What Comes First?
Q: Dear Dr. Crapo: I’m hard on my teeth. My dentist brings that to my attention just about every time I go in, which is regularly. I’ve had crowns done on breaking teeth on my molars. I’ve worn, off and on, a night guard. The last visit he said I’d have to get my front teeth capped because I’m breaking the edges and he’d filled them about three times, so they weren’t strong enough to hold more fillings. He also pointed out I had some gum recession and I’d need grafting to hike up the gums on my bottom front teeth and secure them so they wouldn’t recede anymore and the same would have to be done on the top front teeth. He laid out a plan of what needed doing but I don’t know what to do first. I haven’t been bothered by the recession, so I thought let’s get the crowns done; then worry about the gums. I asked him about straightening my teeth because when I was a kid they took out my upper right eyetooth because it was coming in wrong. People don’t notice it but my upper front teeth don’t exactly line up with my lower front teeth. He said the teeth could be made to look straighter but crowning couldn’t compensate for the amount of drift that occurred after they took out my eyetooth. I know I need to get this done but where do I start? I don’t want braces.
A: Your situation is complex; giving you a definitive answer is difficult, so I’ll give you principles and an ideal scenario with the hope it falls into your timeline, budget and personal commitment. Bite instability due to misalignment is common. Destructive bite instability is less common and often hard to manage or correct because it is unpredictable in what is causing the forces on the teeth to wear and break them. Bite imbalances, stress, physical exertion, sleep apnea, anxiety, grinding and clenching while in delta or deep sleep are causes for forceful tooth on tooth destruction. Some people are functional grinders, meaning they chew their food with excessive force for longer than the average period of time before swallowing. In your situation talk to your dentist about getting the teeth balanced as best possible. Sometimes tooth breakdown and gum recession go hand-in-hand. After this is accomplished, have the grafting done that is necessary to support the bone around the teeth that show recession – there is a direct correlation of gum loss to bone loss. Three millimeters of gum recession mean three millimeters of bone loss around the roots. After grafting, wait about three months for maturing of the gum grafting, then have the teeth crowned in a way that promotes ideal tooth-to-tooth function. Good planning and execution will give you a strong and beautiful result.
Based on actual patient cases
Calvin Ross Crapo