“Ground down teeth” describes the progressive loss of tooth structure, which dentists refer to as tooth wear. This wear is categorized into three primary forms: attrition (tooth-to-tooth contact), abrasion (friction from foreign objects), and erosion (chemical dissolution by acids). The progressive loss of enamel and dentin can lead to sensitivity, altered bite alignment, and compromised aesthetics. Addressing this requires a professional evaluation to determine the underlying cause, followed by a treatment plan to fix the damage and prevent future loss.
Identifying the Cause of Tooth Wear
Successful restoration relies on accurately identifying and stopping the forces that caused the damage. Dentists look for distinct patterns of wear corresponding to the main mechanical or chemical causes. The most frequent mechanical cause is bruxism, the involuntary clenching or grinding of teeth, often a nocturnal habit, which leads to the flattened surfaces characteristic of attrition. This excessive force can also cause abfraction, where tooth structure is lost near the gumline due to the stress of flexing the tooth.
Dental abrasion is another significant contributor, typically caused by aggressive brushing techniques or using a hard-bristled toothbrush. Abrasion leaves V-shaped defects near the gum margins and can also result from habits like chewing on pens or using teeth as tools. Chemical loss, or erosion, presents as a smooth, rounded appearance on the tooth surface. Acidic sources can be external (e.g., frequent consumption of carbonated beverages or citrus fruits) or internal, arising from medical conditions like gastroesophageal reflux disease (GERD) or eating disorders.
Minor Repairs Using Bonding and Veneers
For mild to moderate damage, especially on the front teeth or incisal edges, dentists often recommend less invasive procedures like dental bonding or porcelain veneers. Dental bonding involves the direct application of a composite resin material to the tooth surface, which the dentist sculpts and polishes to repair chips or fill worn areas. This technique is often completed in a single appointment, making it a cost-effective solution that requires no significant removal of natural tooth structure. However, composite resin is less durable than porcelain, typically lasting three to ten years, and is more susceptible to staining.
Porcelain veneers represent a more durable and aesthetic option, particularly for widespread surface wear. These restorations are thin, custom-made shells of ceramic material fabricated in a dental laboratory to cover the entire front surface of the tooth. Veneers are highly stain-resistant and possess a natural translucency that mimics the appearance of natural enamel. The procedure requires the removal of a small amount of enamel to ensure a precise fit, meaning the process is considered irreversible. While the initial cost is higher than bonding, veneers offer superior longevity, often lasting 10 to 25 years.
Major Restoration Using Crowns and Reconstruction
When tooth wear is severe, compromising the structural integrity of the tooth or affecting the patient’s bite height, more comprehensive solutions become necessary. Dental crowns are full-coverage caps that encase the entire visible portion of a damaged tooth, restoring its size, shape, and strength. They are typically used when half or more of the tooth structure has been lost and a conservative repair is insufficient to bear chewing forces. Crowns can be fabricated from materials like porcelain, zirconia, or porcelain fused to metal, offering a balance of aesthetics and durability depending on the tooth’s location and function.
For intermediate damage to the back teeth, onlays and inlays offer a conservative alternative to full crowns. Inlays are custom-fabricated restorations that fit within the chewing surface, while onlays cover one or more of the tooth’s cusps, often referred to as partial crowns. These indirect restorations are laboratory-made and bonded into place, preserving more natural tooth material than a crown while providing superior strength and longevity. In cases where generalized, severe wear has affected most teeth, causing bite collapse and jaw joint issues, a full mouth reconstruction (FMR) may be required. FMR is a comprehensive, multi-stage treatment plan that uses crowns, onlays, and other procedures to rebuild the entire mouth, restoring the correct vertical dimension and bite relationship.
Strategies for Stopping Future Grinding
Once worn teeth have been successfully restored, preventing recurrence of the damage requires managing the underlying cause. For patients whose wear is attributed to nocturnal grinding or clenching, a custom-fitted occlusal guard is the most common preventative measure. This appliance, made of hard acrylic, creates a barrier between the upper and lower teeth, protecting restorative materials and remaining natural teeth from destructive forces. A guard custom-made by a dentist is preferred over over-the-counter options because it provides a precise fit that balances the bite and prevents shifting.
For some patients, minor adjustments to the bite surface, known as occlusal equilibration, may be performed to eliminate uneven contact points that contribute to wear patterns. Addressing the systemic causes of tooth wear is important for long-term success. This may involve consulting a physician to manage underlying conditions like GERD, which causes acid erosion, or seeking behavioral therapy. Since stress and anxiety are linked to bruxism, stress-reduction techniques and biofeedback can help patients gain awareness and control over the habit.