What Is Tooth Attrition?
Tooth attrition is a form of mechanical wear that occurs when opposing teeth make direct contact with one another. Every time you chew, swallow, or bring your teeth together, small amounts of enamel are subject to friction. Under normal circumstances, this wear is minimal and progresses very slowly over a lifetime. However, when habits such as grinding or clenching are present, or when the bite is not evenly balanced, the rate of wear can increase significantly.
It is helpful to distinguish attrition from other forms of tooth wear. Erosion refers to the chemical dissolution of enamel by acids — from dietary sources or gastric reflux. Abrasion describes wear caused by external mechanical forces, such as overly vigorous toothbrushing or habitual contact with hard objects. Attrition is specifically the result of tooth-against-tooth friction.
As enamel gradually thins, the softer dentine layer beneath becomes increasingly exposed. Dentine wears more quickly than enamel and contains microscopic tubules that connect to the tooth's nerve, which is why sensitivity often develops as attrition progresses. Understanding the nature and cause of the wear is important for determining the most effective management approach.
Common Causes of Worn Teeth
The severity and pattern of tooth wear vary between individuals and depend on a combination of factors. The following are among the most commonly identified contributors to attrition:
Teeth Grinding (Bruxism)
Habitual grinding, often occurring during sleep, subjects the teeth to repeated lateral and vertical forces that progressively wear down enamel on the biting surfaces and tooth edges.
Jaw Clenching
Sustained clenching places continuous pressure on the teeth without the sliding motion of grinding. Over time, this can flatten biting surfaces and contribute to fatigue in the jaw muscles and joints.
Bite Imbalance (Malocclusion)
When the teeth do not meet evenly during biting and chewing, certain teeth bear a disproportionate share of the load. This uneven pressure can accelerate wear on specific teeth or groups of teeth.
Stress-Related Tooth Contact
Many people unconsciously bring their teeth together or clench during periods of stress, concentration, or physical exertion. Over months and years, this repeated contact contributes to cumulative enamel loss.
Age-Related Wear
Some degree of enamel wear is a natural consequence of decades of chewing. However, when wear exceeds what would be expected for a person’s age, contributing factors such as grinding or bite imbalance should be investigated.
Signs and Symptoms of Worn Teeth
Attrition tends to develop gradually, and early signs may go unnoticed. As wear progresses, the following changes may become apparent:
Flattened Chewing Surfaces
The natural contours and cusps of the back teeth become progressively smoothed and flattened, reducing chewing efficiency and altering how the teeth fit together.
Shortened or Worn-Down Teeth
Front teeth may appear visibly shorter than before, and the biting edges may become thin, uneven, or slightly translucent as enamel is lost.
Increased Tooth Sensitivity
As enamel thins and the underlying dentine layer becomes exposed, teeth may become more sensitive to hot, cold, sweet, or acidic foods and drinks.
Jaw Discomfort or Tension
Grinding and clenching can cause fatigue, tenderness, or aching in the jaw muscles, particularly upon waking. Some individuals may also experience clicking or limited jaw movement.
Changes in Bite Alignment
Progressive wear can alter how the upper and lower teeth meet, potentially leading to an unstable or uncomfortable bite that may contribute to further uneven wear.
Cracks or Small Fractures
Teeth weakened by significant enamel loss are more susceptible to developing small cracks, chips, or fractures, particularly under normal biting forces.
Not all of these signs will be present in every case. The pattern and severity of symptoms depend on the underlying cause and duration of the wear.
Why Bite Assessment Is Important
Excessive tooth wear is frequently linked to how the teeth come together during biting and chewing. When the bite is not evenly balanced, certain teeth or tooth surfaces bear a greater share of the load, leading to accelerated and uneven wear patterns.
Grinding often occurs during sleep, meaning many individuals are unaware of the habit until a dentist identifies characteristic wear patterns during examination. A partner may notice grinding sounds at night, but in many cases the only evidence is the gradual flattening or shortening of the teeth.
A thorough bite assessment helps your dentist identify areas of uneven pressure, evaluate whether grinding or clenching is contributing to the wear, and determine whether protective or restorative intervention may help reduce further damage. Early identification is particularly valuable, as it allows management to begin before more extensive enamel loss occurs.
How Dentists Assess Worn Teeth
A structured clinical assessment helps determine the extent, pattern, and likely cause of tooth wear, guiding the most appropriate management approach:
Clinical Examination
A thorough visual and tactile inspection of all tooth surfaces to identify patterns of wear, flattened cusps, shortened teeth, and any signs of cracking or fracture.
Bite and Occlusal Analysis
Assessment of how the upper and lower teeth meet during biting and chewing, using articulating paper or digital analysis to identify areas of uneven contact and pressure distribution.
Assessment of Contributing Factors
Discussion of grinding habits, stress levels, sleep quality, jaw symptoms, and medical history to identify factors that may be contributing to the pattern of wear.
Dental Imaging
X-rays or other imaging where clinically indicated to assess the extent of structural changes, check for root or bone involvement, and evaluate the condition of existing restorations.
Wear Pattern Evaluation
Analysis of the distribution and severity of wear across the teeth to distinguish attrition from erosion or abrasion, and to determine whether the wear is progressing or stable.
Professional Management and Treatment Options
The approach to managing worn teeth depends on the severity of the wear, the contributing factors, and the areas affected. Your dentist will discuss the most suitable options based on the clinical findings. Management may include:
Monitoring Mild Wear
Where wear is mild and not progressing rapidly, your dentist may recommend regular monitoring with periodic photographs or impressions to track any changes over time.
Bite Assessment and Adjustment
If uneven tooth contact is contributing to wear, selective adjustment of the biting surfaces may help distribute forces more evenly and reduce localised pressure on specific teeth.
Protective Night Guards
A custom-made bite guard worn during sleep may be recommended to help protect the teeth from further grinding damage. These are designed to fit precisely and distribute biting forces across a broader area.
Composite Bonding
Where wear has altered tooth shape or exposed sensitive dentine, composite bonding may be used to rebuild worn surfaces, restore natural contours, and provide a protective layer over vulnerable areas.
Dental Crowns
In cases of advanced structural compromise, dental crowns may be recommended to restore the tooth’s shape, height, and strength, and to protect against further deterioration.
Comprehensive Bite Rehabilitation
In severe cases affecting multiple teeth, a phased restorative plan may be discussed to rebuild the bite, restore function, and improve long-term stability. This is planned carefully on an individual basis.
Treatment outcomes vary depending on individual circumstances. Your dentist will explain what can reasonably be expected based on the specific pattern and severity of wear.
Professional Assessment for Worn Teeth
A professional bite evaluation helps determine whether monitoring, protective appliances, or restorative treatment is appropriate for your level of tooth wear. Your dentist can identify the contributing factors and recommend a tailored management plan.
Depending on the findings, your dentist may recommend general dentistry and monitoring, composite bonding to restore worn surfaces, dental crowns for structurally compromised teeth, or an emergency dental assessment if pain develops.
Assessment and treatment for worn teeth are available at our London clinics. You can attend our South Kensington dental clinic or our City of London clinic near St Paul's for a professional dental review.
Can Worn Teeth Be Restored?
Once enamel has been lost through attrition, it cannot regenerate naturally. However, modern restorative dentistry offers several approaches to rebuilding worn tooth surfaces, improving function, and restoring a more natural appearance.
For mild to moderate wear, composite bonding can be used to add material to worn biting edges and surfaces, effectively recreating the tooth's original contour. In more advanced cases, dental crowns may be recommended to restore height, strength, and structural integrity to significantly compromised teeth.
Long-term monitoring remains important even after restorative treatment, particularly if grinding or clenching continues. Protective strategies — including custom night guards — help safeguard both natural teeth and any restorations from further wear. Your dentist will discuss realistic expectations and a maintenance plan tailored to your situation.
Reducing the Risk of Further Wear
While some tooth wear is unavoidable, the following strategies may help protect your remaining enamel and reduce the rate of further attrition:
- Discuss any grinding or clenching habits with your dentist so they can assess the extent of wear and recommend appropriate management
- Wear a custom-made night guard as advised by your dentist to protect your teeth during sleep
- Attend regular dental check-ups so early signs of accelerated wear can be identified and monitored
- Address bite imbalance early — uneven tooth contact can concentrate forces and accelerate localised wear
- Be mindful of daytime clenching during periods of stress or concentration, and try to keep your teeth slightly apart when at rest
- Avoid chewing on hard objects such as pens, ice, or fingernails, which can contribute to mechanical wear
