Tooth Wear: Diagnosing and Treating Teeth That Are Wearing Down
Tooth wear, sometimes called tooth surface loss, is the gradual loss of tooth structure from acid, grinding or brushing. This page, for anyone whose teeth are wearing down, explains the four mechanisms, how the cause is diagnosed, why monitoring and controlling the cause usually come before restoring, how worn teeth are rebuilt and protected, when to see a dentist, and what affects the cost.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
This page is reviewed by Dr Ibraheem Ijaz, the practice's principal dentist and a General Dental Practitioner (GDC 301711). His qualifications are BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What is tooth wear?
Tooth wear is the cumulative loss of mineralised tooth substance caused by chemical or mechanical factors, or both, according to UK prevention guidance. The guidance, Delivering Better Oral Health, describes it as generally slow and sometimes episodic. It has also been called tooth surface loss, a term the guidance now discourages in clinical use.
Some wear is a natural part of ageing, so the guidance says its extent and seriousness must be judged against a person's age. Our page on why worn teeth get shorter covers the signs. Tooth wear is managed within restorative dentistry, which focuses on keeping and repairing natural teeth wherever possible.
What are the four mechanisms of tooth wear?
The four mechanisms usually named in tooth wear are erosion, attrition, abrasion and abfraction, defined here from UK guidance. Most tooth wear involves more than one.
- Erosion: chemical loss from acids that do not come from plaque bacteria, whether from food, drink and some medicines or from stomach acid.
- Attrition: physical loss from tooth-to-tooth contact. The NHS lists worn teeth among the effects of grinding (bruxism).
- Abrasion: physical loss caused by objects other than teeth, such as a toothbrush, a hard object or the tongue.
- Abfraction: a term for notches at the gumline, which UK guidance associates with vigorous brushing. The term has been used to describe stress fractures from biting forces, but the guidance finds a lack of clinical evidence that this is a separate cause, and does not recommend the term.
Acid wear has its own page on dental erosion and acid wear, and grinding has its own page on teeth grinding and clenching (bruxism).
How is the cause of tooth wear diagnosed?
In general, diagnosing tooth wear combines an examination of the worn surfaces with questions about diet, habits and health. UK guidance recommends the Basic Erosive Wear Examination (BEWE) at every patient's routine examination. It scores the most worn surface in each sixth of the mouth from 0 to 3, and a score of 3 (wear over more than half of a surface) in every sixth justifies further investigation.
The history looks for the risk factors the guidance lists, from acidic drinks, reflux and vomiting to brushing habits and grinding. Where a medical cause is suspected, the guidance says GP referral should be considered.
Should worn teeth be monitored or restored?
Guidance favours monitoring worn teeth and controlling the cause where possible, as restoring is not always needed. A 2018 British Dental Journal guide to managing tooth wear concluded that restorative treatment is not always indicated, even for severe wear, and that if the patient has no complaints, counselling and monitoring is probably the preferable option.
A 2017 European consensus statement on severe tooth wear says restoration should usually be delayed for as long as possible, with decisions depending mainly on the severity of the wear, its effects and the patient's wishes.
Monitoring means recording the teeth and comparing them over time: Delivering Better Oral Health suggests a wear index for early wear and, if wear is more severe, study models and photographs. It notes there are not yet accurate ways to measure wear over time.
How is the cause of tooth wear controlled?
Controlling the cause means changing the habit, diet or medical problem behind the wear; UK guidance treats this as key to managing tooth wear. It rates much of the evidence behind its advice as low certainty.
Acid (erosion)
- Keep acidic drinks to mealtimes, and avoid swishing, swilling or holding drinks in the mouth; a wide-bore straw may be considered for acidic drinks.
- If you vomit often, avoid brushing straight afterwards; rinse with water, then use fluoride toothpaste on a finger or a fluoride mouthwash.
- If you have reflux or an eating disorder, seek medical advice and support.
Tooth decay is a separate process driven by plaque bacteria, covered on our page about diet and tooth decay.
Brushing (abrasion)
- Use a soft-to-medium toothbrush, adapt an aggressive brushing technique, choose a standard or low-abrasive toothpaste, and avoid opening things with your teeth.
Grinding and clenching (attrition)
Grinding can happen awake or asleep, and the NHS names stress and anxiety as its most common cause. UK guidance suggests raising awareness of the habit and considering stress-related factors. The NHS also suggests ways to relax, a regular bedtime, regular dental check-ups, and not smoking or drinking too much alcohol or caffeine.
To ask about tooth wear, book online or call 0114 288 2121.
How are worn teeth restored?
In general, worn teeth that need restoring are rebuilt by adding material back, and published guidance prefers minimally invasive, adhesive options backed by prevention. The 2018 British Dental Journal guide concluded that these are preferred when severe wear is rebuilt at an increased vertical dimension, especially in young patients.
Vertical dimension is the height of the bite. Raising it creates space for new material, which can mean less natural tooth is cut away. Composite build-ups are one way to do this: a ten-year UK NHS hospital study of composite placed at an increased bite height for localised front-tooth wear concluded that, with some degree of maintenance, repeated use of composite restorations is a viable option over ten years.
Wear across the whole bite can need many teeth rebuilt, which our page on rebuilding a worn or collapsed bite explains. Direct composite on worn front-tooth edges is described on our page about edge bonding. For one damaged tooth, our guide helps with working out which option suits. If your main concern is how your teeth look, the appearance of short or worn front teeth has its own page.
How are worn teeth protected after treatment?
Protecting worn teeth after treatment means continuing to control the cause, because restorations can wear or break if acid or grinding continues. The 2018 British Dental Journal guide concluded that restorations, even ones considered definitive, may have a limited lifetime in severe wear because of grinding and erosion.
In a ten-year UK NHS hospital study of composite build-ups for front-tooth wear, the restorations commonly failed through wear, fracture and marginal discolouration. For people who grind, our page on protecting your teeth at night explains night guards.
What tooth wear care is offered at Deepcar Dental Care?
Restorative treatments at Deepcar Dental Care include tooth wear management, bite raising appliances and full mouth rehabilitation. Composite on worn back teeth to rebuild the bite is also offered.
Night guards are offered for patients who grind, and are charged separately.
When should you see a dentist about worn teeth?
See a dentist if worn teeth become sensitive or painful, or a tooth chips. Sensitivity on its own does not necessarily mean wear is getting worse, UK guidance says.
- Sensitive or damaged teeth: the NHS advises seeing a dentist if you grind your teeth and have tooth damage, sensitive teeth or pain in your jaw, face or ear, if your partner says you grind in your sleep, or if you're worried about your child grinding their teeth. The Oral Health Foundation advises seeing a dentist if the pain is severe, sensitivity lasts more than a few weeks, only one tooth is affected, or the pain comes on suddenly.
- Toothache: the NHS advises seeing a dentist if toothache lasts more than 2 days, does not go away when you take painkillers, comes with a high temperature, pain when you bite, red gums or a bad taste in your mouth, or your cheek or jaw is swollen. Call your dentist; if they are closed, their answerphone may tell you what to do. If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online, or find a dentist and ask for an emergency appointment. A GP cannot give dental treatment.
- Toothache with swelling: go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak. Do not drive to A&E. Ask someone to drive you, or call 999 and ask for an ambulance. Bring any medicines you take with you.
- Chipped, cracked or broken tooth: the NHS advises seeing a dentist. For urgent treatment, call a dentist; if they are closed, their answerphone may say what to do. If you do not have a dentist or cannot get an emergency appointment, call 111, or find a dentist and ask for an emergency appointment. Keep any broken-off piece in milk or saliva and take it with you.
How much does tooth wear treatment cost?
Tooth wear treatment cost depends on the cause, the amount of tooth lost and the treatment used.
Frequently asked questions
Is some tooth wear normal as you get older?
Yes, some tooth wear is a natural part of ageing. UK prevention guidance says its extent and seriousness must be judged against a person's age. Wear can affect baby teeth as well as adult teeth, and the guidance stresses finding wear beyond normal ageing early.
Does it matter when I brush after an acidic drink?
UK guidance says there is no strong evidence that the timing of toothbrushing is of great importance. It advises brushing twice a day with fluoride toothpaste suited to your age. The Oral Health Foundation, writing about sensitive teeth, advises waiting at least 1 hour after acidic food or drink before brushing.
Which drinks are least likely to cause acid wear?
Unflavoured still or sparkling water, milk, tea and coffee have the lowest erosive potential, according to UK prevention guidance. Fizzy soft drinks, fruit juices, energy and sports drinks and wine are among the acidic drinks it lists. Flavoured or lemon sparkling water has high erosive potential, and warming a drink raises its erosive potential.
What does the NHS say about night guards for grinding?
The NHS says a dentist may recommend a mouth guard or mouth splint, worn at night to protect the teeth. These can be made by a dentist to fit precisely over the upper or lower teeth. Treatment isn't always needed, and a GP can help with causes such as stress, anxiety, smoking, drinking too much or taking drugs.
What is the Dahl concept?
The Dahl concept creates space between the upper and lower teeth in one part of the mouth so worn front teeth can be restored. A 2005 British Dental Journal review explains that it began as a removable metal bite platform, is traditionally linked with worn teeth, and names preservation of tooth tissue among its advantages.
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Contact the practice online or by phone. Deepcar Dental Care is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH, on the ground floor, wheelchair accessible and with free parking directly outside. Patients describe their visits in our patient reviews.
334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
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