When it comes to oral health, there are two things main issues to consider. The first and perhaps most important point is the functional and structural health of your mouth. Essentially, do the teeth perform the way they are meant to? Can they bite and chew without damage to the person or themselves? The second issue to consider is a cosmetic one. Teeth can be structurally sound and function perfectly but in some way not be quite as cosmetically pleasing as you might like. A flattened incisal edge is a case of a tooth that might be perfectly structurally sound but not quite aesthetically pleasing. Here’s what you should know.

What is the incisal edge?

An incisal edge is sometimes confused with an incisal ridge. While an incisal ridge is the bottom portion of the tooth farthest from the gum, the incisal ridge refers to the angle on the tooth that occurs where two flat surfaces meet. This is the area between the teeth, farthest from the gum line.

Although the incisal edge is primarily of aesthetic concern, there are some functional issues that can occur when there is a flattened incisal edge. The interaction between the lips and tongue and the flattened incisal edge can cause some difficulty in producing speech that is clear. This could result in changes in speech or the development of a speech impediment.

Additionally, if the incisal edges are not properly contoured and are either too long or short, their function in terms of biting and chewing could be compromised. This may seem minor to begin with, but misalignment can cause patients to compensate in other ways (e.g., chewing or biting in an unusual manner), which can lead to other oral health challenges down the road.

When is a flattened incisal edge an issue?

In terms of flattened incisal edges, “wear is considered excessive when it causes esthetic concerns to the patient and causes symptoms of discomfort.”

As incisal edges begin to flatten, cosmetic concerns may be primary, but over time even the function and structure of the tooth can be affected. Left to its own devices, this wear can proceed through the enamel and into the dentin.

Once this occurs, the tooth is largely unprotected and vulnerable to tooth decay and periodontal disease.

What can cause a flattened incisal edge?

Flattened incisal edges have a variety of causes. In many cases, some form of dental attrition is present. Tooth attrition is wear caused by one tooth’s contact with another. Teeth do wear down naturally over time, but dental attrition speeds this process up. Over time, this wear can even reach through the enamel into the dentin.

One of the most obvious signs of dental attrition is a flattened incisal edge, but as it progresses, fillings and other dental restorations may fail and fall out, or teeth can become mottled and discolored.

There are two other types of dental attrition that can contribute to a flattened incisal edge.

1. Tooth abrasion

While tooth attrition is caused by one tooth contacting another, tooth abrasion occurs as a result of outside forces acting on the teeth.

The most common of these forces is vigorous and aggressive tooth brushing, often with a hard-bristled brush. Tooth abrasion can also be caused by overuse of abrasive toothpaste and toothpicks, both of which can create ridges in all surfaces of the teeth.

2. Tooth erosion

Tooth erosion of teeth occurs when we use our teeth for something other than their intended purpose.

Biologically speaking, teeth are designed to bite and chew. They are not meant to be used as bottle openers, nut crackers, tool holders, string cutters, or nail trimmers. These common uses of teeth cause far more wear-and-tear per occurrence than do natural uses like eating, yet people often discount the damage they are doing.

How to treat flattened incisal edge

Teeth with a flattened incisal edge may still be functional, but if the factors causing the wear are not addressed it will continue. It is possible, however, to treat and recontour the tooth to improve its functional and aesthetic appeal.

If the flattened incisal edge is caused by malocclusion, especially a class III malocclusion with an open bite, your orthodontist can