Despite its strength, the outer tooth surface can be worn down to expose the weaker dentine below.
This exposed dentine can be sensitive, be more prone to decay and is much more readily worn.
If wear occurs very rapidly there can be a resultant loss of facial height – the chin will appear closer to the nose.
Sagging cheeks and deeper creasing of the lips at the corners of the mouth arise from this collapse.
Watch how we blend art and science to design ideal smiles.
This process can be used to address a wide range of aesthetic issues including worn teeth.
How do teeth wear?
One or more of the three factors listed below cause excessive wear:
Bruxism is the grinding of teeth against teeth and it is always involved where there is an accelerated loss of tooth height.
Bruxism most commonly occurs at night while you are asleep – many people are unaware of this habit and the damage it’s causing.
Enamel can be “abraded” away by foreign objects. Examples of this are:
- Tooth brush abrasion The use of medium or hard bristle brushes or particularly abrasive toothpastes will accelerate enamel loss.
- Biting of fingernails, chewing on pens or holding objects between teeth
- Oral Jewellery Lip and tongue piercings often wear away or cause the fracture of adjacent teeth.
The chemical wear of enamel is called erosion. The chemical involved is an acid and it can come from a number of sources:
- Citrus foods. Lemons, Limes, Oranges and Grapefruits and some candies (particular sour candies) contain Citric Acid
- Most soft drinks, sports drinks and fruit juices are very acidic
- Coffee and tea contains corrosive acids
- Red and white wine are highly acidic
- Stomach Acids. Bulimic individuals and those who suffer from gastric reflux regularly expose their teeth to harsh acids.
- Dry mouth. Chronic dehydration, reduced salivary gland function and some medications can all cause a drop in the amount of saliva present. The saliva that does remain is often quite acidic.
How do we treat wear?
As with all medical conditions, treatment often begins with recognising and preventing causative factors:
- Control bruxism.
As a condition with multiple causative factors, this is easier said than done. A properly fitted and adjusted occlusal splint worn while sleeping is a common protective device. Read More
- Change to soft bristled or electric toothbrushes and less abrasive toothpastes
- Curb oral habits such as nail biting and remove oral jewellery
- Recognise and reduce dietary acids. Many can’t be completely avoided so after use, rinse your mouth well with water and don’t brush your teeth untill about 30 minutes after the acid is washed away.
- Seek medical help bulimia or gastric reflux issues.
- Drink adequate daily water to prevent dehydration. This is often listed as 1.5L per day.
- Have salivary gland function tested if you have regular and unexplained dry mouth.
- Explore if there are effective alternatives to medications that cause dry mouth.
Correction is not always a straight forward process of simply replacing the structure lost with a dental restorative material. The treatment required often depends on the rate that the wear occurred.
Slow rate of wear
If wear occurs relatively slowly the teeth will try to maintain proper biting relations to those they oppose by erupting slightly to compensate for this wear.
As a result of the tooth moving downwards, the gums (which are attached to the teeth) will also move downwards giving the appearance of short stout teeth with a gummy smile. The biting edges of the teeth however will appear in a relatively normal position. Therefore, the teeth cannot be made to look their natural height again by adding to the biting edge.
The gum line needs to be moved upwards by:
With orthodontic braces. Teeth can be moved back to the position they were once in, and the gums will move along with them.Read More
“Crown lengthening” is a procedure where excess gum tissue (along with the underlying excess bone) is removed to give the tooth a longer appearance. It is commonly carried out on upper front teeth to correct differing gum heights, and will contribute to an ideal aesthetic outcome. Read More
Once the gums are in a better position, the worn teeth can be returned to their ideal shape with:
Fast, aggressive wear
Sometimes the wear occurs at a rate that the teeth cannot compensate for. This will lead to a collapse in the bite – effectively, the chin will move closer to the nose.
The resulting shorter lower face height can accentuate the aging process, causing sagging cheeks and deeper creasing of the lips at the corners of the mouth.
The short face height can be corrected by addressing the bite collapse. All remaining teeth have to be considered for some kind of restoration to reopen the bite with balanced forces on all teeth. Read More
Worn teeth at the front of the mouth will be returned to their ideal shape with: