BRUXISM

by Dr. Nadia Abazarnia

What happens when a person grinds and clenches their teeth and how does it affect the anterior teeth?

Do you ever wake up from a night’s sleep with sore teeth and jaws? You could be grinding your teeth. Grinding your teeth is known as bruxism. This rhythmic clenching of the jaws and grinding of the teeth may develop at any age.

Teeth grinding is usual done unconsciously in your sleep, but it can also occur when you are awake. During the day, a person who is concentrating on a task will often place his teeth together and apply force through a contraction of the jaw muscles.

During sleep, it presents as clenching and rhythmic contractions. The most common symptom of teeth grinding is a headache other symptoms include muscle aches, enlargement of facial muscles, temporomandibular joint (TMJ) discomfort, stiffness of the shoulders and neck, ear pain and sleep disorders. The teeth are adversely affected and show abnormal wear and mobility. This leads to fracture and loss of teeth.

It is important to have your dentist evaluate you with a comprehensive exam and develop a treatment plan that is specialized for you. The best way to protect your teeth and prevent tooth wear and fracture is to wear an occlusal appliance. These are custom made, specially fitted plastic mouth pieces that fit over your top or bottom teeth.

Wearing one of these appliances will reduce jaw muscle pain and protect both your teeth and temporomandibular joint. The appliances are usually worn at bedtime and are considered the treatment of choice.

SIGNS & SYMPTOMS of BRUXISM

  • excessive tooth wear, which flattens the occlusal (biting) surface.
  • tooth fractures, and repeated failure of dental restorations (fillings, crowns, etc.)
  • hypersensitive teeth, caused by wearing away of the thickness of insulating layers of dentin and enamel around the dental pulp
  • inflammation of periodontal ligament of teeth, which may make them sore to bite on and possibly also a degree of loosening of the teeth.

How dose Clenching and grinding affect anterior teeth

The anterior (front) teeth show severe tooth wear which has exposed the dentin layer (normally covered by enamel). The pulp chamber is visible through the overlying dentin. Tertiary dentin will have been laid down by the pulp in response to the loss of tooth structure. Multiple fracture lines are also visible and can lead to cracking and chipping of these teeth.

The treatment of choice in these cases are wearing an occlusal guard at night time and restoring these teeth with composite resin material (tooth color material), in severe cases full coverage crowns are the treatment of choice.

Porcelain Veneers and Crowns

By Dr. Sepi Fatahi DMD

Full Porcelain

For many years, full porcelain restorations have been considered the most lifelike and natural looking restorations available. They are extremely beautiful and the best choice for the ultimate cosmetic result. Porcelain also does not conduct heat and cold very efficiently, so sensitivity to hot and cold foods during the initial placement period is often reduced. However, full porcelain crowns are not always the best choice for every tooth in the mouth. Here’s why:

Porcelain has the unique combination of being both strong and weak at the same time, much like an eggshell. Porcelain is harder than tooth enamel, so it can be damaging to the opposing natural teeth especially in patients who clench and grind habitually. But porcelain can also be brittle and fracture easily when it is too thin or it is habitually flexed through the forces imposed by clenching and grinding.

In order to guard against fractures related to thinness, a full porcelain crown must be thicker all around than a gold restoration. This means that more healthy tooth structure may need to be removed to allow for the porcelain to be thick enough for overall strength and durability. Additionally, full porcelain must be bonded to the teeth differently than a gold restoration. Glass ionomer cements cannot be used. Some patients are more sensitive to these bonding procedures than others, and can experience extended tooth sensitivity during the initial placement period.

the benefits of full porcelain

  • Produces the most beautiful and lifelike cosmetic result
  • Does not conduct heat or cold well, reducing temperature sensitivity
  • Non-reactive in patients with metal sensitivities

Best for:

Front teeth and any other tooth where an exquisite cosmetic result is the primary concern.

potential drawbacks of full porcelain

  • Fractures more easily than other materials
  • More tooth structure must be removed than would be necessary for a gold crown
  • Can be damaging to opposing teeth

May not be not suitable for:

Molar restorations in patients who clench and grind; patients with sensitivities to specific bonding techniques and materials (testing is available); patients who do not have enough healthy tooth structure available to support the thickness of a porcelain restoration.

Porcelain fused to gold

Until some of the more recent developments in the use of zirconium as a base for porcelain dental restorations, porcelain fused to gold crowns offered the best compromise between the strength and durability of gold and the cosmetic benefits of porcelain.

A porcelain fused to gold crown is made exactly as it sounds like it might be – porcelain is fused and stacked in layers on top of a high-noble gold alloy base. The porcelain offers a much better cosmetic result than a full gold crown, and the gold base not only allows for the use of glass-ionomer cements, but also acts as a protective barrier for the tooth even if the porcelain might fracture. But porcelain fused to gold crowns are not nearly as popular as they used to be.

One reason is because the gold base creates an automatic opacity in the porcelain that looks less lifelike in the mouth than full porcelain or porcelain fused to other materials like zirconium. Also, when used on the front teeth, a porcelain fused to gold crown can sometimes show a dark metal edge at the gumline when recession occurs. And certainly for any patient with metal allergies or sensitivities, any crown that contains a metal alloy base may not be a suitable choice.

Porcelain fused to gold crowns are still available, however, and they are still a useful option – especially for patients who may have several of these crowns already and are looking to match their existing dental work.

the benefits of porcelain fused to gold

  • Stronger and more durable than full porcelain
  • Better cosmetic option than full gold
  • Allows for the use of glass ionomer cements that are often less sensitive than full porcelain bonding techniques
  • Gold base still protects the tooth, even if some of the porcelain fractures off

Best for:

Patients who already have several porcelain fused to gold crowns and want to match them; patients who may not be good candidates for an all porcelain crown or a porcelain fused to zirconium crown, but still want a better cosmetic result than a full gold crown.

potential drawbacks of porcelain fused to gold

  • Opacity caused by metal base makes porcelain look less lifelike
  • Dark metal edge is sometimes visible at the gumline
  • Porcelain may fracture off the metal base
  • Gold is cast like jewelry from molten metal which can sometimes leave micro-gaps at the margins which are more vulnerable to decay

May not be suitable for:

Patients with specific metal allergies or sensitivities (testing is available); front teeth; back teeth in patients who clench and grind.

Porcelain fused to zirconia and full zirconia

Zirconia, or zirconium dioxide, is a white crystalline oxide made from the metal zirconium. In its cubic form, it creates the simulated diamond-like stone we all know as cubic zirconia. But zirconia has also been used and studied for many years in the production of all kinds of ceramics, including dental restorations.

Zirconia is an ideal base for porcelain because the bonding process between the zirconia and the porcelain is stronger than it is with porcelain and gold. This means that the porcelain is less likely to fracture away from a zirconia base. Zirconia can also be colored to match teeth and it is translucent, mimicking the natural look of teeth far better than any crown with a gold base could.

Zirconia at its core is still derived from metal, however, and that comes with some advantages and disadvantages. Glass ionomer cements work extremely well with Zirconia based crowns, which is often a benefit for patients who are sensitive to porcelain bonding techniques. However, even though zirconia is almost never reactive as a metal in the mouth, some patients with extreme metal sensitivities may want to be tested for reactivity before placing a permanent zirconia restoration.

the benefits of zirconia

  • As strong and durable as gold, but translucent with a better cosmetic result
  • Allows for the use of glass ionomer cements that are often less sensitive than full porcelain bonding techniques
  • Full zirconia is stronger than porcelain, although not quite as cosmetically attractive
  • Porcelain fused to zirconia is less likely to fracture than porcelain fused to gold
  • Crowns and bases are milled from digital scans making the margins extremely accurate
  • May be less expensive than gold or gold-based crowns

Best for:

Any full crown restoration where a beautiful cosmetic result is desired, but extra strength and durability are required.

potential drawbacks of zirconia

  • Not suitable as veneers or other partial tooth restorations
  • May be reactive for some patients with specific metal sensitivities (testing is available)

May not be suitable for:

Patients with specific metal allergies or sensitivities (testing is available).