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Home / Stories / What a worn smile is telling you
In preparation: draft for Dr Amit Patel's review before publication. Not yet live.
Stories · Dr Adam White
Teeth are meant to last a lifetime, not to wear away in the process. When they do, the wear has a cause, and the cause tells us how to treat it. This is a guide to reading a worn smile and what can be done about it.
Tooth wear is usually one of three things, and often two of them together. Grinding and clenching, most of it at night and most of it unnoticed, rubs tooth against tooth until the edges flatten and the biting surfaces lose their shape. Dentists call this attrition. It tends to show first on the front teeth and the tips of the canines.
Acid erosion is different. Acid from fizzy drinks, fruit, wine or, in some people, from the stomach softens the enamel so it dissolves rather than chips. The surfaces look smooth, cupped and glassy. The third is abrasion: wear from something other than teeth, most often a hard toothbrush used with too much force, which notches the teeth near the gum line.
Worn teeth are usually shorter than they were, so the smile shows less tooth and the face can look a little older than it should. Front edges become flat, thin or translucent, sometimes with small chips. Fillings may start to stand proud of the tooth around them, because the filling has not worn but the enamel has.
Sensitivity to cold is common once enamel thins and the softer dentine beneath is exposed. Some people notice a dull ache in the jaw muscles on waking, or a partner notices the grinding. Others notice nothing at all, which is why the scan we take at every appointment matters: it records the surfaces, and successive scans show whether they are changing.
It is tempting to go straight to rebuilding. But if the teeth are being worn by grinding, new restorations will be ground too, and if the enamel is being dissolved by acid, the edges of the new work will be undermined. The first job is to work out what is doing the damage and to slow or stop it.
That means a proper conversation as well as an examination: what you drink and when, whether you have reflux, how you sleep, what your bite is doing. Sometimes the answer is a night guard and a change of habit, and nothing more for now. We would rather protect what you have and watch than build on a problem that is still moving.
Where teeth have lost enough height to need rebuilding, the options run from the simple to the comprehensive. Composite bonding can restore the lost edges of front teeth in a single visit, adding back length and shape with tooth-coloured material sculpted directly onto the tooth. It is conservative, repairable and a good first step.
More extensive wear may call for veneers or crowns, and where the whole bite has lost height, a full-mouth rehabilitation that rebuilds the upper and lower teeth together. Those cases are planned digitally, often with a trial smile you can see and wear before anything permanent is made, and they are planned by more than one of us. Dr Amit Patel and I share tooth wear and full-mouth cases.
For grinders, a night guard is the single most useful thing we make. It is a custom appliance, formed on a model from your scan, that sits over the teeth while you sleep. The guard takes the wear instead of the enamel and, in many people, eases the jaw muscles too. Dr Jonathan Davies, whose interest is tooth grinding, often leads these.
There are three kinds, and the right one depends on how hard you grind and what we are protecting. A soft guard is £395, a combination guard with a soft lining and hard outer is £495, and a balanced hard guard, adjusted so the bite meets evenly, is £895. Because it is made from a scan, it fits closely, and a guard that fits is one you keep wearing.
If you recognise any of this, a check-up is the place to start. We scan, examine and, where helpful, take X-rays, then talk through what the wear is telling us. Should treatment be needed, it is set out and costed in writing first, and the usual order is to protect the teeth before rebuilding them.
Tooth wear is slow, which is its danger and its mercy. The damage creeps, but there is nearly always time to stop it before the choices narrow. The earlier the cause is found, the simpler and less costly the dentistry tends to be, and the more of your own enamel we get to keep.
The one thing to remember
Worn teeth are a sign of grinding, acid or abrasion, and the cause must be found and managed before anything is rebuilt. Protect first, usually with a night guard, then restore what has been lost with bonding, veneers or a planned rehabilitation.
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