Straight from the Horse’s Mouth

Question:

I have strong teeth, well the remaining ones seem strong. They’re only in the front so when I smile it’s a horsey grin because all you can see is front teeth with gaps up top and on the bottom. They kind of look like horse teeth too. When I bite, the edges fit right together or on top of each other. That’s been the way from the beginning. I’m nearing golden age so I’ve worn the teeth down quite a bit.

My dentist has filled the edges many times but that wears down and then chips out. The long and short of it is that my teeth are failing. I was told the last time at my dentist’s that I’ve got another big abscess, though I can’t feel it other than the tooth in question feeling a bit loose, so I’m slowly losing my teeth. Can I keep the ones I’ve got and get crowns and implants? The doc said he didn’t know if I had enough bone, but I had a bone scan and there may be just enough for implants with some bone grafting. It’s not vanity, its function.

Horses nip off the grass with their front teeth then send it way back into the jaw to munch it up on big hidden molars. My horsey grin is all there is – no back teeth to do the munching. I’m getting to the age where there’s still gas in the tank but I can’t go anywhere – at least not with my front grill. So, what do I do? I can still eat I just can’t smile.

Answer:

With your self-deprecating sense of humour I don’t know if people notice your smile, but you do and that’s important. If your remaining teeth are failing badly (abscesses, breaking etc.) it might be time to replace them with implant supported teeth. This could be a one day affair – teeth in a day is a real option and is producing wonderful function and beauty for a great many people.

If you want to save and restore what you’ve got and add implants (if you have adequate bone) that may be alright but you have a bite that is not easy to reconstruct. If you have an end to end or edge to edge front tooth contact bite as your normal bite position, extreme care in crowning your remaining teeth and crowning the implants for reconstruction is a must. End to end positioned front teeth tend to wear first, then back teeth wear. Over time different rates of wear cause greater damage in isolated areas. Often it is the back teeth that sadly enough are lost. If you go this route, excellent maintenance practices will ensure its success.

Overwhelmed!

Question:

I’m from Poland. Two years ago, I moved to Canada. Last week I went to the dentist because a filling fell out. I also have other problems with some broken pieces, I don’t know if tooth or filling. He looked at my mouth then told me about other problems I wasn’t aware of. He told me I had a very strong bite. He said my bite was too strong for the fillings. He said my teeth would keep breaking. He told me my wisdom teeth were bad to keep. He said they make my bite even harder for my fillings. He told me one of my root canals was not working and I might need surgery on it. He told me my front teeth were dissolving and wearing very fast for my age. I am thirty-five. I don’t know why my teeth are dissolving and breaking. He said I would need crowns on my teeth. It sounds expensive and confuses me. This is the first time I have heard of these problems. I don’t know if it’s right all of these things. Can you tell me if this can be right? What do I do if it costs too much money?

Answer: 

Though the experience you’ve had may seem overwhelming – and it is – a careful and thorough approach is best. From what you’ve related, three forces are operating aggressively that must be checked. Mechanical forces are causing breakdown of your white fillings. Chemical forces are causing the erosion (dissolving) to your teeth and bacterial forces are causing your root canal to fail.

Mechanical forces (your bite forces) need to be managed with protective care. This will prevent destructive wear. Also, your dentist may well be right about your wisdom teeth. Many times, their removal decreases the mechanical forces in your mouth.

Chemical forces may be diet-related or part of your makeup. It will be very important to keep a written record for at least two weeks (a month is better) of everything you eat. Soda, sports drinks, and energy drinks can produce devastating breakdown in combination with grinding and clenching. It is also important to note the manner in which you drink. Swishing these drinks throughout your mouth is especially harmful. Front teeth are more affected by acidic drinks that are swished. Another source of acid is stomach acid that gets regurgitated up and into the back of the mouth and starts dissolving the inside and top of back teeth.

Finally, the bacterial problems associated with root canal failure may have to be solved surgically. This is done when there is no other route to eliminate the bacteria.

Start carefully, proceed from most urgent to least urgent, one step at a time. A good plan and consistent effort will save your teeth.