We agree, we're unclear why your dentist has suggested the radical change in your treatment plan.

Bruxism can be an aggravating factor in the development of periodontial disease. And if gum disease was an issue in your case, that could explain the recommendation for dentures. But you suggest that you have been told it is not.

Over all, the challenges associated with involved treatment plans involving bruxism can be substantial. We ran across this article (Bruxism and prosthetic treatment: A critical review) and it seems to explain things pretty well.

The section about bruxism and dentures is short but seems to suggest that maintaining denture comfort is sometimes a problem. It also suggests that ridge resorption (loss of bone that the dentures rest on) might be an issue when bruxism is involved.

We would think that denture wear would be a consideration too. Of course all of these issues assume that the dentures are worn.

A big part in understanding the reason for the suggested change in treatment approach would have to do with why your tooth hurts.

Possibly it's the exposed dentin problem you've always had that was controlled with sealants (although previous you described it as sensitivity to "air/cold" but now as pain when biting down).

If so, possibly at this point (due to continued wear) your dentist feels that sealant will now no longer stay in place even as well as it had before.

If not, a crown will be needed. As a further complication, possibly a crown can't be placed without first performing root canal treatment (because the nerve will be exposed when the tooth is trimmed down for the crown).

In regard to problems more characteristically associated with pain triggered when biting down:

Possibly the pain is related to gum disease (although you suggest not), for which tooth extraction might be the only solution.

Or possibly one or more teeth now have irreversibly inflammed nerves (due to the constant tramuma from bruxism or thermal insult). If so, root canal treatment would be needed, and also ideally a crown for each tooth.

Possibly the pain is due to tooth fracture/cracking. If so a crown would be needed, and possibly root canal treatment too, if the teeth can be saved at all.

Each of these latter scenarios might introduce a new level of treatment that's needed (greater effort, greater expense, poor long term outlook due to the bruxism) and your dentist is trying to look at the bigger picture in terms of those issues, and as such has suggested the new tact.

Since they didn't offer, simply ask what it would take to just treat your symptomatic tooth/teeth.
Get an idea of the effort and cost involved, and the expected longevity of the repair. And then weigh that against whatever options they suggest and decide what is best for you.

Best of luck.

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