Tooth Wear
 

What is Attrition?

Attrition is wear from tooth to tooth contact- though it may be accelerated by erosion.

Most commonly this comes from grinding your teeth (dentists call this 'bruxism').

It affects approximately 1/3 of us- yes- 1/3 of the population! Clenching and the rhythmic rocking of your teeth back and forwards also cause attrition- this habit often develops during periods of concentration, stress or listening to music.

How does Attrition Occur?

When you eat your food, it's very rare that your teeth actually come together and contact each other (try biting up and down as you are reading this).

Most of the time you simply puncture and squash your food, breaking it up into little pieces ready to swallow. We have complex feedback mechanisms to allow us to do this.

Now imagine you take out the food, press your teeth together and slide them across one another. You can begin to appreciate the damage this will do given enough time.

Enamel is the hardest substance in the body and resists this wear very well, but it does take its toll and over years of abuse, this crucial layer of your teeth will wear away to reveal the dentine underneath.

We know how much softer and easier it is to wear dentine down by erosion, and attrition (grinding) is no different. Once into dentine, the effect on your teeth is amplified and tooth wear accelerates considerably.

The height of your teeth will continue to be lost until something is done to stop it. If left to progress, the nerve chamber will eventually become visible and the vitality (life) of the nerve may be compromised.

What does Attrition Look Like?

Attrition typically looks like this:

The cusps and mountainous shapes of your molar teeth that help with chewing your food begin to flatten over time.

Your incisor teeth generally start out at different levels and with the top teeth biting in-front of the bottom teeth. We may refer to this as a normal overjet and overbite . This arrangement helps to protect your teeth and cut up your food.

Over time we can wear the teeth into an 'edge to edge' bite and the tips of all the teeth often become one level at this point. Gradually more and more height will be lost from the teeth and changes in your face will start to occur as you loose some of your ‘vertical dimension’.

Primary (baby) teeth tend to have softer and thinner enamel than the adult teeth that follow. This means we often see children with quite considerable wear on their baby teeth before they fall out, especially if the child is grinding. Looking at examples of worn baby teeth is good because it very closely resembles how your teeth may look into old age. However, if tooth wear is a problem, instead of it taking many decades as in adulthood, it could occur in a few short years.

How does the Dentist Diagnose Attrition?

The dentist will look for the characteristic signs of attrition on your teeth when examining you and ask questions to find out the information below:

Signs and symptoms that attrition is a factor in your tooth wear include:
  • Your teeth meet evenly all the way around
  • The teeth all look the same height, there is no difference between the lateral incisors and the central incisors.
  • If you slide your teeth across each other then they all stay in contact during the movement.
  • The patterns on the teeth are very worn- the cusps are flattened.
  • The enamel of the molar teeth looks flat and thin.
  • You have frequent chips and small fractures of your teeth and fillings. This is most noticeable on the enamel of your front upper teeth as they are the teeth most easily seen.
  • A partner hears you grinding during the night.
  • You wake up with tension, a headache or an ache in your jaw or teeth. This is because when your teeth are contacting during the night, the lower jaw presses firmly against the base of your skull and it is this pressure that gives rise to such symptoms.
  • The muscles invoved in moving your jaws (that is the masseter, pterygoid muscles and the temporalis) are tender or even slightly enlarged; a process known as hypertrophy.
Note. These are the same as the signs and symptoms for grinding.

If you have porcelain crowns that bite onto natural tooth, they can be a potential source of tooth wear. Technically this is abrasion because it is not tooth to tooth, but I still put it here because the effect can be far more damaging if you also grind your teeth.

Some porcelains are much harder than others and the level of glaze and polishing is an important factor in the amount of wear that occurs.

Your dentist often needs to adjust the porcelain surface to accommodate the bite, but the polishing that follows is extremely important