Q: Dear Dr. Crapo: My father has been complaining of his teeth being sharp and he says they cut his cheeks and tongue when chewing his food. Sometimes it happens when he swallows and he says it can happen with certain words when he is talking. I went with him to the dentist to see what could be done. My father told the dentist he needed some fillings because he thought he had holes that were catching food and causing his teeth to be sharp. The dentist examined my father. He said that the holes were not areas caused by decay but holes caused by extreme grinding of his teeth. He said that more than two-thirds of his upper front teeth were worn away and over half of each of the lower front teeth were worn down. He also said that this wear was so far advanced that the teeth would have to be built up with crowns.
My father has only nine teeth on top but has most of his teeth on the bottom. He needs implants the dentist said, because my father’s mouth would not hold a denture and he needs back teeth to carry the pressure he’s putting on the remaining teeth. He said that some of my father’s teeth might have to have root canals because there’s so much wear. We have to have more information but can it be this extreme?
A:Extreme tooth loss has a number of causes. Those who suffer from bulimia experience moderate to severe wear. Heavy grinders who eat acidic foods experience it as well. Through a process of abrasion and chemical erosion, the enamel is worn away. This is followed by dentin and being much softer than the enamel, wears more quickly. If this process is not arrested, teeth can wear all the way to the gum line.
When a tooth or group of teeth is worn to this degree, it is at times necessary to root canal these teeth and it often requires all the teeth in the arch (upper or lower or both) to be crowned to return the missing tooth architecture for proper function.
At this point, it will be necessary for your father to go through a very thorough diagnosis before starting treatment. A good diagnosis will lead to proper treatment. Once treatment is complete, it would do well to protect the new teeth against the powerful forces exerted by his muscles of mastication (chewing), so that he does not do to his new teeth, what he has done to his existing teeth.
This can be done with a well constructed bite-guard splint.