Tooth wear is one of those things that happens slowly enough that most people do not notice until it is well advanced. The teeth get shorter, the edges get thinner, the fillings start to stand proud of the surrounding tooth, and the bite starts to feel different. By the time someone notices, there is often a meaningful amount of structure to rebuild. At Dentist Pymble, we treat worn and eroded teeth for patients across the Ku-ring-gai region, and the right treatment depends on identifying which kind of wear is happening and addressing each one. This page covers the four types of tooth wear, what causes them, and how they are treated.

What is tooth wear?

Tooth wear is the loss of tooth structure that is not caused by decay. It happens to everyone to some degree as part of normal ageing, but when the rate of wear is faster than expected, the teeth can become visibly shorter, thinner, more sensitive, and more prone to chipping. The causes are usually multiple — a typical 50-year-old patient with worn teeth is grinding at night, drinking too much soft drink during the day, and brushing too aggressively. Identifying each contributor is what makes the treatment plan work.

Attrition, abrasion, erosion, abfraction — what’s the difference?

Four different mechanisms, often occurring together:

• Attrition — wear from tooth-to-tooth contact. Usually caused by grinding or clenching (bruxism), most often at night. Affects the biting surfaces and the front edges of the teeth.
• Abrasion — wear from foreign objects. Usually caused by aggressive toothbrushing, but also from habits like holding a pipe between the teeth, biting on pens, or using the teeth to open things. Affects the gum line and the visible surfaces.
• Erosion — wear from acid that is not bacterial in origin. Dietary acid (soft drinks, sports drinks, citrus, wine), gastric acid (reflux, bulimia, morning sickness), or environmental acid (chlorine in swimmers). Affects the smooth surfaces and the biting edges, and leaves the teeth looking glassy and thin.
• Abfraction — wear from flexure. The theory is that excessive bite forces cause the tooth to flex slightly at the gum line, leading to small notches or grooves that appear over time. The mechanism is debated, but the lesions are real.

Most worn-tooth cases are a mix of two or three of these. The patient who grinds at night and drinks three soft drinks a day has attrition from the grinding and erosion from the acid, working on the same teeth at the same time. Treating only one of the two leaves the other one still working.

Why are my teeth wearing down?

The most common combination is night-time grinding plus dietary acid. The grinding happens while you sleep, so most patients do not know they are doing it — the clue is worn biting surfaces, morning headaches, a jaw that feels tight when you wake up, and a partner who hears you grinding. The acid comes from soft drinks, sports drinks, citrus, wine, and fruit juice. The combination is particularly aggressive because the acid softens the enamel, and the grinding then wears it away much faster than either would alone.

Other common combinations include gastric reflux plus night-time grinding, aggressive brushing plus dietary acid, and bulimia or eating disorders plus brushing after vomiting. The cause matters because the treatment depends on it. A night guard without addressing the acid does half the job. Cutting out the soft drink without addressing the grinding does the other half.

What does tooth wear do to my smile?

The most visible signs are shorter teeth, thinner edges, translucency at the tips of the front teeth, fillings that look raised above the surrounding tooth, and a smile that has lost its youthful contour. The functional signs are sensitivity to cold and sweet, chipping of the front edges, and a bite that feels different — often because the teeth have lost so much height that the jaw has to close further to find a stable position.

None of this is reversible on its own, but all of it is treatable. The right answer depends on how much structure has been lost, what the cause is, and what the patient wants the final result to look like.

How is tooth wear treated in Pymble?

Treatment has three phases: stop the wear, rebuild what has been lost, and maintain the result.

Stop the wear — address each cause. Night guard for grinding. Dietary changes and acid management for erosion. Brushing technique change for abrasion. Reflux management with a GP for gastric acid. Without this phase, the rebuilding work will fail.

Rebuild what has been lost — depending on the amount of structure and the location. Minor wear is often restored with composite bonding — tooth-coloured material added back to the worn surfaces in a single appointment. Moderate wear is restored with ceramic onlays or veneers — lab-made restorations that cover the worn surfaces and provide long-term durability. Severe wear, particularly when the bite has collapsed, may require crowns on multiple teeth to rebuild the bite and the smile.

Maintain the result — night guard wear, dietary vigilance, fluoride toothpaste, regular check-ups and cleans, and prompt attention to any new wear that appears.

How can I stop my teeth wearing down?

The biggest wins are the night guard (for grinders), cutting back on acidic drinks (for erosion), and fixing the brushing technique (for abrasion). For reflux-related erosion, working with your GP to get the reflux under control is essential. For patients with eating disorders, recovery is the foundation of any dental treatment.

An occlusal splint (night guard) is the single most useful intervention for most patients with worn teeth. It is a hard acrylic guard worn over the upper or lower teeth at night that takes the grinding force rather than the teeth. It does not stop you from grinding, but it stops the grinding from wearing the teeth down. For patients with significant wear, a night guard is non-negotiable — the rebuilding work will fail without it.

If you live in Pymble, Gordon, Turramurra, Wahroonga or anywhere else in the Ku-ring-gai area and you have noticed your teeth are wearing down, call our practice. We see neighbouring Gordon patients and other nearby residents, and the sooner we identify the cause, the less invasive the treatment usually needs to be.

Frequently asked questions

Is tooth wear a normal part of ageing? Some wear is normal — teeth do lose a small amount of structure over a lifetime. The question is the rate. If your teeth are visibly shorter than they were 10 years ago, or if you are getting sensitivity and chipping that wasn’t there before, the rate is faster than it should be and worth investigating.

Can worn teeth be rebuilt? Yes, in most cases. Composite bonding works well for minor wear. Ceramic onlays, veneers, and crowns work for more significant wear. The right answer depends on the amount of structure lost, the cause, and what you want the result to look like.

Does a night guard really help? Yes — it is the single most useful intervention for patients who grind or clench. It does not stop the grinding habit, but it absorbs the force so the teeth don’t wear down. Without it, any restorative work you have done is at risk of failing.

Will my teeth keep wearing down if I do nothing? Yes, slowly but surely. The rate depends on the cause. Grinding-related wear tends to be faster than erosion-related wear, and combined mechanisms are faster than either alone. Doing nothing is reasonable for very mild wear, but for moderate to severe wear the treatment is usually less invasive earlier than later.

How much does treatment for worn teeth cost in Pymble? It depends on the extent of the wear and the chosen treatment. A night guard is at the lower end. Composite bonding is in the middle. Full-mouth reconstruction with multiple crowns is the most significant investment. We will always provide a written quote and a phased plan so you can prioritise the most important work first.