Enamel Wear and Bite Misalignment: Can Orthodontic Treatment Protect Your Dental Health?

Your teeth are designed to work together when you bite and chew, but an uneven bite can put more pressure on some teeth than others. Over time, this uneven pressure can cause tooth wear, particularly if certain areas of the teeth are repeatedly taking more force than they should.

Orthodontic treatment can help by improving the way your upper and lower teeth meet and distributing biting forces more evenly. It can’t restore enamel that’s already been lost, and tooth wear can have several other causes, but improving a misaligned bite may help protect the enamel that remains.

Your dentist may refer to this as your occlusion – how your upper and lower teeth meet when you bite and chew. When the teeth don’t meet correctly, this is known as malocclusion. In some cases, malocclusion means that particular teeth are exposed to considerably more pressure than others.

Tooth wear is common. The national 2023 Adult Oral Health Survey found that 71% of adults in England with natural teeth had some tooth wear, as measured by the Basic Erosive Wear Examination (BEWE) index; while for 22% it was moderate and for 5% it was severe. Enamel doesn’t grow back, so protecting the enamel you have left matters. 

If an uneven bite is contributing to excessive pressure on certain teeth, orthodontic treatment may be one way to address the underlying problem. But when is it appropriate, and how much can it really help?

Can a misaligned bite alignment damage teeth?

A misaligned bite can contribute to tooth wear in some cases, but the relationship isn’t straightforward. Research hasn’t shown that most types of malocclusion consistently cause the loss of tooth surface. However, certain bite patterns have been linked with more severe tooth wear, in particular, a deep bite associated with Class II Division 2 malocclusion – a type of bite where the upper front teeth overlap the lower teeth more deeply than usual. 

A misaligned bite can contribute to tooth wear in some cases, but the evidence is limited. A review in the Journal of Orthodontics linked edge-to-edge bites, overbites deeper than 4 mm and Class II malocclusion with higher levels of tooth surface loss, though the authors rated much of the underlying evidence as low to moderate quality. A 2024 systematic review examining the treatment of Class II Division 2 malocclusion in patients with severe tooth wear highlights the association between this bite pattern and severe wear.

One possible explanation is that an uneven bite can concentrate chewing forces on particular teeth rather than distributing them more evenly. Where this happens, those teeth – and any fillings or crowns they support – may be exposed to greater mechanical stress.

Think of a car with misaligned wheels: one tyre may wear faster than the others because the forces acting on it are uneven. A similar principle can apply to individual teeth, although tooth wear is more complex and can have several causes.

So, while a misaligned bite doesn’t automatically mean your teeth will wear prematurely, identifying and managing an uneven bite may be relevant when certain teeth are showing signs of excessive wear.

Three ways teeth wear down

1. Attrition is wear from tooth-on-tooth friction, the type most closely tied to your bite.
2. Erosion is the chemical dissolving of enamel by acids from food, drink or the stomach.
3. Abrasion is wear from outside objects or overly aggressive toothbrushing.

What uneven wear looks like

When enamel thins, the softer layer underneath (called the dentine) may start to show. You might notice:

• flattened biting surfaces
• chipped edges or tiny cracks
• sensitivity to hot and cold drinks

Uneven tooth wear tends to appear on whichever teeth carry the most load. In a deep bite, these are often the front teeth. Crowding, spacing or an uneven bite can create that imbalance, which can affect your teeth and jaw joints as well as your enamel.

Does a crossbite cause enamel wear?

It can, but not in everyone. In a crossbite, which is one type of malocclusion, some upper teeth close inside the lower teeth instead of outside them. The jaw often shifts sideways to make the teeth fit, which creates extra friction on particular surfaces.

However, having a bite irregularity doesn’t automatically mean you’ll suffer severe enamel loss. A Cardiff University study of 307 adults aged 30 to 31 found no significant differences in tooth wear in relation to the need for or receipt of orthodontic treatment. So because a malocclusion alone doesn’t predict wear, an individual clinical assessment is essential to evaluate your personal risk.

Types of malocclusions 

Dentists classify bites using the system developed by Edward H. Angle, an American dentist who coined the term malocclusion and published his classification system for it in 1899. It’s based on how the upper and lower first molars meet. Some bite patterns can concentrate chewing forces on particular teeth, which may contribute to uneven wear, though the evidence is limited.

Class I: The molars meet normally, though teeth may be crowded or spaced.

Class II: The lower jaw and molars sit behind the upper. In Division 1 the upper front teeth typically stick out (increased overjet). In Division 2, they tilt inward, and there’s usually a deep bite, where the upper teeth overlap the lower ones more than usual, which can put heavy vertical pressure on the front teeth.

Class III: The lower jaw and molars sit ahead of the upper, often producing an underbite.

Other bite patterns. In an open bite, the front teeth don’t meet, so the back teeth may take more of the chewing load. In a crossbite, some upper teeth sit inside the lower ones, and the jaw sometimes shifts sideways to close.

How can orthodontics protect enamel?

Orthodontic treatment moves teeth into better positions so that the upper and lower teeth can meet and function more effectively. In some people with tooth wear, correcting a co-existing malocclusion may help address the way the teeth meet and reduce the risk of further problems. However, tooth wear has several possible causes, so orthodontic treatment isn’t suitable for every case.

Orthodontic treatment can correct the bite so that the front and back teeth meet more evenly. This can reduce the chance of damage to prominent teeth, which is particularly relevant where protruding teeth may be more vulnerable to damage from trauma.

A 2024 review in the British Dental Journal, “The role of orthodontics in the management of tooth wear”, explains that orthodontics can help manage tooth wear by correcting co-existing malocclusion and, where restorative treatment is needed, creating space for restorations.

Which treatments are used?

• Fixed metal or ceramic braces
• Clear aligners such as Invisalign
• Self-ligating brackets, which hold the wire without elastic ties
• Palatal expanders, which can widen the upper jaw and help correct some crossbites, particularly in growing patients
• Elastics, which fine-tune how the upper and lower teeth meet

Which one suits you depends on your bite, your teeth and your goals. Protecting enamel with braces comes down to the final position of your teeth. The aim is for the teeth to meet more evenly, reducing excessive pressure on particular teeth.

What about enamel you’ve already lost?

Orthodontic treatment can’t replace tooth structure that’s already been lost. In some cases, however, correcting a co-existing malocclusion may form part of a wider plan to manage tooth wear and help create the space needed for restorative treatment.

Worn teeth may be rebuilt with restorative materials, such as tooth-coloured composite, while more extensive wear may require other forms of restorative treatment.

What else wears down enamel?

Alignment is only part of the picture. Acid, grinding and clenching also wear enamel, whatever your bite looks like, so long-term oral health depends on dealing with all of them.

Acid erosion

Acidic soft drinks, fruit juices, fruit teas and wine can cause softer enamel. So can gastric reflux and repeated vomiting, as seen in eating disorders like bulimia. Softened enamel wears far more easily under chewing pressure.

Grinding and clenching

Bruxism – the unconscious grinding or clenching of teeth – wears down enamel, no matter how straight your teeth are. It can also cause jaw tension, jaw pain, and strain on the temporomandibular joint (TMJ) and the masseter, your main chewing muscle. Custom night guards and bite splints cushion the teeth and ease that strain. Easing that tension can make a real difference to your quality of life.

Cleaning during treatment

Brush twice a day with fluoride toothpaste, use interdental brushes around brackets and wires, and go easy on sugary or acidic snacks. Good hygiene keeps your gums healthy and helps prevent demineralisation, the chalky white marks that can form around brackets.

What to expect at Hampstead Orthodontic Practice

A consultation is the best first step, as it shows where your teeth are wearing, how your bite works and which treatment plan makes sense for you. At your assessment, digital scanning can give your orthodontist a detailed record of your teeth and bite to help plan treatment. Orthodontics can’t replace lost enamel, but correcting a misaligned bite may help distribute chewing forces more evenly and form part of a plan to manage further tooth wear and support long-term oral health.

If you’ve noticed flattened edges, chips or sensitivity to hot and cold, we’d love to help you find out why. Get in touch with Hampstead Orthodontic Practice in London to schedule a free consultation and talk through your treatment options. 

FAQs

Can braces or aligners reverse enamel wear?

Unfortunately, no, as enamel doesn’t regrow. Orthodontic treatment can help spread biting forces more evenly and create space for restorations, but worn teeth are rebuilt with restorative treatments such as composite bonding or crowns.

How do I know if my bite is causing tooth wear?

Flattened or chipped edges, wear on just a few teeth, sensitivity to hot and cold, or jaw pain can all be signs. Only a dentist or orthodontist can tell whether your bite, acid or grinding is responsible.

Which bite problems are most likely to cause uneven tooth wear?

Deep bites, particularly Class II Division 2, are most often linked to heavy wear. Crossbites and open bites can also overload certain teeth. But many people with these bites show no unusual wear, so assessment is individual.

Can I have orthodontic treatment if my teeth are already worn?

Often, yes. Moving teeth first can create space for restorative work. Your orthodontist and dentist will plan the order of treatment together.

Will braces or aligners stop me grinding or clenching my teeth?

Not on their own. Bruxism can wear enamel, whatever your bite looks like. A custom night guard or bite splint is the usual protection, and your orthodontist can advise on this alongside treatment.

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