Teeth attrition refers to the gradual loss of tooth substance resulting from direct tooth-to-tooth contact. This mechanical wear affects the biting and chewing surfaces of teeth, though it can also occur on the sides where teeth meet. While a certain degree of tooth wear is a natural part of aging, excessive attrition can lead to significant dental problems, requiring professional attention.
Causes and Signs of Teeth Attrition
The primary cause of teeth attrition is bruxism, which involves the grinding or clenching of teeth. This habit can occur during waking hours and sleep, placing significant strain on the teeth. Misaligned teeth (malocclusion) can also contribute to attrition by causing uneven distribution of chewing forces, concentrating wear on certain areas. Some developmental defects of tooth enamel, or a diet high in hard or abrasive foods, can accelerate wear.
Individuals experiencing attrition may notice visual signs. The chewing surfaces of molars appear flattened, and front teeth can become shortened or chipped. As the outer layer of enamel wears away, the underlying dentin, which is yellowish, can become exposed, resulting in a discolored or darker appearance of the tooth.
Physical symptoms can also develop. Increased tooth sensitivity to hot, cold, or sweet stimuli is common as the protective enamel diminishes. Some individuals may experience jaw pain, headaches, or discomfort in the temporomandibular joint (TMJ) due to muscle strain from clenching or grinding.
Distinguishing Attrition from Other Tooth Wear
Understanding the different types of tooth wear helps in accurate diagnosis and treatment. Attrition involves the wearing away of tooth structure due to direct contact between opposing teeth, manifesting as smooth, flattened facets on the biting surfaces.
Abrasion, by contrast, is the loss of tooth structure caused by external mechanical forces from foreign objects. Examples include toothbrushing, chewing on non-food items like pens or ice, or use of toothpicks. Abrasion presents as V-shaped notches near the gumline, particularly on the outer surfaces of premolars and canines.
Erosion involves the chemical dissolution of tooth enamel and dentin by acids, not mechanical friction. This acid exposure can come from acidic foods and drinks, or from stomach acid from conditions such as acid reflux or vomiting. Eroded teeth appear smooth, shiny, and can have a “cupped” appearance on the chewing surfaces without distinct wear facets.
Abfraction refers to small, wedge-shaped lesions that develop near the gumline, attributed to forces that cause the tooth to flex under stress. It is thought to be related to occlusal stress and can appear similar to abrasion. These lesions are sharp-angled and affect single teeth, premolars.
Management and Treatment Options
Managing teeth attrition involves addressing the underlying cause to prevent further damage. For individuals with bruxism, a custom-fitted occlusal guard (a night guard) is a common solution. These devices are worn over the teeth during sleep to create a protective barrier and distribute biting forces more evenly, reducing tooth-on-tooth friction. Stress management techniques, such as mindfulness or counseling, can help reduce the frequency and intensity of bruxism. If malocclusion is a contributing factor, an orthodontic evaluation can be recommended to correct the bite alignment.
Restorative treatments are available to repair existing damage from attrition, depending on the severity of tooth structure loss. For minor wear, dental bonding can be used, where a tooth-colored resin material is applied and sculpted to restore its shape. This procedure is quick and can be completed in a single dental visit.
For significant loss of tooth structure or aesthetic concerns, veneers or crowns can be recommended. Dental veneers are thin, custom-made shells of porcelain or composite resin, bonded to the front surface of teeth to restore appearance and function. Dental crowns are tooth-colored caps that cover the entire visible portion of a weakened tooth, protecting it from further damage and restoring its shape and function. Inlays and onlays are also options for moderate wear when a full crown is not needed, restoring specific parts of the tooth. A dental professional must diagnose the cause and extent of attrition before recommending treatment.