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 might be fixed.

A typical case.

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

A classic look of someone who grinds their teeth.

A picture of a person whose teeth have been 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.

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

A picture of a person who has a normal (non-worn) smile.

The look of a normal (non-worn) smile.

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.

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

A picture of a person who has tooth wear due to tooth grinding.

The even look of teeth worn down by bruxism.

  • 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.)


Takeaways from this section.

This same general wear pattern tends to occur naturally as we age. And often by the time a person has reached their "senior" years it has become quite noticeable.

That's why the smile of a bruxer looks aged. Restoring the person's teeth back closer to their original shape returns "youthfulness" to their smile.


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. (Read the 'takeaways' box below for more details.)

However, the exact length that's re-established for the teeth isn't as important as the pattern that's created. Recreating a "normal" pattern (like the one illustrated in our "normal" picture above) is what returns a smile to a more customary and youthful appearance.

Takeaways from this section.

As mentioned above, the length that's possible for a person's restored teeth may not be the same one that existed before their wear took place. The degree of change that's possible will be dictated by their bite, as it is now at this point in their life.

While the damage caused by grinding is frequently most obvious on a person's front teeth, it's likely that their back teeth have worn down too (it just depends on the position their jaw is held in when they grind).

And while these changes (both front and back) have been slowly taking place, the person's jaw joint will have gradually adapted to this new configuration too.

That means that when making a fix the dentist can only make changes for the front teeth to a degree that they:

  • Don't keep the back teeth from coming together.
  • Don't cause problems for the jaw joint by significantly altering the person's bite.

All of this means that, while some degree of modification can be made, the teeth likely can't be returned to the same (full) size they were before the damage took place. This would be especially true with cases where extreme amounts of wear have taken place.


b) Dental crowns probably make the best choice.

When formulating a plan for fixing the damage caused by bruxism, the treating dentist will have concerns about which types of dental restorations might make a suitable choice for the repair.

A primary concern will be that the new restorations must be able to withstand extreme forces generated during episodes of clenching and grinding. (Even in cases where a person's bruxism is "controlled," a dentist must anticipate that at least some such episodes may continue.)

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

About choosing dental crowns.
PFM crowns.

Because of the great strength characteristics that they offer, porcelain-fused-to-metal dental crowns (PFM's) are often utilized. They're known for being durable and lasting restorations.

As a drawback, the ceramic surface of these crowns can be abrasive to teeth that bite against them.

As a solution, and as long as doing so doesn't unduly compromise the restoration's aesthetics, it may be possible for these tooth-contact surfaces to be metal (which is kinder to the opposing teeth).

All-ceramic crowns.

The prudence of choosing all-ceramic crowns for a bruxer simply depends on the type of "porcelain" from which they're made.

Some types of ceramics are fairly fragile and not capable of withstanding great forces. Others (like the compound zirconia) have substantial strength characteristics.

The trade-off encountered when using stronger types of ceramics is one of a greater risk of wear of the opposing teeth and a slightly less natural-looking appearance.

Gold crowns.

Gold crowns make one of the best choices for restoring bruxism cases.

Gold has a wear coefficient that's similar to enamel, which means it won't cause excessive damage to opposing teeth. And since it's a metal, crowns made out of it are unlikely to fracture.

Of course, the big disadvantage of this type of restoration is its appearance. It can make an excellent choice for back teeth but few people want gold upfront.

Obviously, choosing the right type of crown is a complex issue and you'll require the advice of your dentist.


About porcelain veneers.

Historically porcelain veneers have had the reputation of being brittle, thus making them a poor choice for applications where they are subjected to heavy clenching and grinding forces.

(This page provides background information about the differences between dental crowns and porcelain veneers and can give you an idea of when each is typically used. One primary advantage of veneers is that less tooth structure is trimmed away when they are placed.)

At this point in time, there are synthetic "porcelains" that can be used to fabricate veneers. And some of these materials are several times stronger than their predecessors. (Two brand names are IPS e.max® and BruxZir®.) However, one trade-off is that these materials aren't as aesthetically pleasing (life-like, natural-looking) as traditional materials can be.

Since considering the placement of porcelain veneers for bruxers lies contrary to traditional conventional wisdom, be sure to quiz your dentist. Ask...

  • Specifically what type of ultra-strong ceramic will be used and why they have chosen it.
  • What they feel is the usual success rate for this type of restoration in this application. (Newer materials and techniques have less established track records.)
  • What their experiences have been with this approach with other patients. (Dentists learn by using new techniques with actual patients. Make sure you understand if you will be one of them.)


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.

Picture of Extreme natural tooth wear due to opposing unpolished dental crowns.

Natural tooth wear caused by opposing dental crowns. See the '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.)


Takeaways from this section.

Any porcelain restoration whose surface has been 'adjusted' (trimmed on) and afterward isn't properly polished or glazed can be quite abrasive to the teeth that bite against it. (Unfortunately, this situation isn't terribly uncommon. Our picture above shows an example.)

The result can be one where the restorations placed to fix the damage caused by tooth grinding can actually cause more of it to occur, likely at a faster pace.

This is not only a concern for opposing natural teeth but also those supporting any type of dental work.

Even placing dental restorations that meet the highest standards can't create a situation where your teeth and their supporting structures are immune to the effects of continued bruxism.

  • The type of damage that occurs may be similar as before (such as tooth wear or crown perforation or breakage).
  • Or it may change in nature (excessive forces can lead to tooth nerve irritation or cause damage to the bone supporting the teeth).

Tooth grinding is a harmful parafunctional habit that must either be controlled or at least minimized (typically by wearing a protective appliance).


Additional pictures of tooth damage caused by bruxism.

The classic appearance of a person who grinds their teeth.

A picture of a person's teeth that have been 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.)

Takeaways from this section.

The dark coloration of the upper left tooth is frequently a sign that it is either in need of or has already had root canal treatment.

This is a separate dental issue and not necessarily related to this person's tooth grinding habit.


Other classic signs of tooth grinding.

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

Picture A.

Picture  of examples of worn teeth.

Types of tooth wear.

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.

Picture B.

Picture of tooth-edge chipping due to tooth grinding.

Tooth chipping related to tooth wear.

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.
Takeaways from this section.

In picture "B", the faint band of grey running across the biting edge of the upper tooth indicates that this area has worn fairly thin.

The grey color is due to the fact that much of the light that strikes this portion of the tooth passes right through it (it's translucent).

In contrast, higher up where the tooth is thicker, light isn't able to pass through but is instead reflected off and back out of the tooth. This gives it its expected white coloration.


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.

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.

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.

Fully closing in the gap between two incisors by placing crowns.

This page's digital makeovers illustrate how "tooth gaps" can be filled in by placing dental...

Click image.

a) Tooth gaps. - The obvious cosmetic deficiency with this smile is the space between the center teeth. b) Bruxism - The notched and worn biting edges of the upper and lower front teeth suggest that this person has a tooth grinding habit. c) Dental crowns. - This makeover illustrates how dental crowns can be used to both fill in tooth gaps and repair worn teeth.


Worn teeth look short.

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

That's common.

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.)

Short teeth

Can my teeth be rebuilt? Something happened while I was in a nursing home and my entire mouth needs lengthing. Where can I go and what are the procedures and costs? I live in zip code 76244/76248. Thank you.


When you grind your teeth, it may seem that just some teeth have become shorter (like your front ones). But most likely all of your teeth have worn correspondingly. Several factors then become an issue:

1) Can your jaw joint that has now become accustom to the "shorter" height of your teeth tolerate the situatation where they are returned to full height? (The answer may be yes, or no, or yes it can tolerate some increased height.)

2) A dentist usually can't only restore the worn teeth that show to full height. If they did then just your front teeth would touch together when you close, not your back ones because they'd still be short. The solution is to rebuild all of your teeth (although, possibly just all of the uppers, or just all of the lowers would suffice). This kind of treatment gets expensive fast.

3) As a tradeoff, a dentist may be able to increase the length of some teeth (like just the front ones) somewhat, yet not make them so long that they interfere with the patient's current (worn down) bite/jaw function situation. That's typically the type of results that we have tried to illustrate in our digital makeovers. (It's a practical approach in the sense that it improves the patient's appearance yet just a minimum number of teeth receive treatment.)

Treatment costs would simply depend on what approach is taken. With any approach, often each tooth being treated will need a dental crown. Here's a link to our page about costs for them.

Does and antibruxism orthodontal retainer exist?

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

This setup happens to work well for me.

In your case, 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.

veneers or crowns

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?

Bruxing and veneers.

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.

Estelite restoration

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).

crowns and repair

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.

Invisalign and Tooth Grinding

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.

Worn down front teeth

At age 62 and under a dentist's care my front bottom teeth have exhibited a considerable amount of wear. My teeth are very small too which adds to the problem of crowning them. I have been to two other dentists who tell me that ALL of my bottom teeth need to be crowned, price, $19,000, which does make sense to me since 3 already have crowns, but for some untold reason they can't be used.???
I can clearly see the exposed dentin. It's been like this for years, but I never knew what it was. If I had I would have used a guard which my dentist never mentioned. He went to Emory, I thought a dentist took an oath to help patients take care of their teeth! Guess money is more important.
Anyway now I feel like I between a rock and a hard place. Do I just have them pulled? Try crowns by trimming away gum tissue? Or implants? Or just go with dentures, which is my last resort. I just can't see putting that much money into my teeth at this age.
I have taken Dilantin for espilesy since I was 3 years old, so I imagine that has not helped my teeth (dry mouth.
Any suggests would be greatly appreciated.


Clearly it's impossible to know anything about your case really from just a few paragraphs.

It did stand out however that you mentioned worn teeth but made no comment about experiencing symptoms (thermal sensitivity, tooth nerve problems caused by tooth trauma and wear, jaw-joint problems, damaged restorations due to wear). So it's unclear what the motivation is for an urgent change at this point.

Also, dentists have discussed rebuilding your teeth with you but there's no mention that any have discussed controlling the effects of your grinding habit afterward. (Just placing the crowns won't be a solution.) Also, a bruxing habit is a contraindication for placing implants. Hopefully any dentist wold be very slow to recommend denture placement vs. just having worn teeth.

There's also no mention of what type of habit has caused the damage. (The effects of night time grinding can likely be controlled by wearing a nightguard. A habit of clenching and grinding during the day is much more difficult and cumbersome to manage.)

If the issue is that:
Finally some dentist has reported to you that significant tooth wear has taken place.
Other than that you have no significant symptoms with your jaws or teeth.
The appearance of your teeth to you, while not your ideal, is acceptable enough.
You definitively know that it is night time grinding that's primarily responsible for your damage.
You are committed to wearing a nightguard so to prevent further damage.
And cost is a consideration and a problem.

Then ask your dentist how having them fit you with an appropriate nightguard and helping to monitor and maintain your status quo isn't a reasonable alternative.

[Re the 3 crowns: The dentist probably envisions trying to restore your worn teeth back to a shape closer to what they were originally (make them taller when new crowns are placed). That could make it easier to place the crowns, improve the look of your teeth, smile and face, and provide benefits for your jaw joint. If that were done, then the 3 existing crowns would be too short in comparison.]

Bruxing damage.

My teeth show far more damage than any images seen on this or other sites. I am almost 50 and have had this problem since a young teenager, tapping my teeth together during the day, particularly when busy or driving. It is only recently that I realised how serious the issue is, as my top teeth are now so thin that they are transparent and cutting my tongue. The dentist is adamant that some repair work is needed urgently, but still says it is cosmetic. Surely with damage this serious it could be done on the NHS?

We're sorry Jo but don't have an answer for you.

In the USA we're absolutely familiar with some dental policies that state that they do not provide coverage for "conditions necessitated by attrition or abrasion."

We surfed quite a bit and really didn't see anything that suggested the same. What we did see was paragraphs like:
"It's important ... that any problems caused by your teeth grinding are treated as soon as possible to prevent further damage."
Treatment ... "clinically necessary to protect and maintain good oral health is available on the NHS. This means the NHS provides any treatment that you need to keep your mouth, teeth, and gums healthy and free of pain, including: ... crowns." (A "band 3" service, not that we necessarily know what band 3 is.)

It would probably be a good idea for you to investigate the information on about "bruxism." Learn about all of the symptoms they discuss that are common with this problem so you're not overlooking any legitimate claims and complaints and make sure your dentist knows you are experiencing them.

Short of that, possibly you need a second opinion, or at least someone who will take the time to explain why your functional problems are only recognized by NHS as cosmetic ones.

Severe enamel loss on upper first molars and bottom back molars


I'm in my 40s and have severe enamel loss on my upper first molars and bottom back molars. I have clenched since being a child and had to get a couple of porcelain crowns for my lower first molars in my early 20s. I currently wear a mouth guard every night. But the enamel loss is so bad that there is no enamel left on the biting surfaces of those teeth and the dentin is fully exposed. Obviously this makes chewing hard foods very uncomfortable. My dentist has informed me that there is not enough space to put a crown on my upper molars and suggests that I get orthodontic treatment to force my upper molars back up into the bone to create room for crowns. This treatment plan sounds like overkill, but I admit I'm no dentist. I read up above about onlays, specifically the Bruxzir onlays. I know it is impossible to say for sure without seeing my teeth, but does it sound like this type of treatment might work for me instead of orthodontic treatment and crowns?


We thought about your case quite a bit, and actually started 3 or 4 different responses to you question, but finally decided that there are really just too many variables involved that we know nothing about to add much of value to the conversation.

Like you, we can envision several scenarios where a minimal reduction onlay or crown might offer a solution. (Both of these types of restorations would require the same amount of chewing surface reduction.)

It certainly seems reasonable that you might suggest the idea of a BruxZir (zirconia) restoration to your dentist so they can explain to you why it doesn't make an acceptable solution. (As your dentist, that's really a part of their obligation to you.)

Monolithic zirconia crowns/onlays are relatively new and as such don't have a long track record on which to evaluate their ultimate longevity/durability, and that may be a concern to your dentist (especially in a case involving extreme bruxism). But it also has to be said that without question zirconia crowns are ever growing in popularity with dentists.

It could be that possibly your dentist isn't all that aware of this type of crown construction and the advantages it possibly offers, or are hesitant to change to something new.

In regard to those issues we'll mention that BruxZir is a trademark of Glidewell Laboratories. Possibly if you contacted them they could give you some leads as to whom in your area places a lot of these restorations and therefore has used them in your type of situation before and knows what type of outcome might be anticipated.

Good luck with this, wish we had more to offer.

Thanks so much for giving my

Thanks so much for giving my question some thought and for your reply. I will bring up Bruxzir crowns/onlays to my dentist and see what he says. Have a great day!

Bottom molars

Hi I have two molars bottom right and left second to back that are missing enamel at the point where the Dentin is exposed and they are very sensitive to cold and throb on and off but also go weeks without throbbing. My dentist said he couldn't put a crown on them unless I went and got braces to open up my bite. I'm willing to do that but I'm not sure why he can't just put an onlay on them. When I where my mouth guard they stop hurting as they are covered and bit exposed. I went to a endodontist for a cone beam scan to make sure the roots were good and there was no abcess or infection. I have no infection nothing the teeth are healthy but just missing the enamel and are almost concave. The endodontist said I didn't need root canals and said I need to get a handle on my TMJD and grinding and fix my bite so all my biting force isn't on these poor two teeth. So I am going to get braces but the pain in these two teeth is bothersome and I feel they just need inlays or something to help the sensitivity and throbbing. What should I do?


Placing an onlay or crown will require the same amount of occlusal reduction (clearance/space on the chewing surface of your teeth). So in regard to your underlying problem (lack of available clearance) they both pose the same difficulty. (An inlay wouldn't provide the solution you're after.)

As discussed in the comments above, some types of onlays/crowns can be very thin, thus reducing the space requirement that your dentist is battling.

We'd assume that your dentist has already considered this option but doesn't consider it acceptable for your situation (heavy bruxing being the conflict). However, if it hasn't been discussed with you there's no harm in asking about it.

Managing your sensitivity during your orthodontic treatment will be a challenge. If your treatment is performed via a system like Invisalign (plastic aligners that fit over your teeth), they would offer protection similar as your mouth guard.

Clearly Invisalign isn't appropriate for all types of cases. But, once again, you might ask if that's an option.

tooth sensitivity

I have the same problem with molar wear...they are riddled with deep pockets on the occluding surface and hurt when I eat citrus, sugar or hard stuff. I avoid those foods when possible, rinse a ton after eating them, brush gently 3x per day. A great help has been a prescription toothpaste that has a lot of fluoride in it. I use it at night, or even sometimes dab a tiny bit into the tooth holes to reduce the pain. It works. This toothpaste supposedly helps rebuild enamel, which I can't understand, but can cause cancer if used too often. Also, use Sensodyne or Pronamel toothpastes regularly. Obviously, wear a nigtguard religioously. Don't eat sugar within 5 hours of bedtime to reduce liklihood of grinding.

Completely worn down teeth, please advise!

Hi I'm writing on behalf of my father who is 67 and who has been suffering from bruxism most of his life. The problem is most of his teeth have been worn down to the point he can barely chew. I think that crowns at this point will be very expensive and also a time consuming, tedious process. Is it possible he could have special removable dentures made to fit over the filed down teeth?


There is a type of appliance termed an overdenture, although it likely isn't exactly the type of appliance we think you are enquiring about.

A cover for worn teeth like we think you mention isn't a common and routine type of dental appliance. Possibly a dentist might take an interest in a case and attempt to make one.

14 crowns upper teeth

My husband is a heavy grinder, 3 different dentist recommended all crowns. He didn't have the money for that. But does now, starting with zirconia on 14 upper teeth. He went to his final fitting for permanent crowns the dentist said the lab thought 4 individuals in the front teeth 5 connected teeth on both sides! For stronger support and his normal teeth are too small. When before she stated that she hoped she took off enough teeth for the crowns. We are concerned if this really is best or somehow cutting corners. She stated she would do individuals any way but we would have to sign a waiver.


Without knowing anything about your husband's case other than what's mentioned in your comment, here's a way the situation might be interpreted:

You husband has teeth that comparatively speaking "are too small."
Most likely due to the way they have worn down from his being a "heavy grindier," they are shorter than what is ideal. (The amount of tooth structure that extends up into a crown aids in its stability, more is generally better.)

When preparing the teeth the dentist needed to trim away enough for the thickness of the crowns, yet leave the teeth as tall as possible to aid in crown stability.
The statement "hoped she took off enough teeth for the crowns" implies that both issues were on her mind, she thought she had favored the situation of leaving the teeth as tall as possible. She hoped that in doing so the strength (thickness) of the crowns wouldn't be compromised.

The laboratory recognized that the tooth preparations they had to work with (the nubs) were shorter than ideal and therefore thought that retention might be a problem, so they suggested that groups of teeth should all be connected.

Doing so would distribute forces over the back teeth collectively, whereas otherwise some individual teeth might receive too much force and their crown might be dislodged. Also geometrically speaking, having several teeth all connected would tend to aid in restoration stability/retention.

Completing cases often is/should be a collaboration between the dentist and laboratory. Although it seems the collaboration took place less when the case was first planned as opposed to midstream, hence your surprise.

A big difference between individual units and attached ones is the ease with which the patient can floss. Performing oral home care is key in providing a long term successful out come for any dental work.

Zirconia crowns are sold to dentists as a solution for bruxing (tooth grinding) cases because of their great strength. And generally speaking they can be thinner than other types of "porcelain" crowns.

A question might arise about the wisdom of placing Zirconia crowns in the situation where heavy forces are involved and the crown is of only minimal thickness (at the thinner end of what's considered acceptable). However this doesn't seem to be an issue that the dental laboratory brought up, so evidently adequate clearance was created when the teeth were trimmed.

What should I do

i was a grinder since very young age and and now that the grinding has significantly reduced, i want to make my teeth look "normal". My teeth are chipped and sensitive to many types of foods such as apples, chocolate, etc. I cant use white strips because it is extremely painful, and that leaves me conscious about my smile. Are there any options?

Mia D

Placing dental crowns would be the usual solution.
The sensitivity you notice is no doubt in part due to the fact that you have worn through the protective enamel covering of the teeth (the dentin layer underneath frequently does display sensitivity).
Also, as your teeth have worn down the nerve inside them is now less protected (less tooth thickness surrounds it), thus you notice increased sensitivity.
Crowns solve both of these problems because they cup over and encase the tooth on which they are placed.
We'd suggest you read through this page, and the pages it links to, to get a better idea of how crowns can be used to resolve cases such as yours. Best of luck.

Flat Top Teeth

Let me start by saying I'm very impressed by the breadth of info here and how you spend the time to answer questions.

I have been a grinder all of my life, having a night guard as a child/teen, lapsing as a young adult, and now having a night guard again in my late 20s. I wear it irregularly, but recently woke up to sensitivity in my right side canine and even more wear and am committed to reducing stress and wearing my night guard every night.

My question, though, is whether veneers would be a good option for building some length back into front teeth (my bite is correct and my teeth are straight, they are just all flat)? I also have a fracture or two in my front teeth and a chip on one of the sides of a molar. My teeth are still fairly healthy, so I don't want a crown if it means cutting a lot away. My concerns are mostly adding strength and restoring the appearance. If I wear my night guard regularly, would porcelain/emax veneers be a good option?


Generally speaking, veneers typically don't make the best choice for persons with a bruxing habit. And generally speaking, veneers aren't used to strengthen teeth.

However you're right, today's dental ceramics, with their improved strength characteristics, make it possible to use restorations such as veneers in applications where previously a ceramic restoration would undoubtedly fail. But ultimately, only your dentist can advise you if that type of restoration makes an appropriate choice for your situation.

What really stood out to us in your post was the description of your bruxing history. If you re-read that, it seems fair to state that you have an earnest intention of controlling the effects of your bruxism from here on further. But as of yet, you have no long term track record in accomplishing that.

One could say that your question about the use of veneers lies at the edge of their intended purpose. And in light of that it would make the best sense to only proceed with that type of application after having an established history of controlling your bruxism, not before.

Even if a type of restoration is placed that can withstand bruxing forces (and really there is no such thing, except in short-term time frames) the excessive forces still generated will produce other complications (wear of opposing untreated teeth, jaw joint problems, headaches, increased tooth mobility, periodontal problems, etc...).

Start with the fundamentals. Establish a firm track record of being successful in controlling the habit (either controlling it and/or its effects, maybe for a year or so, or whatever it take for you to know that you'll continue with it), then make plans from there. Stack the odds in your favor as much as you can before taking a big, expensive, irreversible step with your teeth. Good luck.

2 front teeth worn thin on edge of both teeth...see light threw

Can re-inforcing back of these 2 teeth prevent them from breaking & getting worse


Only your dentist can determine this, but in most cases as the backside of your teeth wear so does your entire bite.

So adding extra thickness to the backside of some teeth would likely throw the rest of your bite out of sorts, and therefore not be a viable solution.

Also, getting a dental material to stay in place (not fracture, come off, or wear) would be difficult too.

Crowning usually makes the best option. It's a more durable type of restoration, and gives your dentist more control over the situation.

How to determine the bite after implants and before crowns

My wife has ground her top and bottom teeth down to nubs. She has no teeth in the back and has been chewing her food using her front teeth for so many years that she was told that she has no predictable bite. Rather than chewing up and down she chews her food by grinding her teeth like a cow chewing the cud. The dentist sent her for implants to add back teeth and is now working on her natural ones in the front. He built up the bottom teeth using composite and has made temporary crowns for her upper teeth. He wanted her to wear these for about two months so that he can determine exactly where her bite is. He said that without knowing this he cannot properly put in the crowns without her breaking them. Does this sound right to you? She is very concerned because her friend who had a similar problem didn't have to go through getting temporary crowns, but used some kind of computer program to determine her bite. The temps were joined together, but that caused a lot of pain for her. He split them up and now they keep falling off. He said that he has no other choice but to try to take a best guess as to her predicted bite. She also noticed that after the dentist ground her teeth into cones for the temps that they appeared to be reddish after a while. She fears that this is bacteria building up underneath the temps. Is her fear legitimate? Thanks.


Generally speaking, everything you mention prior to the sentence "Does this sound right to you?" does.
1) The dentist has made an estimate of what they think the "vertical dimension of occlusion" needs to be for your wife's case.
2) Via temporary means, they have established this vertical and are testing it (Can the patient function and speak properly? Can her jaw joint tolerate this added teeth height?, How have the temporary restorations fared?, etc...). And they have the ability to adjust it if they find they have missed the mark.

While newer (electronic and computer-oriented) methods of determining vertical dimension do exist, we won't concede that they are better. The method you describe seems consistent with what's been used by dentists for literally decades on end prior to the digital age. (The vast majority of dentists probably continue to use traditional techniques.)

Considering the extensiveness of the work being performed, one would question the prudence of not using some type of trial period before spending what must be 10's of thousands on permanent restorations, no matter what method was used to first estimate the case's vertical.

This case involves a parafunctional habit that has destroyed an entire set of teeth. No artificial tooth or tooth covering approaches what nature gave originally. Her dentist needs all the information they can collect in their attempt to treat her case successfully. The outlook for the new restorations will be far worse if the height of the new teeth is not correct.

In regard to the upper crowns, and related to the parafunctional jaw movements/activities that are involved (cud chewing), the dentist has a situation where the crowned teeth are exposed to excessive forces, and lateral (sideways) ones too.

Especially in the case where teeth are shorter than normal, crown retention certainly can be a problem when excessive and lateral forces are involved. In an attempt to stabilize the crowns, the dentist splinted them together. Now as individual units, it's easy to see how retention might be a problem.

It's pretty much impossible to make a reply about tooth color or bacterial build up. There are simply too many unknowns involved for us (we have no case history, no knowledge of what took place during the procedure, no chance to visualize the condition to understand what is noticed) to be able to make a valid comment.

In regard to appropriately crafted and cemented temporary crowns, there should be no concerns about bacteria seeping in between the crown and tooth and accumulating.


I’m in my 50s and not one dentist in the past has mentioned my grinding. My teeth at the front are probably about 50% smaller. It’s only a family member that’s a dentist that pointed it out.
I approached my dentist and he wants to now do composite resin on the front 12 then a night guard.
Is this going to work. From what I can read , I will break and chip composite resin , I’ve never been able to have composite fillings with my hard bite.
Please could you advise. Thank you.


Your dentist's plans seem to rely on using the nightguard to mitigate the effects of your teeth grinding, so the forces your new composite restorations are exposed to are more "normal" and therefore will be able to provide you with adequate service.

1) Some of the composite restorations (uppers probably) will be covered over by the guard and protected.
2) Other of the restorations (lowers), when you grind, will rub against the comparatively softer plastic of the guard rather than your own teeth, which is good for them.
3) Wearing the guard should redistribute the forces you create when you clamp down and grind among all of your teeth, thus reducing the level of forces the restorations on the front teeth are exposed to.

So in theory, yes that plan might work. But that plan is counting on the fact that you wear your night guard 100% of nights. And that no grinding/clenching activity occurs during the day (or else you wear your night guard during the day too). Only you can determine how realistic that seems.

It's curious why only that plan was suggested. At the extremes, some questions are ...
1) How is placing the composites a better plan than just wearing a night guard?
2) If restorations are needed, why were composites suggested rather than dental crowns?

Based on their original recommendation, one would have to assume that your dentist either finds your case so advanced/difficult that they feel they have no other options to offer that seem practical to attempt. Or else they have assumed that you are not interested in pursuing other, more durable, types of restorations. You should talk to them again and let them explain.

* Comments marked with an asterisk, along with their associated replies, have either been edited for brevity/clarity, or have been moved to a page that's better aligned with their subject matter, or both. If relocated, the comment and its replies retain their original datestamps, which may affect the chronology of the page's comments section.

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