Worn down teeth, known as tooth wear, can significantly compromise both the function and appearance of a person’s smile. This loss of tooth structure occurs through mechanical and chemical processes, leading to shortened, chipped, or sensitive teeth. Fixing this damage is not a one-size-fits-all process; the appropriate treatment depends entirely on the severity of the wear and the specific underlying cause. A successful solution requires first identifying and stopping the source of the wear before undertaking any restorative procedures.
Identifying the Underlying Cause of Wear
The repair of worn teeth begins with a professional diagnosis to pinpoint the type of wear responsible for the damage. Attrition involves the mechanical loss of tooth structure from direct tooth-on-tooth contact, typically seen on the biting surfaces of the back teeth and the edges of the front teeth. This is often accelerated by bruxism, the habitual clenching or grinding of teeth, which frequently occurs unconsciously during sleep.
Abrasion is the loss of tooth structure due to mechanical forces from foreign objects other than opposing teeth, commonly presenting as V- or wedge-shaped notches near the gumline. Aggressive horizontal brushing with a hard-bristled toothbrush or highly abrasive toothpaste are common culprits. Habits like chewing on pens or using teeth to open packages also contribute. Erosion represents the chemical loss of enamel and dentin caused by acid dissolving the mineral structure without bacterial involvement.
Acid exposure can come from extrinsic sources, such as frequent consumption of highly acidic foods and drinks like citrus fruits, sodas, and wine. Intrinsic acid from the stomach, often due to conditions like gastroesophageal reflux disease (GERD) or eating disorders involving frequent vomiting, can cause widespread thinning of the enamel. Without diagnosing and controlling the specific cause—whether grinding, aggressive brushing, or acid exposure—any restorative work will be at risk of failing due to the ongoing destructive process.
Restorative Solutions for Mild to Moderate Wear
When tooth wear is superficial, localized, or involves minor loss of surface structure, conservative, direct restorative methods can effectively repair the damage. Composite bonding utilizes a tooth-colored resin material applied directly to the tooth, sculpted to the desired shape, and hardened with a special light. This technique is excellent for restoring chipped edges, lengthening shortened teeth, or closing small gaps, often completed in a single dental appointment.
The bonding material adheres securely to the natural tooth structure, allowing the dentist to be conservative with preparation, meaning minimal healthy tooth structure needs to be removed. While not as durable as porcelain restorations, composite is highly aesthetic and can be easily repaired or modified if minor damage occurs. For grooves or notches formed near the gum line, often caused by abrasion or flexural forces, dental fillings using the same composite resin are a common solution.
These restorative fillings address the cosmetic concern, protect the exposed dentin, and reduce sensitivity. In instances of minor surface irregularities, subtle recontouring of the enamel can smooth sharp edges and improve the bite without adding material. These direct restorations are preferred because they are minimally invasive, cost-effective, and provide an immediate improvement in both function and appearance.
Advanced Treatments for Severe Tooth Damage
For cases where significant tooth structure has been lost, affecting the bite relationship or structural integrity, more comprehensive and durable indirect restorations are necessary. Dental crowns are full-coverage restorations that encase the entire visible portion of a tooth, providing maximum strength and protecting severely shortened or compromised teeth. Crowns are typically fabricated in a dental laboratory from high-strength materials like ceramic or zirconia, offering superior longevity and resistance to further wear.
Porcelain veneers are thin, custom-made shells bonded to the front surface of teeth, making them the preferred choice for advanced aesthetic wear on the front teeth. While primarily addressing appearance, veneers also restore lost length and can subtly influence the overall bite scheme when bonded to the biting edge. Severe, generalized wear often requires full mouth rehabilitation, particularly when the vertical dimension of occlusion (VDO) has collapsed.
Restoring VDO means increasing the height of the bite to create space for new restorative material and re-establish proper jaw alignment and function. This complex intervention uses a combination of crowns, onlays, and veneers across multiple teeth, often involving both the upper and lower arches. Such extensive treatment focuses on structural integrity and major bite correction, differentiating it from conservative, single-tooth solutions used for mild wear.
Preventing Future Wear and Maintaining Restorations
Restoring worn teeth is only one half of the solution; long-term success depends on eliminating the original destructive forces to protect both natural teeth and new restorations. For patients whose wear is caused by bruxism, a custom-fitted occlusal guard, commonly called a nightguard or splint, is a fundamental protective appliance. This device creates a physical barrier between the upper and lower teeth, absorbing the intense forces generated during clenching and grinding.
Dietary modifications are crucial for managing erosion, primarily by reducing the frequency of consuming highly acidic beverages and foods. Instead of eliminating acidic items entirely, rinse the mouth with plain water immediately after consumption to neutralize the acid and minimize its contact time with the enamel. Oral hygiene techniques must also be adjusted by switching to a soft-bristled toothbrush and using a gentle, circular motion to prevent further abrasion near the gumline. These actions, combined with regular professional maintenance, ensure the longevity of any restorative work and prevent the recurrence of tooth wear.