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.
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.
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.
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.)
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 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.
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.)
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.
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.
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...
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.
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...
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.
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...
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.
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