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Feb 2023

The Dahl Technique for Restoring Worn Front Teeth

Tooth Wear- an increasing dental issue

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.

What are the causes of tooth wear?

One of the most common causes of worn teeth is bruxism. This is essentially night time grinding which can place enormous strain on the dentition and musculature. Some studies have shown that the average time for tooth to tooth contact whilst night grinding is between 3-4 hours. During the day, we generally only make contact for an average of 17-20 minutes. Hence, bruxism can account for 300 times greater tooth contact overnight! No wonder teeth start to wear down!

Another cause of tooth wear is acid in the diet or due to medical reasons such as gastric reflux. Many foods and drinks have a low PH which can lead to the dissolution of tooth enamel. Enamel erosion in combination with bruxism can lead to rapid loss of tooth enamel and dentine. Did you know that a simple hot water and lemon drink, advocated by many so called health experts, has a PH similar to battery acid. Once a week may be fine but not once a day!

Overbrushing ones teeth or brushing too hard will also lead to teeth wearing down especially in the bucco cervical area ( at the gum line). The typical clinical feature of this is an elliptical ridge with a concave surface. This can be quite sensitive initially and lead to greater issues if not treated or at the least maintained.

What is the Dahl Technique?

The concept was originally introduced in 1975 by a dentist called Dahl, to create space in the treatment of front teeth wear. It involved the patient wearing a removable, chrome-cobalt appliance with an anterior bite plate to separate the back teeth. This prevented the back teeth from closing down initially but he discovered that over time, the back teeth made contact.

According to Dahl, this was caused by a combination of the intrusion of the anterior teeth and the eruption of the posterior teeth. This process usually occurred over 16-20 weeks.

With the advent of adhesive dentistry and modern composite bonding materials, the need for using removing appliances diminished and direct restoration of the teeth was possible with the increase of the OVD ( referenced above) reducing the incisal guidance angle (essentially the angle at which the front teeth slide around) and in turn creating an improved functional situation.

Once the back teeth have made contact again, the front teeth can be restored with minimal preparation or they can simply be monitored and maintained over the following months and years with composite.

We have used this concept for over 17 years with great success and as our case shows, it can really have a life changing effect.

Our Case of the Month January 2023

Our case is a classic one with severe lower front teeth wear and it got to the stage where the teeth were breaking apart. Something had to be done and the Dahl technique is ideal for the first stage treatment.

Severe Front Teeth Wear

pre dahl treatment

As you can see, the lower front 6 teeth are heavily worn down especially the front 4 incisor teeth.

After the Dahl treatment

post dahl treatment

Direct composite bonding has returned the teeth back to the normal dimensions and the OVD has been increased with an improved incisal guidance angle

Do you suffer from tooth wear?

If you suffer from tooth wear and would like treatment, contact us and we will provide guidance on what would be best for you in the short and long term.


Oct 2022

The Truth About Tooth Wear

Do you know what the one of the most common dental problems is in the United Kingdom? It's not cavities or gum disease. It's tooth wear! Tooth wear can be caused by a number of factors including acid erosion, bruxism (teeth grinding at night ), and poor oral hygiene. In this blog post, we will discuss the causes, treatment, cost, and prevention of tooth wear. We will also answer some common questions about this condition. If you have tooth wear, you must simply read this article.… READ MORE
Jan 2022

Tooth Wear & Cosmetic Bonding Case Of The Month

Our case of the month for November 2021 was a classic tooth bonding case involving severe tooth wear. Tooth wear is an increasing problem with grinding at night becoming an ever increasing problem coupled with acid in the diet. The combination of these two factors can lead to the softening and dissolving enamel leading to thin edges, chipping, fractures and exposure of the underlying dentine which can be very sensitive. The beauty of cosmetic bonding is that we can treat the wear, protect the teeth and impr… READ MORE
Nov 2019

Bruxism Treatment And Bite Re-Construction Before And After Case

Our case of the month for November involves a re-construction of the bite over a number of years. The main reason for treatment was due to severe tooth wear due to bruxism. Bruxism is essentially grinding at night to such an extent that the enamel is worn over a number of years. This can cause a number of problems such as: Tooth sensitivity Difficulty in eating Lack of a coherent bite Aesthetic issues Pain leading to root canal treatment in severe cases Tooth wear, on the whole, can be prevented o… READ MORE
Feb 2018

Tooth Wear Treatment For Lower Front Teeth

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 … READ MORE