Tooth wear: when it stops being only a cosmetic issue

What is tooth wear?

It is the loss of tooth structure unrelated to decay. Some wear is normal with age, but it can become excessive, and then it is called pathological wear.

It has three mechanisms, which most often combine: attrition (tooth against tooth), abrasion (an external agent, for example very forceful brushing) and erosion (acids from the diet or from reflux).

How do I recognise wear?

• The edges of the front teeth look shortened, thinned or slightly translucent.
• The chewing surfaces have become flat or dished.
• You notice sensitivity to cold or to sweet foods.
• Teeth have cracked or small chips have appeared at the edge.
• The teeth have darkened, as the dentine under the enamel shows through.

These signs do not have a single cause. A clinical examination is the only way to tell them apart.

When is it no longer only a cosmetic issue?

When wear reaches dentine, causes sensitivity, reduces the ability to chew, or visibly progresses from one year to the next.

Dentine wears faster than enamel, so once exposed the process accelerates. For that reason it is not something to postpone for many years.

Why do I treat the cause before rebuilding the teeth?

A restoration placed over an active cause will wear or fracture in turn. If the wear comes from erosion, the acid source has to be identified. If it comes from bruxism, protection of the bite is needed.

That is why the first step is not to rebuild teeth but to understand why they wore. Sometimes other specialists are involved, for example for reflux.

How is it treated?

The European consensus on severe tooth wear generally recommends approaches that are as conservative as possible, using adhesively bonded materials and monitoring over time. There is no aggressive intervention unless it is needed.

In mild cases, controlling the cause and monitoring may be enough. In advanced ones a planned rehabilitation is needed, described on the page about complex oral rehabilitation.