wear down to the gum line. Early detection and treatment is more reliable and predictable.