Severe tooth wear is one of the most complex presentations in restorative dentistry, and it is also one of the most commonly underestimated by patients who have lived with it so gradually that they have normalised what they see in the mirror. Teeth wear down over time for three main reasons: bruxism, which is grinding or clenching of the teeth, usually during sleep, that subjects the enamel and dentine to repeated high-intensity forces far beyond what normal chewing produces; acid erosion, from dietary acids in carbonated drinks, citrus fruits, and acidic foods, or from stomach acid in patients with acid reflux or a history of bulimia, which progressively dissolves the enamel surface; and attrition, the gradual mechanical wear that comes with decades of normal use, accelerated in patients who have a destructive bite pattern or who have lost multiple teeth and placed excessive demand on the remaining ones. When tooth structure is lost from these causes over years and decades, the teeth become shorter and flatter, the bite closes down, and the vertical dimension of occlusion, the distance between the upper and lower jaw when the teeth are together, collapses. This collapse changes the entire appearance of the lower face: the chin rotates upward and forward, deep facial lines appear at the corners of the mouth, and the patient looks older than their age. Dr. Namratha Umesh, MDS Prosthodontics and Implantology from RGUHS Bengaluru with 27 years and 20,000 patients at Dental Conceptz, approaches severely worn dentition as a whole-mouth problem that requires a whole-mouth solution. A single crown on one worn tooth achieves nothing when all the surrounding teeth are equally worn: the bite remains collapsed and the new crown will wear to match the rest within a short time. Restoring the bite for severely worn teeth requires opening the vertical dimension to the correct height and simultaneously restoring all the teeth to the new bite relationship. This is done with a precisely planned protocol: a diagnostic wax-up models the proposed outcome in three dimensions before any tooth is touched; a trial restoration in provisional materials is worn for weeks to months so the patient can verify comfort, function, and aesthetics before anything permanent is placed; and the final restorations, in zirconia, lithium disilicate, or other appropriate materials, are placed only once the bite has been confirmed as stable and comfortable. Where bruxism is an ongoing factor, a customised occlusal splint is incorporated into the long-term management plan to protect the new restorations from the forces that destroyed the original dentition.
Written by Dr. Namratha Umesh, MDS Prosthodontics and Implantology (RGUHS, Bengaluru), Fellow and Diplomate ICOI (USA), Fellow ITI (Switzerland), Fellow ISOI (India), Diplomate World Congress of Oral Implantology (Japan), Fellowship in Orofacial Pain and Sleep Medicine (Roseman University, Utah, USA), Director and Chief Dental Surgeon, Dental Conceptz, Sahakar Nagar (733, A Block, 15th Main, opposite Ganesh Temple, Bengaluru 560092) and Dental Conceptz, Jakkur (369, Santosh Vihar, 19th A Cross, Jakkur Main Road, Bengaluru 560064). 27+ years. 20,000+ patients. Phone: +91 9480016622.
