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.


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