Tooth wear is the progressive loss of tooth structure, affecting the aesthetic appearance and functional integrity of the front teeth. It results from three primary mechanisms: attrition, abrasion, and erosion, which can occur individually or in combination. Since front teeth are highly visible, wear is concerning for the smile’s appearance. Thinning enamel often leads to increased sensitivity to temperature changes. Addressing wear requires identifying the specific cause and selecting a restoration method that rebuilds lost structure while protecting the remaining tooth.
Identifying the Underlying Causes of Tooth Wear
Attrition is the mechanical wearing down caused by tooth-to-tooth contact. The most common cause of accelerated attrition is bruxism, the habitual clenching or grinding of teeth, which often occurs involuntarily during sleep. This constant, excessive force flattens the incisal (biting) edges of the front teeth. It removes the hard enamel layer, exposing the softer dentin underneath.
Abrasion results from friction caused by foreign objects repeatedly contacting the teeth. This wear often appears as wedge-shaped or V-shaped indentations near the gum line. Common causes include overly vigorous or incorrect toothbrushing techniques, using a hard-bristled brush, or habits like biting on pens or fingernails. This physical rubbing wears away the protective enamel and cementum at the neck of the tooth.
Erosion involves the chemical dissolution of tooth enamel due to acid exposure, without bacterial involvement. Acids can be extrinsic, such as those from highly acidic dietary sources like citrus fruits, carbonated beverages, and wines, which soften the enamel surface. Internal sources, such as chronic acid reflux (GERD) or frequent vomiting, introduce powerful gastric acid. This acid is particularly damaging to the lingual (tongue-side) surfaces of the front teeth.
Assessing the Severity of Dental Abrasion and Erosion
A dentist must accurately diagnose the extent and pattern of wear to ensure the chosen restorative approach is appropriate. Diagnosis often involves clinical grading systems, such as the Basic Erosive Wear Examination (BEWE), which scores the severity of the damage. This systematic assessment helps determine the depth of structure loss and guides the clinician in selecting the most conservative repair.
Assessing the proximity of the wear to the dental pulp is a critical component of diagnosis. When wear is severe, the overlying dentin thins, risking pulp cavity exposure, which may necessitate more complex treatment. For extensive, generalized wear, the dentist also evaluates the loss of the Occlusal Vertical Dimension (OVD). Rebuilding this vertical distance between the jaws is a complex process that often requires a full-mouth approach to restore the original bite height and function.
Restorative Treatment Options for Worn Front Teeth
The primary goal of restorative treatment is to rebuild the lost tooth structure while addressing aesthetic concerns. For minor to moderate wear, the least invasive option is Composite Bonding, a direct restoration procedure performed in a single visit. The dentist applies a tooth-colored composite resin material directly to the worn surface, meticulously sculpting and shaping it to restore the tooth’s original contour before hardening it with a specialized light.
For more significant aesthetic improvements or moderate structural loss, indirect restorations like Porcelain Veneers are often recommended. These are thin, custom-fabricated shells, typically made of durable ceramic, that are permanently bonded to the front surface of the tooth. Placement usually requires removing a small amount of enamel to create space for the restoration, ensuring a natural fit, excellent strength, and color stability.
In cases of severe structure loss, where the tooth is significantly shortened or weakened, a Dental Crown may be necessary. A crown covers the entire tooth above the gum line, providing maximum support and reinforcement. It fully encapsulates the remaining structure to protect it from fracture and further wear. If the underlying cause is a malocclusion or incorrect bite, an initial phase of Orthodontic treatment, such as clear aligners, may be required before placing restorative material.
Long-Term Management and Prevention
Successful treatment depends on maintaining the restorations and eliminating the original cause of the wear. For individuals diagnosed with bruxism, a custom-fitted Occlusal Guard (night guard) is fabricated to be worn during sleep. This appliance creates a physical barrier that separates the upper and lower teeth, protecting both natural structure and new restorations from grinding forces.
Preventing acid erosion requires specific dietary and behavioral modifications to reduce the frequency and duration of acid exposure. This involves limiting acidic foods and beverages, using a straw to bypass the front teeth, and immediately rinsing the mouth with water to neutralize the acid. It is important to avoid brushing immediately after an acid attack, as the softened enamel is susceptible to further abrasion.
To mitigate abrasive wear, proper oral hygiene habits must be adopted, starting with a soft-bristled toothbrush and a non-abrasive toothpaste. Brushing should be performed with gentle, circular motions rather than an aggressive scrubbing action. This protects the gums and the junction of the tooth and root, ensuring the longevity of any restorative treatment.