Tooth wear due to bruxism (teeth grinding). -

Pictures of damaged teeth. / Digital makeover (before-and-after) examples showing how repairs can be made using dental crowns.

The smiles of people who clench and grind their teeth typically develop a characteristic look. It's one where their teeth are worn flat across, as if they've been ground down using a file.

The pictures on this page provide examples of this wear pattern. Each comes from our group of virtual smile makeovers that features before-and-after picture sets illustrating (and explaining) how the damage caused by tooth grinding can be fixed.

A typical case.

When looking at the smile below, any dentist would quickly conclude that this person has a bruxing habit.

Teeth worn by bruxism.

View the full-size makeover animation for this case.

The word "brux" is the term that dentists use to refer to a patient's habit of tooth clenching and grinding.

This activity may be something that they do: 1) Subconsciously during their waking hours, 2) While they sleep, or 3) Both.

The classic wear pattern.

The look of a normal smile.

The look of a normal smile.

To fully understand the type of damaged that has taken place in the picture above, one needs to know what the teeth of a normal smile usually look like.

a) Normal smiles.

When looking at a person's 6 upper front teeth:

  • The central incisors (center teeth) are usually about the same length as the cuspids (eyeteeth).
  • The lateral incisors (the teeth in between the centrals and cuspids) are just a little bit shorter.

b) The smiles of bruxers.

Wear due to tooth grinding.

Teeth worn down by bruxism.

When teeth have been worn down from a habit of tooth clenching and grinding:

  • All of the upper front teeth usually have a similar length.
  • Instead of having gently rounded contours, their biting edges are frequently worn straight across. (They often display chipping, see additional pictures further down on this page.)
  • It's often easy to imagine how the flattened biting edges of the lower teeth match up exactly with the flat edges of the upper ones. (This being the position the jaw is held in when the person grinds.)

The fix.

a) Restoring the relative lengths of the teeth.

The "after" picture for this makeover case (the "normal" picture above) shows how a dentist might rebuild this person's teeth by way of placing dental crowns.

The goal would be to return the teeth to a similar length pattern as existed before. (Central incisors and canines about the same, with the lateral incisors just a little bit shorter.)

A compromise may be necessary.

The precise length that's possible for the restored teeth may not be their original one. And, in fact, with most cases it probably won't be. (Open the 'takeaways' box below for more details.)

However, the exact length established isn't as important as the length pattern that's displayed (like that shown in our "normal" picture above). Recreating this pattern is what helps to return a smile to a more customary and youthful appearance.

b) Dental crowns probably make the best choice.

When plans for fixing the damage caused by bruxism are being made, the treating dentist will have concerns about which types of dental restorations make a suitable choice for the repair.

That's because they must be able to withstand the extreme forces generated during episodes of clenching and grinding.

In a majority of cases, dental crowns probably make the most durable, longest-lasting choice (as opposed to porcelain veneers or dental bonding).

The bruxism must be controlled.

!! This is probably the most important section of this whole page.

It's imperative for the patient to understand that whether or not they have repair work performed, if their teeth-grinding habit continues some type of dental damage will continue to occur.

Methods of control.

  • It's possible that by bringing their habit to their attention, a person may be able to control their bruxing activity during their waking hours. However, for many people this approach won't provide an effective solution.
  • For protection while asleep, a "nightguard" appliance should be worn.
  • For bruxers who can't control their daytime habit, this same appliance may need to be worn somewhat during their waking hours too.

The consequences of not controlling grinding activity.

As mentioned above, if a person's grinding habit isn't brought under control some type of ill effects will continue to occur.

The patient must understand that by choosing to proceed with the repair and restoration of their teeth they are only treating a symptom of their condition, not the condition itself.

Extreme tooth wear due to unpolished dental crowns.

Extreme wear caused by dental crowns. See 'Takeaways' box below for details.

  • In the case where no reconstructive treatment is performed, damage to the person's natural teeth will continue to occur. The rate of wear may accelerate as (harder) tooth enamel is worn through and the (softer) dentin inner layer of the tooth becomes exposed.
  • Any new restorations that have been placed will be exposed to the wear and tear effects of bruxism. Their superior strength may help to slow down the changes that occur but it can be expected that this continued activity will impact how long they will ultimately last.
  • In some cases, placing restorations may aggravate the patient's condition. For example, they may change the nature of or accelerate the rate of damage experienced. (See "takeaway" box below.)

Additional pictures of tooth damage caused by bruxism.

Teeth worn by bruxism.

View the full-size makeover animation for this case.

Just as above, any dentist looking at this picture would immediately come to the conclusion that this person has a serious tooth-grinding habit.

It's a simple equation: Prolonged periods of tooth-to-tooth contact = Tooth wear.

With this example, it looks like most of the upper front teeth have portions that have simply been ground off. (And, in effect, they have.)

You can actually see how the flat, worn biting edges of the lower teeth mirror the flat, worn surfaces of the upper teeth. (When this person does their grinding, it's apparent that they hold their lower jaw just slightly to their left.)

Teeth damaged by bruxism.

Picture A.

Other classic signs of tooth grinding.

Not all cases of bruxism involve a situation where all of the teeth have been worn down flat.

a) Wear facets.

Depending upon the alignment of the person's teeth, one or more of them may cause or receive the bulk of the damage.

As an example, picture "A" shows a case where:

  • The center upper and lower teeth show the flat-across type of wear that's often seen.
  • The lower teeth off to the side show evidence of wear (termed 'wear facets') but it's less extensive than on the center teeth.
  • The opposing upper side teeth likely have corresponding wear facets on their backside.
Tooth-edge chipping due to tooth grinding.

Picture B.

b) Tooth chipping.

Another phenomenon that's often seen with teeth that have worn down due to tooth grinding is chipping.

Enamel is a strong dental tissue but it's also brittle. If it's worn down to a very thin, sharp edge, tiny fragile bits of it will tend to chip off.

In cases where a large portion of the biting edge has been worn thin, larger sections of tooth structure may break away.

Bruxism makeover cases illustrating how dental crowns can be used to repair worn teeth.

Here's a sampling of cases from our Virtual Makeover database. Each one is a before-and-after picture set showing the type of damaged that tooth grinding can cause and details about how the subject's teeth might be rebuilt.

To see additional cases, use the "View Similar" button below.

Restoring a darkened front tooth and its neighbor with dental crowns.

This digital makeover shows how the use of just a few dental restorations can sometimes...

Click image.

a) Dental crowns - With this makeover simulation, crowns are used to improve the color, shape and apparent alignment of teeth. b) Causes - It's possible that much of the wear has been caused by a tooth grinding habit. c) Root canal treatment - It seems likely that there is a history of nerve-space issues with the darkened tooth.

Using dental crowns to repair the damage caused by bruxism.

This digital smile makeover provides an example of teeth that have worn, primarily due to bruxism (...

Click image.

a) Tooth grinding - The wear pattern visible with this case suggests that a history of bruxism is involved.b) Dental crowns - This case explains why dental crowns would likely make the best choice for making repairs.

Fixing a small cavity, rebuilding worn teeth.

The most detracting aspect of this person's smile is the dark spot on their upper right tooth. And while that, no...

Click image.

a) Worn teeth / Bruxism - This smile has the characteristic wear pattern of a person who grinds their teeth. You can literally visualize how the smooth surfaces and notches of the biting edges of the upper and lower teeth fit together. b) Dental crowns - As this case outlines, unless this grinding habit can be controlled, dental crowns offer the only hope for a lasting outcome.



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My teeth have worn a lot and now look stubby. Can they be made bigger?

That's a common event. As the teeth wear, their length does become shorter, sometimes to the point that they don't show as much. This also makes the smile look "older" than it really is, because we associate the look of worn teeth with older people.

Sometimes the length of worn teeth can be increased. It all depends on the person's bite. For example, the front teeth can't lengthened so much that when they come together they keep the back teeth from fully closing.

Browse through this section and look for sample smiles that look like yours. Then look at that case's makeover simulation to get an idea of what type of length might be possible to add. (Obviously only the dentist doing the work can really make that determination.)

Hi, I have recently completed orthodontal work. I'm a clencher, which mainly effects posterior teeth. I wanted the orthodontist to provide an antibruxism retainer to keep my back molars apart at night. But I've been supplied with what looks like standard plastic whitening trays (although plastic seems a little more stronger) which I actually makes me clench even more. After questioning my dentist, he said this is an antibruxism retainer, but it just doesn't do the job I expected it to. Can anyone advise further please?

You used the plural term "trays" (as in upper and lower).

I am a bruxer, have had ortho treatment, and wear upper and lower "trays" (called an Essix retainer).

This set up works very well for me.

If the way your teeth come together when wearing your appliances isn't in harmony with your jaw joint (for example, if one area touches before any other as you close your teeth together), it may cause you to brux more.

As a start -
Ask your dentist to check for "prematurities" when you close and to "equilibrate" the appliances (trim/adjust) so to remove them.

I just got all upper 8 front teeth crowned because I grind my teeth. Now I want to get my bottom 6 done. My dentist said veneers Even though I grind them. What should I do?

It's correct that porcelain veneers make a poor choice for individual teeth that are regularly exposed to excessive forces (like grinding your teeth).

It may be that although you do grind your dentist has determined that your lower front teeth aren't really involved with this activity, and thus placing them is OK.

If your front lower teeth have significant wear, it's hard to think that that interpretation is accurate, with the exception that possibly your dentist altered your bite with this in mind when they placed the upper crowns.

It's OK to place porcelain veneers if the effects of the grinding are controlled (like by wearing a nightguard over your teeth). But if you grind when at times when you're not wearing your appliance (like during the day), damage is still likely to occur.

Your dentist might be thinking of having the restorations made using one of the stronger types of "porcelains" (eMax, Zirconia). The trade-off is these materials don't look as life-like as others (which on lower bottom teeth might not be much of an issue). Also, keep in mind these are newer technologies and don't have a 10 or 20 year historic track record to evaluate.

My teeth are heavily worn down due to bruxism (before I was wearing a mouthguard at night), and my dentist suggested to alter my bite and restore some of the teeth using photopolymer composite material Estelite. Is it basically a veneer, that will be placed over each molar? Is Estelite the best technology in the market currently? How long could I expect it to last (assuming I'll continue to wear mouthguard at night)? Is it possible to significantly alter the bite with this technology?

Many thanks!

We can only answer your question in general terms.

From a standpoint of durability and longevity of the repair, teeth that have extensive wear are typically repaired via placing crowns (gold, PFM or all-ceramic/zirconia) or onlays (crown-like restorations that just cover the chewing aspect of the tooth).

In cases where the wear just involves localized areas on back teeth, rather than perform the extensive grinding that placing crowns or onlays typically involve, the dentist may opt to just fill in the divots with dental composite (like the one you mention). That's a reasonable trade-off, opting for a less durable material/repair in exchange for trimming away less sound tooth structure.

Creating an onlay for a back tooth (building up and covering over its entire chewing surface, which is possibly the the "veneering" option you mention) entirely out of dental composite (any brand) may make a poor choice, especially if excessive forces are involved (in your case, if your bruxism is not controlled 100% of the time).

I used to grind my teeth heavily as a kid. My dentist said I have the grinding equivalent to a 50yr old man, I was 16 at the time 22 now. I don't grind them anymore because the root problem was taken care of but I drank and ate a lot of sugars drinks and food and my enamel/tooth is chipped off on my top front teeth right by my gum line. It is very noticeable when I smile. My question is there any way possible to repair the chipping by my gum line and also make my teeth longer without having to get them pulled and getting dentures? I'm still really young and have bad social anxiety because of my teeth. Any information would would help!! Thank you

As your comment suggests you anticipate, yes crowns can be a very suitable way to accomplish both of the repairs you mention. Two points in particular should be brought up.

1) Your dentist can only lengthen your teeth to the degree your occlusion ("bite") now allows.

When you grind, all of your teeth (front, back, upper, lower) are typically worn to at least some degree. This changes both your bite (the way your teeth come together) and the way your jaw joint operates.

Due to these factors, your dentist may not be able to return your teeth to their full original length. You'll simply have to ask.

2) Even crowned teeth can have complications with tooth decay. Unless you bring your decay rate under control, crowns (which are expensive and time consuming to place) may not give you the service you expect.

I'm 16 and have recently finished 10 months of wearing invisalign to correct my smile - not that there was anything seriously wrong, I just wanted straighter-looking teeth. In my last month of wearing the Invisalign, I noticed that one of my bottom central teeth was wearing-away at the top and thought it might be due to plaque or something. Since having the invisalign removed and been fitted retainers, I wear them during the night (as directed) but not during the day. I've noticed my other bottom central tooth has developed the same wear as the one next to it, so I'm beginning to think I may grind or clench my teeth. I've had a very sore jaw and it's been clicking for 2 years now, my ortho just said to go to a physio so I did, but they said there was nothing I could do about it. Anyway, I'm just not sure what to do, it's only been 1 month since I got my Invisalign off and I've noticed significant wear and tear to my teeth already, I don't know what to do and I don't want all of the money I've spent to go to waste! Thanks :)

You don't state but the assumption would be that you wear an Essix-style retainer(s).

If there is no hole formed in your retainer(s), the wear is obviously taking place during your waking (non-retainer wearing) hours.

In theory, that makes it something you can control, although that's much easier said than done.

In fact, normal "rest" position for the jaw is with your teeth slightly apart (a position where no tooth wear can take place).

Little (or at least very slow) tooth wear would be expected from tooth-to-tooth contact such as that that occurs from activities like chewing (with the exception of excessive chewing, like with gum).

So, the issue becomes, focusing on and controlling the parafunctional daytime habit. The one that brings your teeth together for prolonged periods of time where wear can take place.

Possibly your dentist can give you advise, tips or suggestions on how to successfully accomplish this. If the habit can't be controlled, wearing some type of daytime appliance (tooth "protector," possibly your retainers) would be indicated to prevent the wear.

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