Flat canine teeth: Causes and treatment solutions

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It is impossible to know the level of tooth grinding an individual does at any point in time. Generally, this genetically inherited habit can be accentuated or worsened during periods of stress.

Initially when the permanent canine (3rd from centre) teeth come through and align into the arch at about the age of 12 -14 years they have ‘points’ on them. These allow all other teeth, but particularly the upper and lower incisors (front teeth between the canines) to separate and not be in contact during sideways grinding (such as night-time bruxing). This protects these incisor teeth from excessive wear.

Worn-down canine tooth.
The same canine tooth – restored.

The causes of flat canine teeth.

In the case of individuals who grind their teeth sideways at night (bruxers), these upper and lower canine teeth rub against each other quite aggressively and with some force. This results in their ‘points’ (or tips) wearing down and the canines flattening and shortening. As this progresses the upper and lower incisors start to get closer to each other during these sideways grinding movements until at some point they ‘touch’. Then, if there is no ‘treatment intervention’, these contacts between incisor teeth start to become harder and more abrasive. From then on, the four upper (and four lower) incisor teeth begin to chip, wear excessively and shorten progressively over time and they essentially ‘self-destruct’.  This all because the worn down, shorter canine teeth have lost their protective function. The process is almost always gradual and painless, so the patient often does not notice.

As an example, the photographs below show the stage where the canines have worn down to the point where the four upper and four lower incisors are contacting when the patient grinds both to the left and to the right.

Worn canine allows traumatic contact on the front incisors
Restored canine protects front teeth from damage (excess wear).

How to reinstate protective function of canine teeth?

Consequently, the advice is that it would now be appropriate to re-instate the protective function of the canines allowing complete separation once again of incisors during these sideways grinding movements. This can be done by bonding tooth coloured material onto the existing enamel of the upper canine teeth and reforming the canine points (tips), as demonstrated in the other photographs below. This is done without damaging the existing enamel of the canine teeth and is a purely ‘add-on’ procedure.

If composite material is used for this treatment, which is ‘softer’ than the natural tooth enamel of the opposing (lower) canines, it will wear selectively over time. By checking the amount of wear of this composite material over time (i.e. say, 6-18 months) one can ascertain the force of the tooth grinding.

If the force is very strong and the composite, therefore, chips or wears down very quickly, the much harder (and more costly) porcelain material may need to substitute the composite. Otherwise, over time the composite, as and when necessary, can simply be replaced.

To conclude, the timing of replacing the canine tips is such that it is important to do before the canines are too short and the incisor teeth begin to be affected.

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