Tooth Wear

Have you ever been to the dentist, had a filling, and the filling didn’t really feel right? Instead of going back for the adjustment, you just waited for it to settle? This is the start of a life long problem, which will end with all your teeth needing to be built up because you have slowly worn them all down.

How does this happen?

Tooth wear is a fairly complex subject, and to add to this, most dentists do not understand it (this is because most dentists will work predominantly in the NHS, and the goal here is to quickly get the filling done, and on to the next patient!)

The first thing to understand is that the jaw joint, the jaw muscles and the bite need to all be in harmony. If something upsets the way you bite, then this will change the movement in the jaw joint, and certain muscles around the joint can be put under tension. This can have one or more of the following results:

1. Tooth sensitivity- and your dentist cannot figure out why
2. Jaw joint pain or clicking in your jaw joint
3. Unexplained and regular headaches

Imagine having an uncomfortable stone in your shoe, if you don’t remove this, you may start to walk slightly differently, to avoid the stone, and this will change the pressure on your upper legs, and spine, which can lead to back pains. Once you know the cause, you can just remove the stone, but if you are not aware, then you may look at back treatments to help you.

How does the body deal with these bite interferences?

Your body usually knows that something is not right, and can do a few things to try and correct this bite interference.

Your body detects that one tooth (or filling) is coming together before the others, and this puts a lot of stress on this one tooth. To help make your bite more even, your jaw will move to a slightly different position, so that more teeth come in contact. This solves the problem of the high spot on your tooth, but in moving your jaw position, the jaw is no longer in its most comfortable position. This can lead to pain in the jaw joints, clicking or popping, or pain in the muscles around the jaw joint, which you will feel as headaches.

Now your body has another problem, the jaw being out of position! To correct this, your body will try and grind away the teeth, so that your jaw can be in a comfortable position again, and there are no high spots in your bite. This is what we call accelerated tooth wear, and this is what it can look like

Example of very early tooth wear

Example of very early tooth wear

This is a patient of mine, and she is about 25 years old. Most people will not see any signs of tooth wear, but as a dentist who always checks for bite interferences and tooth wear, I can see wear on the canine teeth (circled). To be fair, if this lady was 40, I would be much less concerned, but this is a lot of wear for someone of 25.

When I checked her bite, it was clear that when her teeth came together, the left canine tooth hit first, then her jaw slid 2mm to the right.

Now, Jayna was not aware of any bite problem, she came to me to have her teeth straightened! What would happen if she ignored this? Well, the problem would silently become worse and worse, and could look something like this:

Advanced tooth wear caused by a bite interference

Advanced tooth wear caused by a bite interference

Can something be done about this?

If you catch this early, the most simple thing to do is to find out where the bite interference is, and either adjust this, or make a specialist night guard, so that at night, the teeth are separated, and jaw in a comfortable position, so that there is no tendency to grind your teeth (most grinding happens at night)

An important note here about night guards – most dentists do not understand how to make a good night guard, and will take one mould, and give you a gum shield like mouth guard, which is soft. There are a few problems with this:

1. As it is soft, it actually encourages you to bite into it more – the opposite effect to what we want
2. No attempt has been made to fine the correct jaw position, so when you bite with this soft night guard, the jaw is not encouraged to sit in a comfortable position!

So why would dentists make this type of night guard? The first reason is ‘lack of education,’ only a few dentists educate themselves to a high standard so that they understand these complex issues. The second is that on the NHS as it is today, a dentist can earn relatively well, by quickly taking a mould, and fitting a night guard, not a good reason, I know, but I used to work in the NHS, and this happens.

What if we are catching it late?

So if your teeth are already worn down, you still have the option of the hard night guard, but to make everything look right again, you may want to build up the lost tooth, in such a way that there is no bite interference, and this is the kind of treatment that can cost thousands of pounds. When people have this done, it is definitely worth it, but think that it all started from something quite simple, and could possibly have been avoided, if a simple filling was done correctly in the first instance.

Is it just fillings that cause this?

No, Although fillings are the most common reason, even having a tooth out, and not replacing it can have a similar effect. What often happens is that the teeth either side of the space start to tilt into the space, and interfere with the bite from there – leading to the same end result.