Major pain - grinding has caused sealants to come off

I've been a night grinder since childhood. In my late teens, the grinding/clenching started happening during the day. Never having "good" insurance, the dentist just said to get a guard like football players use and wear it at night. In my late 20's, I finally got dental insurance but wouldn't you know - the grinding and all effects from it was never covered. I was having some issues with sensitivity to cold/air and the dentist said it was because I was grinding the enamel off my teeth. So, he placed "sealants" on the very back upper teeth (the dentist said I was born without upper wisdom teeth and that this is perfectly normal for some folks). It just looked like a little bottle of white out that he painted onto the teeth and then "set" it with a blue light until it hardened. He said that would help for a while and warned me that the sealants would eventually come off because the grinding was so bad. It did help - no more sensitivity. But because I still grind/clench, I had the sealants replaced 3 times over a period of about 5 years. Never any pain after the first placement though. Just when I would go in for my regular cleanings, he would say that they had worn down again and we needed to reapply the sealant. We tried all sorts of medication to help with the grinding - muscle relaxers, benzos, sleep meds, etc., but nothing has ever really worked. I went through 12 weeks of biofeedback, had a sleep study (no apnea or obstruction) and still attend psychotherapy weekly (all of which the insurance happily covers). I also paid almost $300 to get a custom made night guard thinking it would be stronger and more comfortable than the ones I was getting at the drug store but I chewed right through it within a month. After that, I went back to the cheap ones you buy at the drug store and dip in hot water to mold. I just couldn't afford to replace the custom ones that often. I do buy new cheap guards pretty regular and I wear them probably 5 out of 7 nights a week (and sometimes during the day if my jaws are really sore from a particularly bad night of grinding). I have to admit, I despise the night guards. They make me feel like I am choking and I usually only make it a few hours before I wake up and have to adjust it which means I don't get a lot of uninterrupted sleep.

Now, at 45, my jaw sort of naturally sits to the left. Sometimes, it is hard for me to keep my mouth closed as it just feels like it is more natural for it to be open a bit. It sort of feels like my face is scrunched up and my cheeks sucked in, if that makes any sense. Several people have commented on the change in the shape of my face but I always thought it was just natural sagging from aging. My bite has changed significantly over the years because of the grinding - one front upper tooth (just to the right of the 2 front teeth) is pushed back and starting to turn just the slightest tinge of grey and the opposing bottom tooth (to the left of the 2 front teeth) has been pushed forward. I also now have a pretty significant overbite. My front teeth feel like they have more give in them than they used to but they are definitely not loose enough to fall out.

Over the past month, my upper back teeth on the left side started to REALLY hurt, particularly when I bite down. I thought one of the sealants might have come off again. But this time when I went in, the dentist didn't even look at it or take x-rays. He just said it was time to pull the top teeth and get fitted for dentures. I was shocked! I've only ever had 2 cavities in my life. Other than the past month or so, I've never had any unbearable pain. He said that we could try crowns or veneers but that it was a waste of money because I cannot get the grinding under control. And, he says there are no other options to help with that as I've tried just about everything to no avail. No, my smile isn't as pretty (and straight) as it used to be but I was always under the impression that natural teeth are ALWAYS better than crowns, veneers, dentures, etc. Am I wrong about that?

I am on medication for Bipolar Disorder I (including anti-convulsants that cause severe dry mouth). The current medication cocktail has kept me more stable than I have been since my diagnosis so my doctor is adamant that we not mess with it. I have been using Biotin to help with the terrible dry mouth and even quit smoking about 5 years ago (major accomplishment). There is a history of gum disease in my family and that has always worried me. I am the only one with my natural teeth - all of my siblings and both parents got dentures in their early 30's because of gum disease. But my dentist says that my gums are fine other than being irritated from the grinding/clenching.

I do NOT want to get dentures but I really can't afford extensive dental work. I just want the teeth to not hurt. Is there any true way to make this happen without pulling them all? And even if we did that and placed dentures, won't the dentures eventually crack from the constant grinding/clenching? Or make my gums sore from pushing the plate up into the gums when I grind/clench? I guess I just assumed we could keep putting the "sealant" on any teeth that were worn down and everything would be okay even if they didn't look all that great. If one falls out or turns black, I might be more concerned with appearances but for right now, I can live with how they look. It is the pain that bothers me most!

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