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Are your teeth worn down? - Tooth Surface Loss (TSL)

Are your teeth worn down?

We have been treating our clients for their dental problems for many years but in the last decade we have become aware of a new problem that can affect all age groups.


In the past the main problems associated with the mouth were tooth decay and gum disease. A new phenomenon has arisen, due to the fact that we are living longer, keeping our teeth longer and exposing our teeth in particular to a wider variety of food stuffs.


This article on tooth surface loss is written by Dr Hitesh Gohil, Principal Dentist at Confident Dental Care in Luton, Beds. 


This new phenomenon comes under the heading of Tooth Surface Loss (TSL). In order to prevent and possibly treat the effects of TSL it is vital to understand the causes of the nature of TSL in each particular individual.


TSL may be physiological, and may have occurred as a natural consequence of ageing, although there is no consensus as to what constitutes physiological TSL. If we look at TSL as a pathological problem we can classify it into groups.


Tooth erosion

Erosion is a chemical process in which the tooth surface is removed in the absence of plaque. These are extrinsic factors such as fresh fruit juices, carbonated drinks and alcoholic beverages; and some foods. Intrinsic factors include gastro-oesophageal reflux and eating disorders.


Tooth abrasion

Abrasion is caused by anything with an abrasive effect such as a toothbrush and dietary factors.


Tooth attrition

Attrition is a process in which tooth tissue is removed as a result of opposing tooth surfaces contacting during function and/or during parafunction.


Bruxism is one of the commonest forms of parafunction. It is defined as the grinding, tapping and/or clenching of one’s teeth when you are not using your teeth for chewing food. Most people grind their teeth at night while they are sleeping, particularly during their dream phase. Some doctors consider it a sleep disorder. It is however a stress related phenomenon, which can be very difficult to treat in patients who show aggressive forms of it or have advanced TSL as a consequence of bruxism.


Dental abfractions (stress lesions)

Abfractions are a consequence of forces on the natural dentition that can cause fatigue, flexure and deformation of the tooth surface leading to eventual loss of the enamel especially along the gum line.


How do we decide what treatment is required?

There are many factors for the dentist to take into account when a patient is suffering from TSL. First we need to find the cause of the problem, and then find out if we can control these factors. There are too many factors to list, but once the dentist has looked at them they will need to decide whether or not treatment is required. Once the factors are taken into account the dentist is better able to formulate a treatment plan.


If a patient shows favourable signs then there are a variety of techniques available to prevent further TSL and also to repair those teeth that are affected.


One possible preventive approach for tooth grinders (a Bruxist)


Preventing further wear and tear on ones teeth can be achieved with varying degrees of success with the use of either a soft or hard bite guard also known as a split or bite guard.  This is a device that is made to measure and designed to fit over either your top or bottom teeth, which can be worn at night while sleeping to prevent the teeth coming into contact. It forms a vital part of any repair work carried out by a dentist in order to preserve and prevent further TSL.


Can you make my teeth look normal again?

Many years ago dentists would use traditional techniques to repair broken or worn down teeth, which sometimes included crowns and porcelain veneers. These are very effective in some situations but most forward thinking dentists will steer away from these techniques.


Why? Well in order to replace lost tooth structure it may be necessary to remove further tooth structure to enable the dentist to fix a crown or a veneer onto a tooth. This is a dangerous route to follow if the tooth is already weak.

What happens when the crown or veneer fails in years to follow? If a veneer fails you will almost certainly require either a new veneer or if the tooth is further damaged a crown may be the only option. This approach was OK 10-15 years ago, but not anymore. With the evolution of dental materials over the last decade we are now able to offer a selection of techniques that allow dentists to rebuild your worn or broken down teeth without drilling your tooth down further and possibly delay the need for veneers or crowns.


How can you repair my teeth without crowns and veneers?

Composite Resin or more commonly known as “white fillings” has evolved into a diverse range of materials with a variety of different strengths and colours. They are now stronger, harder wearing, more aesthetic and reliable than ever. The technique we use is termed “Bonding”.


Composite resins are able to restore the shape and function of a tooth by allowing the dentist to chemically bond the material, layer by layer onto the worn or broken tooth.

All this can be achieved while the patient sits in the chair in one or several appointments, depending on how many teeth require repairing.


Most of the time no local anaesthetic is required, hence no needles. No pain is involved as we don’t drill into your teeth. The results show that patients can smile and eat with confidence, without the need to have expensive and invasive treatment.


Case studies of worn teeth


Case 1

This patient suffers from bruxism and erosion. They were provided with a bite guard for the lower teeth, dietary advice was given and the upper teeth were rebuilt with composite resin.


Confident Dental Care case study1
Before                                                                                After

Case 2

This patient was unhappy with their smile, but at the same time did not want nor could afford veneers. We used composite resin to replace the lost tooth structure and supplied them with a bite guard to prevent further TSL as the main cause was bruxism.


Confident Dental Care case study 2
Before                                                After
Dr Hitesh Gohil BSc (hons), BDS (Lon)

Dr Gohil is a Luton cosmetic dentist who graduated from King’s College London in 1993 with an honours degree in biochemistry & physiology, then in 1999 qualified with a degree in dentistry from King’s Dental Institute in London. He then worked at King’s Dental Hospital alongside some of the UK’s leading consultants. For the last 8 years Dr Gohil has been working in general practice in Central London as well as being Principal Dentist at Confident Dental Care in Luton. He has a special interest in aesthetics and cosmetic treatments as well as routine dental care.

Find out more about Confident Dental Care.

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