I Wish I’d Known
Question: Dear Dr. Crapo, About five years ago I had some upper front porcelain veneers done. They look good and have given me good service. In the past year I’ve noticed that when my teeth are together, my jaw seems to be forced backward. It is quite uncomfortable and hard to understand. I saw a dentist who took molds and did a thorough analysis. The first thing he saw was that my lower front and my lower right and left back teeth were really worn down. He showed me when I closed, that my jaw was being pushed back as my teeth settled into the worn surfaces. He said that it can be a problem when natural teeth have to chew and function against teeth with porcelain crowns or veneers because porcelain is many times more abrasive than one’s own enamel. I didn’t know that. I’m wondering why I wasn’t told. He showed me that I’m a grinder and that I’ve started to chip a bit off the veneers, though it doesn’t show and I haven’t noticed it. If it hadn’t been for my jaw aching I don’t think I would have looked into what was going on. What can be done? What would be best? I’ve worn through two crowns on the teeth behind my lower eye teeth, that he said were made of plastic, so I’ve got to get them replaced. I didn’t realize what was happening. Can this somehow be corrected? What about my jaw pain?
Answer: Severe abrasion caused by porcelain “rubbing” against natural enamel is a problem in individuals who are functional or parafunctional grinders. In other words, people who grind through their food to ensure complete mastication (chewing) or those who grind in their sleep or during the day but are not aware that they are doing it. In adults and some adolescents, this trait or habit can be discerned before any dental work is begun. Signs of moderate to severe wear should be recognized and figured into any treatment provided.
If your upper teeth are in good shape relatively speaking, your lower teeth may be returned to their natural length. This may get pricey but if done properly it would place the function of your jaw into a supportive location, so that your bite doesn’t force your joints into a posterior (rear) position. This will relieve things greatly. Using porcelain or porcelain like materials will prevent the wear that you’ve experienced.
If this solution is too costly, the condition could be managed with a fully adjusted and self-adjusting splint (like a bite-guard), that would prevent further grinding and help your jaw while the splint/guard is in place.
If we can help, we’d like to. Call 250-800-3647 for a free consultation.
This article was originally featured in the Victoria Times Colonist on November 1, 2015.