The Dahl Technique for Restoring Worn Front Teeth

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.

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.

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 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.

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.