Restoring Worn Teeth

Tooth enamel is the hardest tissue in the body, but it cannot regenerate. Some wear over the years is normal; the problem starts when it progresses faster than expected for your age. Front teeth get shorter, their edges become thin and see-through, the yellowish dentine beneath the enamel is exposed, the teeth become sensitive to cold and small pieces start to chip off. Restoring worn teeth means replacing that lost tissue with composite or ceramic.

But the order matters. A restoration placed before whatever is wearing the teeth has been stopped is exposed to the same force or the same acid, and like the tooth, it wears and breaks.

What is wearing my teeth down?

There are three main types of wear, and in most patients more than one is at work. The pattern in the mouth usually tells us which one dominates.

Enamel that has been softened by acid is far more vulnerable to rubbing. That is why, in someone who has reflux and also clenches, wear progresses faster than either would cause on its own.

Why does the cause have to be dealt with first?

• Clenching: A hard acrylic guard worn at night protects both the new restorations and the remaining teeth. The causes of clenching and how it is treated are on the bruxism treatment page.
• Reflux and vomiting: If we see marked erosion on the palate side of the upper front teeth, we suspect reflux even if the patient is not aware of it, and we recommend seeing your doctor or a gastroenterologist. Unless the source of the acid is treated, the tooth around the edges of the restorations keeps dissolving too.
• Diet: What matters is usually not how much acidic drink you have but how often. Lemon water, sparkling water or sports drinks sipped throughout the day keep the teeth under acid for hours. It is better to have them with meals, rinse with water afterwards and wait about half an hour before brushing.
• Brushing: A soft brush, light pressure and a low-abrasion toothpaste. If the bristles of your brush splay out within a few weeks, you are pressing too hard.
• Dry mouth: Saliva is a natural buffer that neutralises acid. Some medicines, drinking too little water or breathing through the mouth reduce saliva, and the same amount of acid then causes more wear. This is also worth discussing with your doctor.

Does all tooth wear need treatment?

No. With mild, slowly progressing wear, the right step is often to monitor it: bring the cause under control, record the teeth with photographs and a digital scan, and compare them a year later. If the wear has stopped, restoration may not be needed. Treatment comes to the fore when sensitivity affects daily life, when teeth start to chip and crack, when dentine is exposed over a large area, or when shortened front teeth spoil both appearance and chewing. If sensitivity is the only complaint, sensitive teeth treatment may be enough to start with.

Which materials are used to rebuild the teeth?

The choice depends on how advanced the wear is, your age and how well the force causing the wear is under control.

• Composite: Added directly to the tooth, with no drilling or very little. In mild and moderate wear, especially in younger patients, it is often the first choice, and it can be repaired if it chips. The technique is the same as composite bonding; here the aim is less about appearance and more about putting back tissue that has been lost.
• Ceramic: In advanced wear it is more durable and more resistant to staining. Thin ceramic onlays covering the chewing surface are used on back teeth, veneers on front teeth, and crowns where very little tooth is left. It usually requires some tooth preparation.

The two are often combined in the same plan: ceramic on the back teeth, which carry the most load, and composite on the front teeth, where easy repair is an advantage. Whichever material is chosen, how long the restorations last depends less on the material than on how well the cause of the wear is controlled.

What if the bite height has been lost?

When all the teeth are worn, the first assumption is that the bite has lost height. Usually it has not: as teeth wear, they slowly keep erupting, together with the surrounding bone, and stay in contact with the opposing teeth. The result is teeth that look short but have no room left for material to be added on top. In these cases the bite height may need to be increased slightly, in a controlled way. We do not do this straight away in ceramic. The new shape and height are first planned with digital smile design and tried in the mouth in composite or a temporary material, and the jaw and muscles get used to them over a few weeks. We move to the permanent material only once the new bite feels comfortable.

What affects the time and the cost?

Building up the edge of a single tooth with composite is a one-visit job; rebuilding the whole mouth spreads over several weeks, with planning, trial and placement stages. The cost depends on how many teeth are restored, the material chosen and whether the bite height is changed. At our clinic in İzmir we set out the options side by side after the examination, and you receive a written, itemised quote. Once the restorations are finished, a night guard and regular check-ups are part of the treatment: if the cause of the wear has not gone away completely, the restorations will also need maintenance over time.