Is Your Nose Getting Closer to Your Chin?

By Brian J. Gray, DDS, MAGD, FICOI

Everyone knows that when we age, we see certain changes in our face (for example, wrinkled skin, less skin tone, shrunken appearance). The soft tissue in the lower one-third of the face is supported by the teeth and jawbone, and gives support to your smile. As we age, we lose support to our smile and we begin to appear older.

Anatomically, the face is divided into thirds: the upper, middle, and lower one-third. The space between your nose and your chin is referred to as the lower one-third. The teeth support the vertical height of your lower face, and more specifically the back teeth support your lower face.

Most dentists agree that minimal and gradual wearing away of the top enamel of the teeth is considered normal during the lifespan of a patient. However, excessive wear on the top surfaces of the teeth can result in abscessed teeth, an irregular bite, decreased chewing capacity, and esthetic disharmony. Patients with these types of problems often require extensive restorative treatment.

How Common Is Tooth Wear?

Although the prevalence of tooth wear, or attrition, is not known, it is thought to be very common in adults over the age of 40. The wearing of the top surfaces of the teeth is most often attributed to attrition, which is the wearing away of one tooth surface by another tooth surface. Attrition is the result of bruxism, or the involuntary grinding of the teeth against each other.

How Does Attrition Occur?

Attrition can be the result of one or a combination of problems such as:

• Congenital Abnormalities: Hereditary abnormalities can cause the malformation of the surfaces of the teeth. This can result in a thin and/or brittle outer layer of the tooth. This leaves the tooth more susceptible to surface wear and a more rapid attrition of tooth structure.
• Parafunctional Habits: One type of parafunctional habit is bruxism, as explained above. Other habits often associated with attrition include biting on needles, pipe stems, pencils, or finger nails, and clenching. Many studies have related stress to attrition.
• Abrasion: It is defined as the wearing away of tooth tissue through mechanical processes. The top surfaces of the teeth are abraded away usually by diet, chewing of abrasives such as tobacco, and environmental factors such as constant exposure to dust and grit (in farming).
• Erosion: Erosion is the destruction of hard dental tissues by chemical action. Diets high in acidic content like juices, colas, and other carbonated drinks are examples of the foods that cause erosion. Patients who suffer from anorexia nervosa or bulimia are prime examples of erosion due to the high acid nature of stomach acids that are constantly regurgitated into the mouth.

What Is the Result of Worn Teeth?

Depending on the severity of the tooth wear, teeth may be broken, shortened, and unattractive. Having worn teeth can result in jaw joint pain (TMJ), a decreased ability to chew, and a sunken appearance to the lower face. All of these results can make a person appear more wrinkled and older.

Can Worn Teeth Be Restored?

Generally, the worn teeth will have to have new fillings placed or redone. When severe wear occurs in the mouth, a crown or multiple crowns may be the only solution.

Can Tooth Wear Be Prevented?

Yes, tooth wear can be prevented, but only if you make regular visits to the dentist. If detected early enough, your dentist may prescribe a plastic nightguard to protect your teeth, much like an athletic mouthguard.