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.

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Replacing Missing Teeth with Implant

by Dr. J. Slaven

Implants have become the standard of care for the replacement of missing teeth. Prior to this development, our choices for replacing missing teeth were fixed bridges or removable partial dentures.

Replacing missing teeth with fixed bridges involves preparing the teeth on each side of the missing teeth for crowns, which are attached to the artificial tooth replacement as one piece that is cemented to the prepared teeth. While this is still an acceptable treatment it has the downside of doing a procedure on two good teeth and turning a one tooth problem into a multiple tooth problem.  Every time a tooth is subjected to a procedure that involves removal of tooth structure its living part, the pulp, becomes inflamed, and it never recovers from this 100%, which can lead to problems such as the need for root canal therapy in the future.  The happiest tooth is one that has not been drilled or ground down, which the teeth supporting a bridge have been.

If there are not teeth on either side of the missing tooth or teeth the non implant option is a removable partial denture.  This also has problems associated with it.  The clips or clasps that hold the partial denture to the supporting teeth put unnatural pressures on these teeth because even the best fitting partial denture will move slightly when chewing.  This can damage the gums and bone around the supporting teeth over time.  I liken this to what happens when you rock a fence post.  Partial dentures require meticulous oral hygiene to prevent decay or gum infection of the supporting teeth.  The clasps create what I call the perfect English Muffin full of nooks and crannies that trap food and allow plaque accumulation.  Although a partial denture is  still considered an acceptable option for replacement of missing teeth, the patient must understand its limitations.

The limitations of both fixed bridges and partial dentures that I have explained do not apply to replacement of teeth with implants.  Implants provide permanent tooth replacement that is as close as we can get to your own natural tooth and are the better choice.