Tooth Wear and Erosion

Three different things that look similar

Erosion is chemical. Acid dissolves the mineral out of enamel, and it does it to whole surfaces at once rather than in spots. It leaves teeth looking glassy, shorter, see-through at the edges, and it makes older fillings appear to stand proud of the tooth around them — the filling has not risen, the tooth has gone down.

Attrition is mechanical, from tooth meeting tooth. Grinding and clenching flatten the biting surfaces and produce wear facets that match between the upper and lower teeth.

Abrasion is from something else: brushing too hard, or brushing enamel that acid has just softened, which takes away far more than brushing alone ever would.

Most worn mouths have more than one of these running at the same time, and they feed each other. Softened enamel grinds away faster. That is why naming the mix matters more than naming a single culprit.

Finding the cause, before anything is restored

The pattern tells us a great deal. Wear concentrated on the inside of the upper front teeth points at stomach acid rather than diet, because that is where reflux and vomit reach first. Wear on the outer surfaces near the gum points at diet and brushing. Matching flat facets point at grinding.

Diet acid is broader than people expect: citrus, soft drinks including sugar-free ones, sparkling water, wine, vinegar dressings and fruit teas. How often it arrives matters more than how much, because each exposure softens enamel for a period afterwards.

Reflux is the one most often missed, because it can happen overnight with no heartburn at all. Where the pattern suggests it, we will say so and suggest you raise it with your doctor. We do not diagnose or treat reflux here.

Medications that dry the mouth, and conditions or treatments that cause repeated vomiting, both belong in the same conversation.

Protecting, which does more than restoring

Nothing we bond onto a tooth will outlast the acid that is still arriving, so this part comes first and it is unglamorous: changing when rather than whether acid arrives, not brushing for an hour after it does, rinsing with water or bicarbonate after being sick, and remineralising with fluoride or hydroxyapatite depending on what you prefer.

Where grinding is part of the picture, a nightguard stops the mechanical half while the chemical half is dealt with.

Measuring it, so you are not guessing

Wear is slow, and memory is a poor instrument for slow change. We photograph and scan the worn surfaces so that the question at your next visit is not whether it looks worse but whether it measures worse.

This is also what decides treatment. Wear that has stopped may need nothing at all. Wear that is still moving needs the cause addressed before any restoration is worth placing.

Rebuilding by adding, not by cutting

When teeth do need restoring, the conservative route is to bond material onto what remains. Thin, shortened front edges can usually be rebuilt with composite in a single visit. Back teeth that have lost height take a ceramic onlay, designed and milled here.

A crown is the wrong instinct on a worn tooth. Crowning requires cutting the tooth down to make room, and on a tooth that has already lost substance to erosion that removes sound structure the erosion had left behind. There are cases that genuinely need it, and we will say so, but it is not where we start.

Where wear is extensive and the bite height itself has been lost, that becomes a planned full-mouth rehabilitation rather than a series of single repairs, and it is quoted and sequenced as one piece of work.

Who does this at Calm Dental

Fees for this treatment are on our fees page, including GST. A written quotation follows examination.

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