Restoring Worn Teeth: How We Treat ‘Grinding’ (Bruxism) Damage

Most patients who grind their teeth have no conscious awareness of doing so. The forces that cause the most severe dental wear typically occur not during waking hours — when the brain’s proprioceptive system moderates biting pressure — but during sleep, when that inhibition is absent and the jaw muscles can generate forces of several hundred newtons against tooth surfaces that were designed to withstand a fraction of that load. The result is a slow, irreversible attrition of enamel that can span years or decades before its effects become clinically obvious or symptomatically significant.

By the time patients notice their teeth look shorter, feel sharper at the edges, or have become persistently sensitive to temperature, a meaningful quantity of enamel has already been permanently lost. Enamel does not regenerate. Unlike bone or soft tissue, it has no cellular mechanism for self-repair. What has worn away is gone, and the trajectory — without intervention — is one of continued loss. The question, at the point of presentation, is never whether wear has occurred. It is how much has been lost, how quickly it is progressing, and what the most clinically appropriate approach to restoration and protection looks like for this particular patient.

Why Teeth Wear Down: Attrition, Abrasion, and Erosion

Tooth wear is not always caused by grinding alone, and an accurate diagnosis requires distinguishing between three distinct mechanisms that can operate independently or in combination. This distinction matters clinically because each mechanism responds to different interventions, and treating the symptom — the wear surface — without identifying the cause is a reliable path to early failure of any restoration.

Attrition is the mechanical wear that results from tooth-to-tooth contact, and it is the signature of bruxism. It presents most characteristically on the incisal edges of the upper and lower front teeth and on the occlusal — biting — surfaces of the posterior teeth, producing flat, polished wear facets that correspond precisely to the opposing dental surface. Under the microscope, these facets are the exact negative image of the teeth on the other side of the bite — the geological record, in miniature, of years of nocturnal grinding.

Abrasion is wear caused by external agents — most commonly incorrect toothbrushing technique, particularly vigorous horizontal scrubbing with a medium or hard-bristled brush, or the habitual use of the teeth as tools to grip, cut, or hold objects. It tends to present as notching or grooves at the gumline, where the enamel is thinnest, and on the buccal — cheek-facing — surfaces of the teeth rather than the occlusal surfaces.

Erosion is chemical wear, caused by acids that dissolve the mineral structure of enamel without any mechanical contact. Dietary acids — from frequent consumption of citrus fruits, carbonated drinks, and vinegar-based foods — are the primary culprit in most patients, though gastric acid reflux is an increasingly recognised cause of severe erosion in adults, producing a characteristic pattern of wear on the palatal surfaces of the upper front teeth that is difficult to attribute to any other source. Erosion produces a characteristic smoothness and rounding of tooth surfaces, and often a cupping — a concave dishing — of the occlusal surfaces of the posterior teeth that is quite distinct from the flat faceting of attrition.

In practice, many patients present with a combination of all three, and the clinical history — dietary habits, reflux symptoms, sleep quality, stress levels, caffeine and alcohol intake — is as informative as the intraoral examination in establishing what is driving the wear and at what rate.

The Aesthetic and Functional Impact

Patients frequently present with wear that is already substantial but that they have not consciously registered because it has occurred too gradually to perceive from day to day. It is often a photograph — particularly a comparison with one taken several years earlier — that makes the change suddenly visible: the front teeth that were once slightly longer than the lower teeth are now level with them, or shorter. The smile line, which once showed a natural curve following the contour of the lower lip, has flattened. The lower third of the face appears slightly compressed.

This compression is not merely cosmetic. The height of the posterior teeth — the premolars and molars — determines what clinicians call the vertical dimension of occlusion: the resting distance between the upper and lower jaw when the teeth are in contact. When this posterior tooth height is reduced by wear, the vertical dimension collapses. The jaws close further than they should, the lower face shortens, and the temporomandibular joints — the hinges of the jaw — are placed under a mechanical load they were not designed to bear in that position. The result, for many patients with significant wear, is a constellation of symptoms that they have not connected to their teeth at all: chronic jaw aching, clicking or locking of the jaw joint, morning headaches concentrated in the temples, earache with no infective cause, and a persistent tightness in the muscles of the face and neck.

These are not incidental symptoms. They are functional consequences of a structural problem, and they resolve — often substantially — when the vertical dimension is restored to its correct level as part of a comprehensive reconstruction plan.

Rebuilding Your Smile: Crowns, Onlays, and Bite Raising

Full mouth reconstruction for significant tooth wear is one of the most technically demanding disciplines in restorative dentistry, and it is an area in which the planning phase is every bit as important as the clinical execution. The goal is not simply to place restorations on worn teeth — it is to re-establish the correct vertical dimension, redistribute occlusal forces evenly across the dental arch, protect the remaining natural tooth structure, and produce an aesthetic result that is harmonious with the patient’s face and proportionate to the degree of change required.

The process at our Harley Street practice begins with a full assessment: photographs, digital scans, jaw recordings to establish the precise relationship between the upper and lower arches, and an analysis of the wear pattern and its probable cause. This data is used to plan the reconstruction digitally before any clinical work begins, establishing the new vertical dimension and the intended final position of every restoration in the plan. A diagnostic wax-up — a three-dimensional model of the planned result — is reviewed and approved before treatment commences.

The restorations used to rebuild worn teeth are selected according to the degree of wear present and the structural condition of the teeth beneath. Where a substantial quantity of tooth structure remains, ceramic, or gold onlays — partial coverage restorations that cover the worn biting surface whilst preserving the remaining tooth walls — offer an excellent balance of strength, aesthetics, and conservation. Where wear has been more severe and the tooth structure is significantly compromised, full-coverage ceramic, or gold crowns provide the structural support and protection the tooth now requires. In cases where the wear has been so advanced that the teeth have shortened to the point where there is insufficient height to retain a conventional restoration, crown lengthening — a minor surgical procedure to expose more tooth structure — may be required as a preparatory step.

The new vertical dimension is typically introduced in a staged and monitored fashion. An interim set of provisional restorations is placed first, allowing the jaw muscles and the temporomandibular joints to adapt to the new occlusal position over a period of weeks to months. This adaptation phase is not merely procedural caution — it is a clinical safeguard that confirms the new vertical dimension is well-tolerated before the definitive restorations are committed to. Only when the provisional phase has been successful — when the patient is comfortable, the functional symptoms have resolved, and the aesthetic outcome is approved — are the final ceramic restorations fabricated and placed.

Maintenance: Night Guards and Future Prevention

Reconstruction addresses the damage that bruxism has already caused. It does not, on its own, address the bruxism itself. A patient who grinds with sufficient force to have worn their natural teeth to the degree that full mouth reconstruction is required will grind with sufficient force to damage their restorations if no protective measure is in place — and ceramic, however strong and durable, is not designed to be the sacrificial layer in an ongoing parafunctional habit.

A bespoke occlusal splint — fabricated from hard acrylic to the precise dimensions of the reconstructed dentition — is an essential component of the long-term maintenance plan for every patient who has undergone restorative treatment for bruxism. Worn during sleep, the splint distributes the forces of grinding evenly across its surface, protecting the underlying restorations from concentrated load and providing a sacrificial layer that can itself be monitored, adjusted, and replaced as needed over time. The splint is not a cure for bruxism, but it is the most effective available means of ensuring that the investment of a full mouth reconstruction is protected against the same forces that necessitated it.

Alongside the splint, we review the contributing factors to each patient’s grinding habit — stress, sleep quality, caffeine and alcohol intake, and any identifiable postural or muscular contributors — and advise on lifestyle modifications where these are realistic and evidence-based. For some patients, referral for physiotherapy or cognitive approaches to stress management forms a valuable adjunct to the dental treatment. The reconstruction repairs the past; the maintenance plan is what determines whether that repair endures.