Tooth wear is something I see regularly, and it's one of those conditions that can progress significantly before patients notice anything is wrong. By the time teeth feel sensitive or look visibly short, quite a lot of enamel has often already been lost.
What does tooth wear actually mean?
Enamel is the hard outer layer of each tooth. Once it's gone, it doesn't grow back. Tooth wear refers to the gradual loss of this enamel (and eventually the softer dentine beneath it) through one or more of several processes.
The main causes
Bruxism (grinding and clenching): This is the most common cause I see. Many people grind their teeth at night without realising it. Over time this flattens the edges of the teeth, particularly the front teeth, and causes them to become short and square-looking. It can also cause jaw pain, headaches and cracked teeth.
Acid erosion: Dietary acids from soft drinks, fruit juice, citrus and wine can dissolve enamel over time. Acid reflux (where stomach acid reaches the mouth) is another significant cause. Erosion tends to affect broader surfaces of teeth rather than just the edges.
Abrasion: Caused by physical wear, most commonly aggressive tooth brushing with a hard-bristled toothbrush, or toothpastes that are highly abrasive.
Attrition: Wear from tooth-on-tooth contact, often related to an unfavourable bite where the teeth don't meet evenly.
How do I know if my teeth are worn?
Signs to look out for:
- Front teeth that appear shorter or flatter than they used to
- Edges of teeth that are transparent or look chipped even though you haven't chipped them
- Increased tooth sensitivity, particularly to cold or acidic foods
- Teeth that feel rough or uneven
- A smile that looks increasingly "aged"
What can be done?
Treatment depends on the cause, the severity and which teeth are affected. The priority is always to identify and address the underlying cause first, otherwise restorations placed on worn teeth will themselves wear prematurely.
- Occlusal splint: A custom-fitted night guard protects the teeth from further wear caused by grinding while you sleep
- Dietary advice: Reducing acid exposure and adjusting habits that are contributing to erosion
- Composite bonding: For mild to moderate wear, composite resin can restore the length and shape of the teeth conservatively and without significant tooth preparation
- Ceramic veneers or crowns: For more significant wear, ceramic restorations offer greater durability and can restore both aesthetics and function
- Invisalign: Where the bite itself is contributing to wear, aligning the teeth can help distribute forces more evenly, often combined with restorations afterwards
Worn teeth are one of my particular areas of interest, I find the treatment planning genuinely rewarding because the results can be quite significant for patients who've been living with the effects for years.