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Case Summary
Exam & Consultation
Crown
Teeth: 7,8,9,10
Last Full Mouth X-Ray: partial x-rays done
Last Cleaning: 5 months ago
Case Description
Due to alleged bruxism, my bottom teeth have worn the inside of the top four front teeth to the point that they are very thin, a nerve is visible and sensitivity is escalating weekly. My dentist is suggesting getting orthodontia first to increase space between the teeth, then having--possibly 4 root canals --then putting on four new crowns. I have had exstensive dental work done over the last two decades but found this treatment plan as bizarre. Help.
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Reply: Bruxism
added: August 30, 2006 - 8:30 PM
Bite problems are often undiagnosed and you are very lucky that your dentist found this issue for you. There may be other treatment options to consider, but this sounds very conservative. Good luck with this. Josh Bernstein, DDSClinical Instructor, LVIhttp://www.allnewsmiles.com
Reply: Bruxism
added: August 31, 2006 - 7:44 AM
Without seeing what kind of dental work in the rest of your mouth it would really be hard to give an opinion. If you have no room for your teeth because they are getting thin then room either has to be made by orthodontics or you need to have a full evaluation which involves models, a wax up to determine your vertical dimension now and where it needs to be. This will allow a dentist to really establish what you need to put you in proper function. It is improper function do to bruxism and other things that cause the teeth to wear down. Braces may not be the right way to go. You may need complete full mouth reconstruction to properly re-create the proper anterior guidance and sliding side to side movements to stop the problem.
Reply: Bruxism
added: September 06, 2006 - 9:35 AM
nuanua,There can be at least three explanations for excessive wear on the front teeth:Interfering fit of the back teeth triggering the jaws to avoid by working in a more exaggerated chewing pattern. I.E., when the jaw comes more forward, away from the interference, in chewing it wears the front teeth prematurely thru excessive friction.An interfering fit where the upper front teeth are too back (or lower front teeth too far forward, or a combination of both) putting the front teeth in the way of a normal closing pattern. The system attempts to adapt (thru wear, loosening of teeth, or attempting to close in a more retruded position which is difficult/uncomfortable to do) and allow the back teeth to chew.Just plain grinding of the teeth subconsciously or in sleep. A poorly understood type of movement disorder.In situation #2 orthodontics is often the treatment of choice in order to get the front teeth out of the way of each other so that the back teeth can do the chewing. However, orthodontics would normally not have much impact on situation #3. And in situation #1, there are often simpler treatment options. In order to determine if orthodontics is the most appropriate approach, a determination of the underlying cause of the wear is the first step. As always: diagnosis is key. Then the merits of possible treatment options can be put in perspective.I hope this helps point you in the right direction.Jim Hinkle, DDS MAGD
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