Q: Dr.Crapo: I’m a fifty-two year old man that breaks everything that goes in his mouth. Two years ago I had a bridge put in and in two weeks, I’d smashed out all the porcelain on the molar of the bridge. This is the second bridge I’ve done that to. When I went back, the dentist said he’d never seen that happen before. He told me he’d replace the bridge with solid metal but I didn’t want to look like I was from the hills every time I smiled. I saw another dentist and he pretty much said the same thing, but also said I needed veneers for my front teeth as they were getting short from all my grinding. I thought, how long would those last before I break them. My teeth are in worse shape than ever and I don’t know what to do or where to go – nobody can tell me why I break everything in my mouth including several broken teeth I have now. If I break all my teeth and have to get dentures, I’m afraid my bite will destroy the denture teeth too. Should I have gotten those veneers? Would that have helped my teeth? I need an explanation that makes sense and a plan that will work.
A: The type of severe grinding (bruxing) you do is characteristic of 2-5 percent of the population. It happens because of malalignments, imbalances, and central nervous system stimulated grinding. Malalignments and imbalances can be corrected but central nervous system grinding must be managed. Malalignments and imbalances cause the back teeth to fit irregularly. Folks like you, exert 200-300 pounds of pressure on your teeth during unaware moments (sleep, intense exertion etc.). The actual pressure generated through the tip of one molar onto another is many times that. Deep grooves and long cusp tips in molar teeth are especially bad because they lock into one another and act like a wedge which provides tremendous splitting power thus breaking teeth, porcelain etc. The only type of veneer that would have helped you is called a “taco” veneer. It covers both the inside and outside of your front teeth. As such, it separates your back teeth. This allows for crowns to be made that have a perfect alignment and shallow grooves and short tips, thus correcting the imbalances. Before going to this expense though, find someone who can do this in a trial format with less expensive materials for about six months. Done properly, you will have a test that will prove that your teeth can be restored without breaking. Then when proof is demonstrated to you and the dentist, permanent treatment can be phased a bit at a time so that you can control the costs.
Based on actual patient cases
Calvin Ross Crapo