Bruxism and worn teeth: why treating the cause comes before any restoration

Bruxism is a parafunctional activity characterised by clenching or grinding of the teeth, predominantly during sleep. Its effect on dental structure is cumulative: years of excessive occlusal forces produce progressive loss of enamel and dentine that, once a critical threshold is exceeded, can no longer be recovered with conservative approaches.

The problem is not bruxism itself, but unrecognised bruxism. Many patients discover they have a nocturnal parafunctional habit only when the damage is already advanced, shorter teeth, hypersensitivity, joint pain, or when a clinician identifies the wear pattern unequivocally during a routine examination.

What happens to teeth without intervention

Wear from bruxism does not arrest spontaneously. Without occlusal protection and parafunctional management, structural loss continues at a rate determined by the intensity of forces generated and individual tissue resistance. In some patients the process is slow and manifests over decades; in others, destruction is rapid and clinically evident by 35-40 years of age.

The consequences are not only aesthetic. Loss of vertical dimension of occlusion, the distance between the upper and lower jaw in the closed position, alters the balance of the entire masticatory system. The temporomandibular joint, masticatory muscles, and periodontal tissues become progressively involved. The clinical picture, straightforward at the outset, grows progressively more complex over time.

Why the cause must be treated before any restoration

A restoration placed without identifying and controlling bruxism is exposed to the same forces that destroyed the natural structure. This applies regardless of the material used: ceramic, composite, zirconia. No prosthetic material withstands unmanaged pathological occlusal forces indefinitely.

The correct protocol involves: bruxism diagnosis and damage quantification; prescription of an occlusal device to protect teeth during sleep; a stabilisation period; clinical reassessment; and only then, restoration planning. In many patients, restorations can be fabricated as adhesive ceramic overlays, without sacrificing healthy enamel, because the space required has already been created by the wear itself.

The night guard is not discontinued after restoration. It remains necessary permanently: it protects the new restorations from the same force that destroyed the natural teeth.

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