How a Decreased Vertical Dimension of Occlusion (VDO) Accelerates Lower Face Visual Ageing

Introduction

Many people notice changes in the lower portion of their face as they age — a shorter-looking chin, deeper lines around the mouth, or lips that appear to have thinned or turned inward. What surprises many patients is that these changes are not always purely cosmetic or the inevitable result of getting older. In some cases, they may be linked to a dental issue known as a decreased vertical dimension of occlusion (VDO).

The vertical dimension of occlusion refers to the measured height of the lower face when the teeth are brought together in a biting position. When this dimension reduces — often due to tooth wear, tooth loss, or worn-down dental restorations — the entire lower third of the face can appear to collapse inward, creating the impression of premature or accelerated facial ageing.

This article explains what a decreased VDO is, why it happens, how it may affect your appearance and oral health, and when it may be worth discussing with a dental professional. As always, treatment suitability must be assessed individually during a clinical examination.

What Is a Decreased Vertical Dimension of Occlusion?

A decreased vertical dimension of occlusion (VDO) occurs when the natural height between the upper and lower jaws — measured when the teeth are in contact — is reduced. This commonly results from tooth wear, tooth loss, or worn restorations. A reduced VDO can cause the lower face to appear shorter, contributing to visible signs of premature facial ageing.

What Is the Vertical Dimension of Occlusion?

The vertical dimension of occlusion (VDO) is a clinical measurement describing the height of the face when the upper and lower teeth meet in their natural biting position. Think of it as the structural support that your teeth provide to the lower third of your face.

When your teeth are healthy and intact, they maintain a natural space — a balanced proportional height — between your chin and the base of your nose. This dimension is established over time through a combination of genetics, growth, and the development of your dentition.

In an ideal occlusion, the upper and lower teeth interlock in a way that holds the jaw in an appropriate position, maintaining not just your bite function but also supporting the overlying soft tissues of the face. When this dimension is adequate, the face retains a balanced lower third proportion.

However, over the course of a lifetime, factors such as tooth wear, grinding (bruxism), tooth loss, or repeated replacement of dental restorations can gradually reduce this height. The result is a VDO that is lower than it should be — and in many cases, this change becomes visible in the face long before a patient may connect it to their dental health.

How Does a Reduced VDO Accelerate Facial Ageing?

The lower third of the face — from the base of the nose to the chin — is fundamentally supported by the dental structures beneath it. When the vertical dimension of occlusion decreases, several visible changes may follow.

The chin appears to rotate upward and forward. With less vertical height between the jaws, the chin effectively moves closer to the nose, creating a shortened lower face. This is sometimes described as a "sunken" appearance.

Perioral lines deepen. Lines around the mouth — sometimes called marionette lines or perioral wrinkles — may become more pronounced. Without sufficient jaw height, the skin and soft tissue around the lips has less support, causing it to fold inward and crease.

Lips may appear thinner or inverted. As the lower jaw closes further than it should, the lips can roll inward, making them appear narrower or less defined.

Jowling and soft tissue laxity may be exaggerated. The reduced support can accelerate the appearance of loose skin along the jawline.

These changes can occur gradually over many years, which is why many patients attribute them solely to natural ageing rather than an underlying dental cause.

Common Causes of a Decreased VDO

Understanding why a reduced VDO develops is an important part of addressing it appropriately. Several dental conditions and habits are commonly associated with this change.

Tooth Wear (Dental Erosion and Attrition)

Progressive tooth wear is one of the most frequent contributors. Wear can result from:

• Bruxism (teeth grinding and clenching), which gradually files down the biting surfaces of teeth
• Acid erosion from dietary sources such as acidic drinks or gastric reflux, which softens and dissolves enamel
• Abrasion from aggressive tooth brushing techniques

Over time, as the biting surfaces of the teeth are worn away, the overall height of the teeth — and therefore the VDO — diminishes.

Tooth Loss

When teeth are lost and not replaced promptly, the remaining teeth may over-erupt or drift, altering the bite relationships and contributing to a reduced occlusal dimension.

Worn or Failing Dental Restorations

Older crowns, bridges, or dentures that have been in place for many years may wear down or settle, gradually lowering the overall bite height.

Natural Bone Resorption

Following tooth loss, the jawbone beneath can resorb over time, which may further contribute to vertical height loss in certain patients, particularly those with complete or partial dentures.

The Dental Science Behind VDO and Facial Structure

To understand why VDO changes affect the face so significantly, it helps to consider the anatomy involved.

The lower face is composed of three primary structural layers: the skeletal framework (the jaw bones and teeth), the muscular layer (the muscles of mastication and facial expression), and the soft tissue and skin overlay.

When the teeth are in their natural occlusal position, they act as a rigid stop point for the closing jaw. They determine how far the lower jaw travels upward when biting. This jaw position, in turn, dictates how taut or relaxed the surrounding muscles and skin are held.

In a healthy occlusion, the lower jaw rests in a position that keeps the overlying muscles at a functional and comfortable length. The soft tissues of the face are held gently taut, supporting the overlying skin and minimising folding.

When VDO decreases, the jaw closes further than it should before the teeth meet. The lower face effectively collapses inward. The muscles — including the orbicularis oris around the lips and the platysma beneath the chin — are held in an excessively shortened position. This shortening causes them to appear lax and can accelerate the formation of soft tissue folds and perioral lines.

From a dental perspective, this demonstrates how profoundly the occlusal relationship influences not just chewing function but also the visible appearance of the lower face.

Signs That May Suggest a Reduced VDO

Patients do not always connect the following signs to dental causes, but any combination of them may be worth discussing with a dental professional:

• Visible shortening of the lower face compared to earlier photographs
• Deepening lines or folds around the mouth, particularly downward-running creases at the corners
• Lips that appear to have thinned, turned inward, or changed in position
• Jaw discomfort, clicking, or popping sounds from the temporomandibular joint (TMJ)
• Muscle fatigue or tension in the jaw and cheeks
• Increasing tooth sensitivity due to surface wear
• Headaches, which some patients report in association with altered bite mechanics

It is important to note that many of these signs can result from a range of causes, and none of the above should be taken as a self-diagnosis. A comprehensive clinical assessment is always required to determine whether a reduced VDO may be contributing.

How Dental Professionals Assess and Address a Reduced VDO

If a reduced vertical dimension of occlusion is suspected, a dental professional will conduct a thorough assessment before recommending any treatment. This typically involves:

Clinical measurement of facial proportions and the existing occlusal relationship. Dentists use specific tools and reference landmarks to assess what the ideal VDO should be for a particular patient.

Study models and bite records to analyse the current relationship between the upper and lower arches in detail.

Radiographic assessment to evaluate bone levels, root and joint health, and the overall condition of the existing dentition.

Trial restorations or provisional appliances are often used before any permanent treatment is undertaken. This allows both the patient and clinician to evaluate how the patient tolerates and responds to a change in VDO before committing to definitive treatment.

Treatment approaches vary considerably depending on the cause and severity, and may include a structured bite-rehabilitation approach for sunken bites, composite or ceramic onlays to restore worn teeth, crown work, implant-retained restorations, or the provision of new dentures constructed at a corrected VDO.

It is important to understand that increasing VDO is a significant clinical undertaking. The jaw, muscles, and joints must all be assessed for their capacity to tolerate and adapt to a new occlusal position. There is no universally appropriate level of correction, and outcomes will always depend on individual clinical factors.

The Role of Tooth Wear in Accelerating VDO Loss

Because tooth wear is one of the most significant contributors to a reduced VDO, it is worth exploring in more detail.

Tooth wear is broadly categorised into three types: erosion (chemical dissolution of enamel, often from acids), attrition (tooth-to-tooth wear, typically from bruxism), and abrasion (wear from external mechanical forces). In practice, many patients experience a combination of these.

The concern with tooth wear and VDO is that it tends to be progressive. Enamel, once lost, does not regenerate. As the biting surfaces of the posterior (back) teeth gradually reduce in height, the jaw closes further, and the process accelerates — worn teeth are more vulnerable to further wear, and the bite relationship continues to change.

For patients who grind their teeth, understanding and managing bruxism is often an important part of preventing further VDO loss. Occlusal splints (sometimes called night guards) may be recommended to protect remaining tooth structure whilst a treatment plan is developed.

When Professional Dental Assessment May Be Appropriate

There is no cause for alarm if you recognise some of the signs described in this article, but it is worth seeking a professional opinion in the following circumstances:

• You have noticed a visible change in the appearance of your lower face that you cannot attribute to weight loss or other lifestyle factors
• You are experiencing jaw joint discomfort, clicking, or limited mouth opening
• You have been told by a dentist that you have significant tooth wear
• You wear dentures that feel increasingly uncomfortable or look like they sit differently than they once did
• You have existing crowns or bridges that are more than 10–15 years old and have not been reviewed recently
• You are considering facial aesthetic treatments but have not had a recent dental check-up

If jaw symptoms are part of your concern, this overview on bite changes and TMJ-related symptoms can help frame useful questions for your consultation.

In all of these situations, a consultation with a dental professional — ideally one experienced in restorative and occlusal dentistry — may help identify whether dental factors are playing a role and what, if any, interventions may be appropriate.

Dental symptoms and treatment options should always be assessed individually during a clinical examination.

Prevention and Oral Health Advice

Whilst some degree of tooth wear occurs naturally over a lifetime, there are several evidence-informed steps patients can take to slow the process and support long-term dental health.

Manage acid exposure. Limit the frequency of acidic drinks such as fizzy water, fruit juices, sports drinks, and wine. Use a straw where appropriate and avoid swishing acidic drinks across your teeth. If you experience frequent heartburn or acid reflux, speak to your GP, as unmanaged gastric acid is a significant contributor to dental erosion. This companion guide on acid reflux and enamel wear explains that pathway in more detail.

Address bruxism early. If you notice worn, flattened, or chipped teeth, or if a sleep partner mentions grinding sounds at night, raise this at your next dental appointment. Occlusal splints can help protect tooth structure during sleep.

Attend regular dental check-ups. Routine dental examinations allow your dentist to monitor and record any tooth wear over time, catch early changes, and intervene before significant VDO loss occurs.

Replace missing teeth promptly. If you lose a tooth, discuss replacement options with your dentist. Leaving a gap can cause adjacent teeth to drift or over-erupt, which may in time affect your occlusal height.

Maintain good oral hygiene. Healthy teeth and gums are better able to support restorations and are more resistant to the complications that can accelerate occlusal changes. If you use clear aligners or orthodontic treatment, ensure your occlusion is properly evaluated as part of the treatment planning process.

Keep dental restorations under review. Crowns, bridges, and dentures all have a functional lifespan. Regular dental reviews allow wear or settling to be identified before it creates a significant change in VDO.

Key Points to Remember

• The vertical dimension of occlusion (VDO) refers to the height of the lower face when the teeth meet in a biting position. It plays a significant role in facial appearance.
• A reduced VDO can cause the lower face to appear shorter, deepen lines around the mouth, and make lips appear thinner — changes that are sometimes mistaken for natural ageing alone.
• Common causes include progressive tooth wear (from grinding or acid erosion), tooth loss, and worn dental restorations.
• Assessment requires clinical examination — VDO changes cannot be accurately evaluated or treated without a thorough dental assessment and appropriate records.
• Early intervention through regular dental reviews, management of tooth wear, and timely replacement of missing teeth may help reduce the risk of significant VDO loss over time.
• Treatment options vary widely based on individual clinical circumstances and must be discussed with a qualified dental professional experienced in restorative dentistry.

Frequently Asked Questions

Can a reduced VDO really affect how old I look?

Yes, in some cases it can. The lower third of the face relies heavily on the structural support provided by the teeth and jaw relationship. When the VDO decreases, the chin appears to rotate closer to the nose, soft tissues lose support, and perioral lines can deepen. Many patients find that restoring the correct VDO through dental rehabilitation has a visible effect on lower face appearance — though outcomes always depend on individual factors and cannot be guaranteed. A dental professional experienced in restorative work would be best placed to discuss what may realistically be achievable in your specific situation.

Is a decreased VDO the same as an overbite?

They are related but not identical. An overbite refers to the vertical overlap of the upper front teeth over the lower front teeth, while VDO specifically refers to the overall height of the lower face in the closed biting position. A deep overbite can be a sign of a reduced VDO, particularly when the lower front teeth bite deeply into the palate. However, VDO and overbite are assessed separately, and changes in one do not always directly mirror changes in the other. A comprehensive clinical assessment is required to understand the relationship in any individual case.

How is VDO restored by a dentist?

Restoring VDO typically involves building up the height of the teeth using restorations such as composite or ceramic onlays, crowns, or implant-supported prosthetics, constructed to a planned new occlusal height. In many cases, dentists use provisional or temporary restorations first, allowing the patient to adapt and for any muscular or joint responses to be monitored before permanent restorations are placed. The treatment is highly individual and requires careful planning over multiple appointments. It is not a quick fix, and any approach should be discussed thoroughly with a qualified restorative dentist.

Can a night guard prevent VDO loss?

An occlusal splint or night guard can help protect existing tooth structure from further wear caused by grinding (bruxism), which may slow the rate of VDO reduction. However, it does not restore height that has already been lost. If tooth wear has already caused a meaningful reduction in VDO, restorative dental treatment would need to be considered in addition to a splint. A dentist can advise on whether a splint is appropriate for your situation and, if so, what type would best suit your needs.

Is VDO loss only a concern for older patients?

Not necessarily. Whilst VDO tends to reduce gradually with age, younger patients who grind their teeth heavily, consume highly acidic diets, or who have experienced early tooth loss may develop significant VDO reduction at a much younger age. It is the cumulative amount of tooth wear — rather than age alone — that determines how quickly VDO changes occur. Regular dental monitoring from an early age is one of the most effective ways of identifying and managing changes before they become advanced.

Will treating my VDO feel uncomfortable?

Most patients adapt well to a corrected VDO, particularly when treatment is introduced gradually and provisional restorations are used to allow the jaw and muscles to adjust. Some patients may initially experience mild muscle awareness or tiredness as the muscles adapt to their new length. Significant discomfort would always be a signal to review the treatment plan with your dentist. Any changes to the bite should always be introduced carefully, with patient comfort and tolerance assessed throughout the process.

Conclusion

A decreased vertical dimension of occlusion is a dental condition that many patients have not heard of — yet it can play a meaningful role in accelerating the appearance of lower face ageing. By reducing the structural height of the lower face, a reduced VDO can contribute to a shortened facial appearance, deeper perioral lines, and a change in the position of the lips — changes that are sometimes attributed solely to natural ageing or lifestyle factors.

Understanding the connection between dental health and facial appearance empowers patients to make more informed decisions about their oral health and the consultations they seek. Whether you have noticed gradual changes in your lower face, have been told you have significant tooth wear, or are simply curious about what may be contributing to facial changes, discussing these concerns with a dental professional is a valuable first step.

With the right assessment, many patients find that a restorative dental approach — tailored carefully to their individual clinical circumstances — can make a meaningful difference to both function and appearance. However, no outcome can be guaranteed, and every treatment plan must be developed based on thorough clinical evaluation.

Dental symptoms and treatment options should always be assessed individually during a clinical examination.

If you are based in London and would like to discuss concerns about tooth wear, bite changes, or facial ageing related to dental factors, speaking with a qualified dental professional is always the most appropriate course of action.