Tooth wear is the progressive loss of the hard, mineralized substance of the tooth structure by means other than decay or trauma. This wear can manifest as a change in the tooth’s shape, a reduction in length, or the loss of the protective outer layer of enamel. Modern dental techniques offer effective methods to repair and restore worn down teeth. The chosen repair strategy depends on the severity of the damage and the underlying cause responsible for the wear.
Identifying the Causes of Tooth Wear
Successful restoration requires identifying and stopping the source of the damage, as repairing teeth without addressing the cause will result in new restorations failing. Tooth wear often involves a combination of three main processes: attrition, erosion, and abrasion. These mechanisms can occur independently or interact, making a proper diagnosis essential for treatment planning.
Attrition is the physical loss of tooth material caused by direct tooth-to-tooth contact. This is commonly seen in patients who suffer from bruxism, which is the involuntary clenching or grinding of teeth, often unconsciously during sleep. The result is a flattening or shortening of the biting surfaces of the teeth.
Erosion involves the chemical breakdown of the tooth structure due to acid exposure not caused by bacteria. Sources of this acid can be extrinsic, coming from highly acidic diets like frequent consumption of sodas or citrus fruits, or intrinsic, originating from the stomach. Medical conditions like gastroesophageal reflux disease (GERD) or eating disorders that cause chronic vomiting introduce gastric acid into the mouth, which dissolves the enamel and exposes the softer dentin layer.
Abrasion is the mechanical wearing away of tooth substance by friction from an external object other than another tooth. Common causes include aggressive horizontal tooth brushing, particularly with a hard-bristled toothbrush or abrasive toothpaste, or habitual actions like nail-biting or chewing on pens. This type of wear often presents as distinctive notches or grooves near the gumline.
Direct Repair Techniques for Minor Damage
When tooth wear is minor to moderate and the underlying structure remains sound, dentists often use direct repair techniques, which are typically completed in a single visit. These methods are conservative, requiring minimal removal of healthy tooth material, and are generally less costly than laboratory-fabricated restorations.
Composite bonding is a highly versatile and popular direct restoration method where a tooth-colored resin material is applied directly to the tooth surface. The dentist sculpts this putty-like material to recreate the original shape of the worn tooth edge or surface, then hardens it instantly using a specialized light. This technique is ideal for repairing minor chips, small cracks, or the slightly shortened edges of front teeth.
Dental fillings are employed to restore specific, localized areas of wear, such as a worn-down biting surface. The restorative material, often a composite resin, is placed directly into the prepared area to replace the lost structure. If minor wear has led to increased sensitivity, a dentist may also apply desensitizing agents or fluoride varnish to help remineralize the exposed structure and reduce discomfort.
Indirect Restorations for Significant Wear
When the tooth has suffered significant structural damage, requiring strength, coverage, and durability, indirect restorations are the preferred solution. These restorations are custom-made outside of the mouth in a dental laboratory from precise impressions and are permanently bonded to the tooth. This process generally requires at least two appointments.
Dental crowns, often referred to as caps, are used when the tooth structure is severely compromised and requires full coverage to restore its strength and function. A crown covers the entire visible portion of the tooth down to the gum line, fully encasing it in a protective and durable material. Materials for crowns have advanced significantly, with all-ceramic options like porcelain, lithium disilicate, and high-strength zirconia offering exceptional aesthetics and longevity.
For a more conservative approach than a full crown, porcelain onlays are used, especially in back teeth, when wear involves some but not all of the biting surface cusps. Onlays are custom-fabricated and bonded to the tooth, providing better strength than a large filling while preserving more natural tooth structure than a crown. Porcelain veneers are thin, custom-made shells bonded to the front surface of teeth, primarily used to correct aesthetic issues like severe wear, discoloration, or irregular shapes.
After investing in durable restorations, preventative measures are necessary to protect them from the forces that caused the initial damage. For patients with a history of bruxism, a custom-fitted night guard or occlusal splint is mandatory to wear while sleeping. This protective device acts as a cushion, distributing the forces of grinding and clenching to prevent cracking or premature wear on the new restorations.