Advanced Dentistry by Design
Dentist Patient | Advanced Dentistry by Design

Tooth Wear and TMD

March 3, 2019
Posted By: Dr. Michelle Khouri
TMD and TMJ worn teeth | Advanced Dentistry by Design


If the eyes are the windows to your soul, then the mouth is the window to your health.  Much can be deduced about a person’s overall well-being just by looking into their mouth, and one of the telltale signs of a disturbance in health is a worn dentition.




What is Tooth Wear?


Tooth wear is the progressive loss of tooth structure for reasons other than decay.  The enamel on the outside surface of the tooth becomes thin, and the underlying dentin layer begins showing through.  Dentin is much more yellow and much more sensitive, which tend to be the two primary complaints of people with worn teeth.

Tooth structure naturally wears down at a rate of about 0.01 mm of tooth structure every year.  That means that ideally, it should take about 100 years for you to lose just 1 mm of tooth structure!  However, studies have found that this is not the case, with many adults experiencing well over 1 mm of tooth loss in just a few short years.  Considering enamel is, on average, only 1.5 mm thick, it won’t take long to wear through it to the much softer and weaker dentin.


What Causes It?


The causes of excessive tooth wear boil down to three main processes: attrition, abrasion, and erosion.

Worn Down Teeth | Advanced Dentistry by Design

Attrition is tooth-to-tooth wear, more commonly known as grinding (or bruxism).  Studies have shown that about 70% of people grind their teeth, and 33% of children.  People tend to grind the most when they are least aware of it—while sleeping at night.  Aside from wearing down teeth, bruxism takes a heavy toll on the TMJ (your jaw joint), leading to inflammation in the area and even displacement of the discs.  In fact, many head and neck issues, such as migraines, headaches, aching shoulders, and misaligned backs, can be tied to abnormalities in the TMJ due to grinding.


Abrasion is tooth wear by a foreign object.  This includes eating food and brushing your teeth.  Abrasion is a very normal cause of tooth wear, and, barring any other external factors, is what accounts for the 0.01 mm natural loss of tooth structure.  However, doing things like regularly chewing on hard candies, foods, or ice, or brushing your teeth too aggressively, can significantly speed up that loss.


Erosion is the loss of tooth structure by chemical means.  For example, indulging in super sour treats, sucking on lemons, or sipping on sports/energy drinks that have an acidic pH all weaken tooth structure and cause it to wear away much more easily.  Unfortunately, erosion is also a big problem in people with acid reflux and women experiencing morning sickness during pregnancy, since the erupting stomach acids are very destructive to the teeth.  Erosion, paired with grinding, are the perfect storm for severe tooth wear.


What Can My Worn Teeth Mean For Me?


Tooth wear extends beyond being just a cosmetic issue.  Yes, it can make your teeth look shorter, flatter, and more yellow in color.  But from a health practitioner’s standpoint, it is important for two key reasons: what is says about your current state of health, and what it can do to your future health.


As mentioned before, two of the biggest causes of tooth wear are grinding and acidic erosion.  But why are you grinding your teeth in the first place?  One of the main reasons could be that you unknowingly have sleep apnea, which is an inability to breath properly while sleeping.  This means your body is not getting the oxygen it needs, which in and of itself has health consequences.  More often than not, people are unaware of this until it is brought to their attention at the dentist’s office after seeing their worn dentition.


And if you stay away from acidic foods, why do your teeth still have an eroded look to them?  It could be that you suffer from GERD (gastro-esophageal reflux disease), ulcers, or other gastro-intestinal issues without even knowing it.


TMJ Disorder | Advanced Dentistry by Design

So what are the consequences of untreated tooth wear?  For one, your teeth will become more and more sensitive, prone to fracture or chipping, and, in severe cases, you may wear your teeth all the way down to the nerve and need root canal treatment.  Aside from the direct effects on your teeth, loss of tooth structure also affects the other parts of the head and neck.  The shorter and flatter your teeth get, the more unstable and collapsed your bite becomes.  This loss of height destabilizes your joints, which, as discussed earlier, leads to chronic migraines, jaw, neck, shoulder, and back pains. 



What are my options?


Fortunately, tooth wear is not an untreatable disease, and there are many different solutions depending on the extent of the wear.  If caught in its early stages, the fix could be as simple has having a nightguard made to protect your teeth from nighttime grinding.  If the wear is due to an underlying health issue, like sleep apnea, special compact appliances are available that can treat the apnea as well, thereby killing two birds with one stone.  If the wear is the result of a potential gastrointestinal problem, your dentist can recommend you see your general physician to treat the issue, and make you an appliance to protect your teeth in the meantime.


For people where the wear has become so advanced that it has changed their bite and is causing them jaw problems and breathing issues, the solution involves a full mouth rehabilitation.  The goal of this treatment is to rebuild the teeth to the appropriate heights, reset the joint to its ideal position, and restore a natural looking, aesthetic smile that the patient can be happy with.

Before and After Teeth | Advanced Dentistry by Design


If you are experiencing any of the signs or symptoms or tooth wear, we encourage you to either contact us or your current dentist to see what your next steps should be.  Our office sees many severe tooth wear, TMJ, and sleep apnea cases regularly, and we would be more than happy to answer any questions you have and your potential treatment options. 

Remember, you have teeth for a reason, and as dentists, it’s our goal to make sure they stay healthy and functional so you can keep using them the rest of your life!


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