Dr. Crapo: I’ve had good teeth all my life. Despite that I’ve noticed my lower front teeth seem shorter. I’ve had fillings in three of them and about every two or three years the fillings seem to pop out. The last time I saw my dentist, he remarked that my lower front teeth showed a lot of grinding wear. I asked him if my back teeth were wearing down too, so he took a second look and said there was very little wear showing. I asked how that could be. He told me I had a deep overbite so wear could happen that way. But then he said “the way you grind is a bit different than what we usually see with people whose upper front teeth cover almost completely their lower front teeth (deep bite) when they put their teeth together”. “Usually” he said, “we would see the fronts of the lower teeth have definite wear areas that look like the flat surfaces of a diamond only much larger and the inside of the upper front teeth would have lots of similar wear and both the upper and lower teeth would be getting thinner and thinner”. “Your teeth” he said, “have none of that, your teeth are flat on their edges. It looks like you bring your edges together and grind the edges so you’re actually shortening your front teeth. When you’re on your front edges, the back teeth are not touching so they don’t wear”. He said I’d need a bite-guard. What is going to happen with these teeth of mine and what do I do? He said I’d lost a full 50% of height on my lower front teeth.
You have a challenging situation that may require several discovery steps or stages before the problem is remedied. First, you must know when the grinding is occurring. If it is at night, it’s easier because faithfully wearing a bite-guard will slow down the wear tremendously. If your grinding occurs during the day, wearing a bite-guard may interfere with your working relationships.
Replacing the 50% of tooth structure you’ve lost is probably not realistic but 25% may be. This would require crowning your twelve front teeth (six teeth on top from eyetooth to eyetooth and the same on the bottom). However, adding length to the front teeth will create a gap between the back teeth which is a problem. I have seen this quite easily and predictably solved after the front teeth are lengthened, by bonding tiny height increasing platforms or shims on top of the upper posterior (rear) teeth. This will ensure contact of all the teeth simultaneously.
This technique should be used carefully and tested to ensure stability and comfort. I have seen extreme grinders benefit from this technique, with a dramatic decrease of broken teeth and crowns.
If we can help, we’d like to. Call 778-410-2080 for a consultation.
Based on actual patient cases.