Worn Teeth

The enamel on your teeth

Your teeth are covered in a protective hard shell called enamel. This layer provides protection from hot, cold and sweet, gives teeth their white colour, and helps support a healthy profile and facial appearance by creating points and ridges on back teeth which support the jaws. Without enamel teeth look yellow and flat, can become sensitive, teeth disappear under the lip and creases can form in the face making individuals look older than they really are.

Many things can damage enamel – fillings, decay, acid food and drink. Sometimes enamel is damaged by clenching and grinding habits, which crack or flatten teeth. You might not even know you have this habit and in many instances these are sub-conscious habits that occur in sleep.

Damage to your teeth

There are two types of movements or habits that can damage your teeth:

Bruxing and Posturing

Bruxing is the habitual sideways grinding of teeth, creating a very flat smile with short, worn teeth. Bruxing mostly occurs during sleep when patients can exert extreme movements that they can never imagine performing while awake. The patient is rarely aware of the habit that is typically heard by a spouse as a sound like rocks rubbing against each other.

There is evidence to suggest that only 6% of the population are true bruxers and this is a brain driven disorder over which there is little control. It can be associated with “restless sleep syndrome”.

Symptoms of Bruxing and Posturing:

• Flat, worn teeth.
• Sensitive teeth.
• Face getting shorter and teeth becoming less visible.
• Pain in your teeth
• Facial pain
• Worn down surfaces on your teeth, revealing the yellow dentine layer
• Broken or chipped teeth, and fillings repeatedly falling out, especially in front teeth
• Ear ache
• Grinding noise which your friends, partners or relatives may notice

Clenching

Clenching is squeezing the chewing muscles of the face, creating extreme forces on teeth, muscles and joints. It can occur during the day and during sleep. Habitual clenching produces very well developed chewing muscles in the face and leads to a square jaw look. Clenchers will sometimes wake, aware of the tension in their facial muscles, and may suffer from joint pain and/or headaches. Commonly, if their teeth are filled, they will experience fractures and cracks in weaker teeth unable to withstand the extreme forces applied.

Some patients can be very sensitive to bite imbalances and this can trigger episodes of clenching.

Symptoms of Clenching

• Tired facial muscles and headaches or facial pain.
• Tight, tense chewing muscles with tender trigger points. Sometimes extremely tender trigger points can mimic lower molar toothache.
• Unexplained pain in the face, unrelated to teeth.
• Broken or chipped teeth
• Cracked teeth.
• ‘Axe cut’ type grooves at the necks of teeth, near the gumline.
• Loosened teeth
• Ear ache
• Difficulty eating tough or hard foods

Treatment of Bruxism

The treatment of bruxism or clenching aims to find the cause of the problem, and repair the damage that bruxism often causes. In extreme cases, people may experience headaches, damaged teeth and sore jaw joints. It may be necessary to repair damaged teeth and crowns, fillings or inlays could be required to repair teeth surfaces.

A dentist may recommend a nightguard or occlusal splint as a preventive option for people with these behaviours. This will help to reduce forces on muscles, joints and teeth and protect teeth and fillings from wear and damage. Sometimes a process called equilibration may be recommended if the dentist feels bite imbalances are the cause.

In extreme cases of facial pain some people may also need the assistance of muscle relaxant medication at night.

Clenchers can gain great benefit from regular injections of botulinum toxin. This paralyses the clenching muscles and over time a reduction in both symptoms and muscle size occurs.

Occlusal splint

An occlusal splint (see image below) may be recommended by your clinician. This will protect your upper and lower teeth from grinding. For comfort and effectiveness, the splint is custom built to your teeth. There are many different designs for splints and your dentist can recommend the appropriate design for you.

Image of an occlusal splint
The occlusal splint is made of hard plastic, and
fits over both top and bottom teeth while you
sleep. This will prevent further damage to your
teeth during the night.

Getting Relief

Symptoms from clenching and bruxism can affect your quality of life. Here are some helpful suggestions to alleviate symptoms when they occur:

Facial massage can be very beneficial to release tension in the chewing muscles and related neck and back zones.
Apply heat packs to sore facial muscles to increase circulation and relieve tension.
Rubbing a small amount of anti-inflammatory gel into a tender muscle will give short term relief.
Find time to relax – clenching is often stress related.
Oral anti-inflammatories will help relieve acute pain.
Avoid very chewy food.
Have sensitive and cracked teeth reviewed by a dentist.
Ask your dentist to make you an occlusal splint – essential if you are a true bruxer.
Remember to protect your enamel – once it is gone it can never grow back.

Image of healthy teeth
Healthy teeth: A healthy tooth
has a normal shape and a full
layer of enamel.

Image of bruxed teeth
Bruxed teeth: Severely bruxed
teeth have been worn down by
grinding.

We always recommend that you visit your Lumino dentist to diagnose any dental problems so they can advise any future treatment and you can have a healthy smile.

Worn teeth – City Dental at Quay Park

worn teeth - Before
Before: Worn bite, chipped and
missing teeth. Lumino City Dental at
Quay Park patient.

worn teeth - After
After: The entire mouth was rebuilt
with crowns and implants. Treatment
performed by Dr Mark Taylor from Lumino
City Dental at Quay Park, Auckland.