Teeth wear for more than one reason. Grinding and clenching flatten edges and can chip them. Acid from reflux or from the diet softens enamel so that ordinary chewing removes it. A hard brush and abrasive paste scrub the necks of the teeth. These patterns can sit on the same mouth. Treating the look of the wear without asking which pattern is active replaces the surface and leaves the cause in place.
The examination looks at the edges, the biting surfaces, the gum line, the opposing teeth, and whether dentin is exposed. Sensitivity, shortened front teeth, and a bite that has collapsed are consequences, not the diagnosis. Photographs and models help compare the next visit with this one. They do not, by themselves, say that every worn tooth needs a crown.
Protection comes before addition when the cause is still going. That can mean a night guard for parafunction, a conversation about acid and reflux with the appropriate physician, fluoride when the enamel or dentin needs it, and a change in how the teeth are brushed. A guard does not cure grinding. It keeps the teeth and any future ceramic from receiving the full load every night. Ceramic placed over active acid wear or heavy grinding without that conversation tends to chip, debond, or wear the teeth it bites against.
Restoration is appropriate when tooth structure is missing enough to affect sensitivity, the bite, or a tooth that is fracturing, and when the cause has a plan. The amount of treatment can be a few teeth. It does not become a full-mouth rehabilitation because the edges look short in a smile photograph. The plan should say which teeth, which material, and what will be done if the wear continues.
