Repairing tooth wear caused by bruxism.

This digital smile makeover illustrates the type of wear that can be caused by bruxing. (Bruxism is a term that refers to the habit of clenching and/or grinding your teeth.)

Our "after" picture shows how dental crowns can be used to both repair the damaged teeth and restore the appearance of the person's smile.

Case history and concerns:

Any dentist looking at this "before" picture would immediately come to the conclusion that this person has damage caused by a serious tooth-grinding habit.

  • You can literally see how the flat, worn biting edges of the lower teeth match the flat, worn surfaces on the upper teeth. (When this person does their grinding, they hold their jaw just slightly to their left.)
  • It's a simple equation; prolonged tooth-to-tooth contact equals tooth wear. With this case, it looks like five of the six upper teeth have simply been ground off and, in effect, they have been.

No doubt you've also noticed that the "before" picture shows that one of the front teeth is noticeably darker than the others. This darkness is most likely an indication that the tooth has had (or needs) root canal treatment. In our case here, this cosmetic problem will be remedied by the same treatment required to repair this tooth's wear.

  • Teeth worn by tooth grinding.
    Teeth worn by tooth grinding. Teeth worn by tooth grinding.
  • Dental crowns have restored the teeth to their original shape.
    Dental crowns have restored the teeth to their original shape. Dental crowns have restored the teeth to their original shape.
 

Photo submitted by website visitor.

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Treatment solutions:

1) The tooth grinding must be controlled. -

This person needs to discuss their bruxing with their dentist so a means of controlling, or at least minimizing, its effects can be found. After counseling, some people learn to control their daytime habit. People who grind their teeth in their sleep will need to wear a night guard appliance.

It's only once that their bruxism has been brought under controlled that a dentist can predictably restore this person's teeth. If it's not controlled, the nature of the damage that takes place may change but some type of damage will continue to occur.

2) Restoring the teeth with crowns. -

Because of the great strength that they can offer, dental crowns (like porcelain-fused-to-metal ones) would probably make the most durable, lasting choice for treating this case.

One of the treatment goals here, just like with the case above, would be to use the crowns to restore the relative lengths of the teeth back to a more normal configuration. That's what we've illustrated in our "after" picture. In reality, however, the extent to which the teeth can be lengthened will be dictated (and possibly limited) by this person's bite.

3) Other treatment considerations. -

Dental bonding would probably make a suitable choice for closing in the spaces between the lower teeth. It's not as strong and lasting as other types of dental restorations (like crowns). But most of the wear and tear associated with this mouth is on the biting and chewing surfaces of the teeth, not in between.

We're assuming that the dark tooth has had the root canal therapy it requires. Placing a dental crown (possibly in conjunction with a dental post and core) will complete this tooth's treatment.

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Input from site visitors.

Night Grinding

I have severely grounded my teeth so much from night grinding the front are dead flat. What's my best way to go about getting treatment?

Aaron

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.

Sleep bricking and crowns large fillings

Hi, I have recently changed dentists as my last dentist was aware I was bricking in my sleep but continued to give me huge fillings far bigger than the teeth themselves were and I'm left with buckled broken fillings everywhere at the back as a result, I also have a fear of dentists would you say for me it would be worth just getting the teeth removed completely instead of going for crowns? As I feel I will grind the crowns off too, the new dentist I'm seeing advised that the previous dentist made the fillings far too big, she said she would like to do root canal or crowns, having had root canal done before I would prefer not to. Is a crown as invasive a procedure as a root canal? I do wear a night guard but my bottom back teeth are wasting away due to the grinding even with the guard

E

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.

tooth shortening

my back teeth shortened quite a bit as I aged, and I got one crown so far, but the dentist filed it down and it is now shorter than my other teeth. I have cracks in my teeth due to biting in a pitted olive but the seed was still in it, so I may need root canal before getting other crowns, but the whole purpose of getting crowns was so my mouth could be back to its regular position , so my lips are not so pouty looking(age wise) cause it is making me drool on sides of my lips. How can I remedy this?

Mary,

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.

cracked teeth

thank you for your advice. and what can I do for the cracks in my teeth that are so small they cannot be seen? and why couldn't they be seen with x-ray? Are some cracks like that? and can they be fixed without having the root canal done on them? all this work on my teeth is going to cost me a fortune. Not to mention what if I have a root canal and my tooth falls apart? then I will be missing a tooth and will be afraid to have another root canal, so what do you suggest on that?

Mary,

If a tooth requires root canal treatment there really is no substitute, we discuss root canals and possible alternatives here.

Teeth that have had root canal treatment can be fragile, we discuss rebuilding root canal teeth here.

It's not so common to visualize tooth cracks on x-rays. For one to be visible, the direction of the crack and the alignment of the x-ray beam would need to be perfectly in line with each other. This seldom occurs.

In regard to repairing "cracked" teeth, you'll simply have to quiz your denist further.

There is a difference between craze lines in a tooth's enamel layer and a tooth having a bonafide crack that involves tooth enamel and dentin.

Cracks often create symptoms, although possibly infrequently. Craze lines don't, and typically require no treatment. Dentists usually diagnose cracked teeth via the patient's symptoms and testing that elicits pain/symptoms. Let your dentist, or a dentist giving you a second opinion, explain more thoroughly.


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