Fixing a small cavity, rebuilding worn teeth.

The most detracting aspect of this person's smile is the dark spot on their upper right tooth. And while that, no doubt, is this person's chief complaint, there's another, more pressing, issue at hand.

This second area of concern is related to the fact that there's evidence that this person grinds their teeth. And this habit (termed "bruxism" by dentists) has started to create significant tooth wear.

This digital smile makeover explains how both issues might be managed.

Case issues and concerns:

1) This person has a dark spot on their upper right central incisor.

  • It's interesting to note that while this spot is likely tooth decay, it doesn't have the characteristic look or location of the typical cavity.
  • It's quite likely that the decay has formed within some type of previously existing tooth surface flaw or developmental pit.

2) This "before" picture shows a lot of evidence of tooth wear caused by bruxism.

  • The upper center teeth (the central incisors) have worn significantly.
    • Their biting edges have worn straight, yet show some waviness due to the fact that they've worn thin and small bits of enamel have chipped off.
    • The grey coloration near the biting edges of these teeth also reveals their thinness.
  • The upper teeth to the sides of the centrals (the lateral incisors) also show wear.
    • The right one has worn straight.
    • The left one has been notched by its contact with a lower tooth.

3) From the wear that's taken place, its easy enough to imagine the position in which this person holds their jaw when they grind their teeth.

  • Worn teeth and a cavity on a front tooth.
    Worn teeth and a cavity on a front tooth. Worn teeth and a cavity on a front tooth.
  • After dental crown placement.
    After dental crown placement. After dental crown placement.
 

Photo submitted by website visitor.

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Treatment solutions:

1) Fixing the dark spot.

Fixing the small cavity on the upper central incisor should be a simple and straightforward affair. Dental bonding is routinely used to make these types of repairs.

Note: In the case where a dental crown is ultimately placed on this tooth (as described below), this small repair may not even be needed.

2) Rebuilding the worn teeth.

Rebuilding the upper teeth so they're closer to their original shape would give this smile a better look. The appearance we've illustrated in our "after" picture could be achieved by placing dental crowns on the center four upper incisors. And smoothing off and recontouring other teeth (as we've illustrated) would help to even out this smile.

3) The larger concern.

By far, the greatest issue here isn't a cosmetic one at all. It has to do with what steps will be taken to control the patient's tooth grinding habit so damage to their teeth doesn't continue to occur.

  • It's possible that this person is unaware of the harm that their habit is causing. If so, now that they know better, possibly they can control it.
  • More likely, their dentist will need to make them some type of guard that they wear at night to protect them from the grinding they do while they sleep. And if their daytime bruxism can't be controlled, then they will need to wear their guard somewhat during the day too.

Without controlling the bruxism, the teeth will continue to wear. And in some cases, the abrasiveness of a person's crowns can even cause the wear rate on opposing teeth to accelerate.

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