Repairing tooth wear caused by bruxism.

The first step is having your dentist help you stop your habit or control its effects.

You used the phrase "night grinding." Stopping a habit you do when you sleep may be impossible. The classic way to control the effects of night grinding is by wearing a "nightguard" (a plastic applicance, usually just worn on the upper teeth, that protects your teeth from the wear and stress of grinding).

Once your habit has been controlled, you and your dentist can then decide:
1) If no more damage will take place, are your teeth functional and esthetically reasonable enough that no treatment is needed?
2) If treatment is needed, then your dentist can develop a treatment plan for you and you can get started on it, sooner or later since no further damage is taking place.

But if you skip straight to fixing up your teeth first without first controlling the effects of your grinding, you'll learn the expensive lesson that no type of dental work can withstand the effects of a serious bruxing habit any better than your natural teeth did. And in some cases, the dental work placed (depending on what kind) may cause far more damage to their opposing teeth (the teeth the restorations bite against) than if no new restorations had ever been placed at all.

In regard to everything mentioned here but especially that of extracting vs rebuilding your teeth, only an evaluation by your dentist can really help in making that choice.

We will mention that generally speaking no type of replacement dental work is better at withstanding the forces created by grinding than natural teeth, that would include implants and partial or complete dentures. Also, in the case that the teeth are not replaced, then the bruxing forces will be directed to those teeth still remaining and therefore deteriorate them more quickly.

It's possible for crowns to wear through and/or break due to the forces of grinding. Also, the hardness/surface roughness of some types of porcelain-surfaced crowns can actually speed up the rate of wear of opposing teeth when bruxism is involved. So as beneficial as this solution can be, there can be continued problems.

The need for root canal and a dental crown are usually two separate issues. Dental crowns are used to rebuild and strengthen teeth. Root canal treatment is characteristically just used to treat the nerve inside a tooth that has become damaged or compromised. They are not an either/or choice, they accomplish different goals.

In your case (you don't mention any nerve-related problems), possibly your dentist feels that your teeth have worn so much that the nerve tissue inside them will be exposed when they are ground down for the crowns. If that's the case, then root canal treatment is indicated for teeth whose nerve is otherwise healthy.

If you wear a nightguard yet from time to time a tooth breaks due to the excessive forces you create, then its seems that the strengthening effect that crowns can provide would be beneficial.

If you wear a nightguard yet you still have the problem of general tooth wear, it implies that you grind your teeth during the day and therefore need to be wearing some type of appliance during the day too, or at least as often as you can.

As important as doing reconstruction work with your mouth is it seems that the fundamental underlying problem is that the effects of your bruxism are still not substantially controlled. And just as it has affected your natural teeth, it will tend to affect your future dental work too.

Especially if having dental work done is an issue for you, you need to know that the stage has first been set so that the work you do have done will be as successful over the long-term as possible. The source problem needs to be addressed, not just the symptoms it has created.

In dental terms, what you discuss is referred to as "opening the patient's vertical dimension."

As you've worn your teeth down, you've lost "vertical." And as a result when your jaws come together they over close (because your teeth aren't as tall as they used to be). That's what makes you mouth and lips look collapsed.

A dentist can only restore a patient's vertical dimension by restoring the height of all of their teeth collectively (all bottoms or uppers or else both, depending on the case). You can't restore the dimensions of teeth one-by-one because then only that one tooth, or those few restored teeth, would touch when you close your jaws together.

A difficulty with this situation is that a person's jaw joint becomes accustom to functioning at their new lost-vertical level. A dentist can't always rebuild a patient's teeth to their full original dimensions because in many cases this change won't be tolerated by their jaw joint (the patient may have jaw-joint pain or clench and grind their teeth excessively or even have difficulties with function).

When changing a patient's vertical dimension, the dentist must first establish what restored level of vertical can be tolerated. They do this by experimenting with the height of temporary crowns, or a temporary appliance the patient wears.

Once the new vertical (level for the height of the teeth) has been deemed acceptable, the permanent crowns can be made.