Excessive Wear

When two surfaces are rubbed against each other, the surfaces will eventually wear away. How fast this occurs and how much surface area is lost depends on the hardness of the surface (resistance to abrasion) and how long the force (abrasive action) continues.

How Abrasion Occurs

Enamel is an extremely hard substance.  Because of the hardness, enamel can resist wear and last throughout a lifetime of chewing food. It protects and covers the underlying and much softer inner tooth substance, dentin, and nerve tissue.

While enamel is very resistant to abrasion, it does occur. Here’s how: The most common abrasion we see is when bottom front teeth rub against top front teeth. The enamel on the biting surfaces of these teeth is moderately thick, up to approximately 2 mm. Over the course of a person’s life, these teeth will come in contact and enamel will slowly be lost. Normally, this happens quite slowly. This type of wear is not of concern. The problem with excessive wear begins when a patient grinds or clenches, putting more force on the teeth or working them together for long periods of time. Although the enamel is very hard, if it is “abused” long enough, it, too, will wear away. Wear occurs more quickly when a natural tooth opposes a porcelain crown. Porcelain is much harder than enamel and may actually wear the enamel away even under normal use. In this case it is critical that the bite be properly adjusted to reduce this possibility.

Consequence of Abrasion

Why is the accelerated wear of enamel a problem? Although the wear continues on all teeth, it is most visible on the lower front teeth. Lower front teeth may be the most important teeth in your mouth, since they control the bite relationships of your top and bottom jaws.

Once the enamel is worn away, two undesirable things can happen. First, the exposed dentin can become sensitive to air or temperature changes. Secondly, when not supported by resilient dentin, the enamel can break off and the tooth will become smaller. As this happens, the natural movement of the tooth pushes the tooth further out of its socket. The now shorter tooth stops only when it meets its opposing tooth. Additionally, the dentin tends to stain more readily than enamel, so there will be a distinct and disagreeable cosmetic appearance that will become excessive as time goes on.

Treatment of Abrasion

The treatment of excessive wear depends on how much tooth is missing. If only the enamel is affected, a protective mouthguard is recommended. If a small to moderate amount of dentin is exposed, it can easily be covered with a bonded, tooth-colored resin. The resin, although not as resistant as the original enamel, is still much harder than the dentin. If you still continue to grind or clench your teeth, the resin will be the only tooth structure now affected. In extreme cases of excessive wear, porcelain veneers or full crowns may be the only means of restoration.

Excessive wear is difficult to diagnose in the early stages. It may take months and years for it to become evident.   When noted, it is best treated early when there is the least amount of tooth loss and the highest chance for a long-lasting, conservative solution.

If you have any questions about excessive wear, please feel free to ask us at (512)250-5012.

-Omni Dental Group