Q: Dr. Crapo, I’m a tooth grinder – have been all my life. My mother says that I ground my baby teeth to the gums. That was over fifty years ago.
I’ve had fillings, at first they were silver fillings and I had all my back teeth filled. Then when I needed new fillings, about fifteen years ago, I started getting white fillings. They didn’t last like the silver ones but they looked better. I went through two sets of white fillings before finally getting crowns two years ago. I had most all my back teeth crowned. In the meantime, my front teeth keep getting shorter but no decay.
Six months ago my crowns started breaking. To date, six have broken or chipped. I’ve changed dentists several times but all I hear is “you’re a humongous grinder – the only thing is to get gold crowns on the teeth so they won’t break”. I don’t like yellow or white metal gleaming from my mouth. I feel like I’m going to lose my teeth and then what – wear through dentures? I’m getting self-conscious about my front teeth because I’ve worn away over half their length, both top and bottom. I’ve tried night guards but that hasn’t helped. I can’t wear them 24-7 and my wife says I snore with my mouth open, so I’m not sure when I grind. Is there any help?
A: You have many dental issues, from possible sleep apnea grinding to stress and functional grinding – each a topic in itself. Before any more dentistry is begun, it will be important to sort this out. Then, following correct reconstruction principles will prevent throwing good money after bad and correct breaking your posterior crowns.
The first principle after discovering the reason for grinding is a clear diagnosis of the mechanics (workings) of your teeth, muscles and joints. Secondly, a working model of the reconstruction is imperative. A mock-up of the front teeth on your dental molds is made to their original length and position. When this is done for you, the back teeth will likely not touch. There will be a 1-4 mm gap between the back teeth on the mock-up. This mock-up acts as a blue print to make crowns for all your front teeth. Temporary landing stops are created on your back teeth to ensure all teeth hit simultaneously when you bite together. Now you have new front teeth and back teeth that touch in perfect harmony. The back teeth can then be crowned one side at a time.
Close monitoring of your bite will almost always find it stable and breakage reduced to zero. It is important after all reconstructions, that your dentist checks this stability regularly to make any minor corrections.
Expensive – surely, a new life – absolutely.