Tooth wear is one of the most prevalent dental conditions that we see in practice day to day. It would not be an exaggeration to say that almost 90% of adult patients suffer from some form of tooth wear albeit to varying degree of severity. Minor tooth wear can lead to issues such as sensitivity to hot and cold whereas severe tooth wear can impair everyday function of chewing and mastication. Severe tooth surface loss will also cause a reduction in the occlusal vertical dimension (OVD) which is a measurement from under the nose to the chin. This will lead to a change in the shape of ones facial structure which is not desirable. The good news is that there are a number of treatments available that are minimally invasive, pain free and far less costly than traditional methods of reconstruction.
 

Our case of the month for February 2018 involves the treatment of tooth wear. Tooth wear is an increasing problem with modern day life. Stress, night time grinding and acidic diets all lead to loss of tooth enamel which is the hardest tissue in the body! The loss of tooth enamel leads to a weakening of the overall tooth structure exposing the underlying dentine which is much weaker and more susceptible to tooth decay and sensitivity. In the first instance, prevention is better than cure. Therefore, if you love acidic drinks and food, sorry, but you will have to change your diet. If you grind at night, a simple night guard will protect your teeth. 
 

Our case of the month for July involves the restoration of severe tooth wear using the Dahl technique.

The Dahl technique is a great concept for the treatment of localised tooth wear, especially on the front teeth. The concept involves potentially a number of methods but we prefer direct bonding. For example, if the upper front teeth are worn but there is no space to restore them, we may use the Dahl concept to restore them. Direct composite restorations are placed to restore the teeth to the original anatomy and contours. This is done very carefully in accordance to occlusal planning (bite). This will cause premature contact on the new restorations and create space between the upper and lower back teeth. However, over time, this space closes and the jaw re adjusts to create contact once more. This can take a number of months. Therefore this treatment is often completely non invasive. Whereas in the past, teeth were cut down to pegs for crowns and veneers to restore tooth wear, we can now use adhesive technology to replace the lost tooth tissue.
 

Our case of the month for October involves composite bonding of the lower front teeth which were heavily worn and using a principle called the Dahl technique. This technique is not very well known but it is fantastic method for treating worn down teeth where there is no space to restore them. For example, when your front teeth wear down due to grinding, acid erosion, bad habits (biting pens, nails etc), there is often little space to restore the teeth using conventional fillings. In the old days, the teeth may have been cut down for invasive procedures such as crowns or veeners. The Dahl technique involves the careful restoration of the worn teeth directly or indirectly with little, if any, tooth preparation. This must be with precision so that the contact on the new restorations is in such a way that the unworn teeth can slowly re-position and make contact over time. Usually this takes 12-16 weeks to occur but what a concept! For example, just take a look at our case below: