Are your teeth ground down teeth?
Ground down teeth can look unesthetic if the grinding occurs on the front teeth. The teeth start to look short and stumpy. We can fix these short teeth!
Examples of ground down teeth.
All of these individuals wore down their teeth and we have fixed them all. Many of the before and after photos can be found on this page but some are on the cosmetic dentistry page.
How did your front teeth get ground down?
Well actually you have worn them down yourself. The actual procession is likely a combination of attrition and erosion.
Attrition of front teeth
Attrition is the wearing away of tooth structure from grinding the top and the bottom together. This condition, when excessive, is called bruxism. Usually individuals with bruxism have at least heard their dentist recommend a night guard. All individuals with teeth like these are doing most of the damage at night. Many times a spouse will inform them because the grinding makes an incredibly irritating noise.
Erosion of front teeth
Erosion is the wearing away of tooth structure due to acid. The major form we see is from our own stomach acid being regurgitated. This also happens at night while we are laying down and the stomach acid can more easily flow into our mouth. Individuals with heartburn, especially at night, are prone to this. Most people have a combination of both bruxism and stomach acid issues to get to the point of the photos above. It does not take very much acid regurgitation when you grind at night to damage your teeth. In fact the stomach acid may not cause any other symptoms
other than the wear of the teeth. There also exists some individuals that introduce the acid through their diet. Mostly that would be individuals that drink large amounts of juice or soda throughout the day and individuals that suck on lemons, a popular habit in central America.
So enough background, what does all this mean for my front teeth?
Well it is obviously less attractive. It makes the individual appear much older as we associate wearing away of teeth with old age. It also gives many people an unattractive gummy smile. This occurs because as the teeth are worn away your body compensates for that by pushing the entire tooth, with it’s ligaments and gum tissue, up so as to stay hitting the opposing tooth. As the teeth are pushed up you start to show more and more gum when you smile, instead of teeth. Also it does make it more difficult to chew and speak normally. Although most people do not really notice this too much because it is a slow process and they adapt over the years. Usually biting into things has become more difficult and people sub-consciously tend to avoid certain foods, part of the adaption.
So what can I do to fix my ground down teeth?
Well fortunately this is one part of the body where we truly can turn back the hand of time in a very non-invasive way. There is almost always 3 steps to return you to normal. The first is getting the gums to go back to where they belong. This is done with either a minor surgery or with braces. Occasionally, if the gums are not too bad, everything can be done in just one step
and we can use our laser to make minor adjustments to the gums. The second step is to build back what was lost. This is done with all ceramic crowns or veneers. The final step is to protect your new smile.
If you didn’t where a night guard before you need to start. Unless your wear was primarily due to erosion then you ARE a bruxer. You can not grind away the ceramics like you did your teeth but you can break them. It is not easy to do and we are using newer stronger ceramics that are much stronger than older ceramics, so it happens less and less. However, even with the stronger ceramics like emax and zirconia it is only a question of when NOT if they will break if no protection is worn at night.
Below is a patient we completed recently that worn down teeth.
This is Mike. He was sick of looking at his old worn down teeth and tired of not being able to chew like he remembered he used to. Over the years Mike had worn down his lower teeth to little stubs. They were no longer functioning properly and did not look very good. Together Mike and I were able to lengthen his teeth and restore him to what he looked like as a young man. Now
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| Before |
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| After |
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| Before biting |
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| After biting. Notice the gumline has also been restored to it’s normal position. |
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| Before all the lower teeth |
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| After all the lower teeth |
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| Before |
smile back!!
What causes teeth to be worn down?
Tooth wear results from 3 distinct processes but often is a combination of them.
- Erosion = loss of tooth structure due to chemicals
- Attrition = tooth against tooth wear
- Abrasion = tooth against foreign object (toothbrush)
Tooth surface loss will typically result in compensatory tooth eruption and alveolar bone growth resulting in no change in vertical dimension of occlusion VDO. Will likely require “gaining” vertical height through ortho or surgery.
Tooth surface loss can exceed compensatory mechanisms resulting in loss of VDO. Result will be a collapse of the anterior lower facial height. Vertical height can simply be added to the occlusal surface of teeth or increasing vertical.
Regaining lost vertical or increasing vertical is determined by esthetics, phonetics, and interocclusal rest space.
A protrusive, lateral bite, and an anterior custom guide table are all helpful prior to any change.
Case of overlay partial to increase vertical.
Better case of crowns and new partial Jahangiri 2002 JPD
Anyone with a grinding habit that does not wear a night guard religiously will end up wearing down their teeth. Sometimes it occurs everywhere, but more often it is localized to just the area that they are grinding the most, whether that’s on the front teeth or sometimes can be just on one side. To regain lost tooth structure and make the tooth longer again we need to find out 2 things. #1 is has the body compensated for the tooth loss and pushed the tooth out farther and farther as it was worn down such as this where the gumline is now moved with the teeth or has the individual just lost that space and the height of the face has just collapsed.