His Teeth Had Worn Down So Slowly He Had Not Noticed His Face Changing

Quick answer: When wear affects the whole mouth rather than a few front teeth, rebuilding often means raising the bite height — a substantial undertaking that should be tested with a removable appliance and a provisional phase for months before anything permanent is made.

The call

His wife had said something about his chin, which is how a good many of these appointments begin.

Yaakov, 58, from Givat Sharett, had teeth that were short across the whole mouth. He had noticed food catching, a bite that felt "collapsed", and that he was biting his cheek regularly.

He had not connected any of it to appearance until someone else did.

What we found

Generalised wear affecting every tooth. Upper front teeth reduced to about two-thirds of their original height with dentine exposed across the edges. Posterior teeth with cupped, flattened biting surfaces and several old restorations standing proud.

Measured, the distance from his nose to his chin with the teeth together had reduced noticeably compared with the same measurement with his jaw at rest — the space between those two positions had increased, which is what happens as teeth shorten and the jaw closes further to meet them.

The facial consequences follow from that: a shortened lower face, deepened folds from the nose to the corners of the mouth, and the corners of the mouth turning down and staying damp, which is why he had cracking there.

Cheek biting because the bite had closed to the point where soft tissue was being caught.

The three causes, all present, as they usually are in cases this generalised:

• Attrition — flat matching facets, from years of grinding.
• Erosion — cupped hollows and proud restorations, from a two-litre-a-day sparkling water habit.
• Age — five decades of ordinary function on top of both.

The critical question in any generalised wear case, and the one that determines the whole treatment plan: has the bite height actually been lost, or have the teeth over-erupted to compensate?

Teeth that wear slowly are usually followed down by their supporting bone, so the jaw relationship stays the same and there is no space to rebuild into. Teeth that wear faster than the compensation can keep up leave genuine lost height.

His was the second, which is less common and considerably easier to treat — there was space available.

What we did

Nothing irreversible for the first year. That is the essential discipline in these cases.

Cause control first, four months. A hard splint at night. Sparkling water restricted to mealtimes and drunk rather than sipped. No brushing within an hour of it.

Casts at four months confirmed the wear had stopped. Nothing gets rebuilt until that is demonstrated, because a rebuild placed into ongoing wear simply wears away.

A removable appliance at the proposed new bite height, worn for three months. This is the step that is most often skipped and matters most. It tests whether he could tolerate an increased vertical dimension — whether his muscles and joints would accept it, whether he could speak and eat normally, whether he developed any joint symptoms.

He wore it, adapted within about two weeks, and reported no problems. Had he not tolerated it, we would have known before anything permanent was made.

A provisional phase, six months. Composite build-ups on every tooth at the new height — not the final restorations, but a full working rehearsal. He functioned in them, we adjusted them, and two areas that were consistently uncomfortable were modified.

Photographs and casts of the provisionals became the blueprint for the definitive work.

Definitive restorations at fifteen months, staged in quadrants: ceramic onlays on the back teeth, preserving as much tooth as possible rather than full crowns, and layered composite on the front teeth.

A new night guard, made over the finished work, because the grinding had not gone anywhere.

The outcome

Facial height restored to what the measurements indicated. The cheek biting resolved once the bite opened. His wife's original observation was addressed, which had not been the clinical objective and was the outcome he mentioned.

Three years on, one onlay has been recemented and two composites polished. He wears the guard nightly.

What to do if this happens to you

1. Get the cause identified and stopped first. Rebuilding into active wear fails.
2. Ask whether bite height has genuinely been lost or whether the teeth have compensated. It changes everything.
3. Insist on a removable appliance trial before any permanent bite change.
4. Insist on a provisional phase of months, not weeks.
5. Ask about onlays rather than full crowns. Worn teeth have little to spare.
6. Expect a night guard for life if grinding is involved.

Teeth worn down across the whole mouth? Ramat Beit Shemesh Urgent Dental Care tests before rebuilding. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.