Grinding Your Teeth: How Bad Can It Get?


Many patients grind their teeth and stress is a frequent contributor to the condition.  Early signs can include wear on the teeth, gum recession and abfractions (tooth loss at the gum line due to the force of grinding).


Early treatment saves tooth structure and preserves a favorable bite. Treatments can include wearing occlusal guards (bite guards that protect the teeth from grinding), adjusting the bite or orthodontics.


Another kind of trouble, which comes with aging, is breaking teeth. This is due to biting on the tooth too hard, where the tooth is not strong enough to withstand the force. Treatments for this level include having a dental crown, root canal therapy usually followed by a crown if the nerves is adversely affected, or possibly having a dental implant to replace a tooth that must be extracted. We usually talk about decay as a problem leading to this, but this can happen from a very strong bite that a tooth cannot withstand.


Now what if you get a combination of the above factors, untreated for a long period of time, and many teeth are affected. This now becomes a tricky, lengthy and costly treatment.

I have one patient, a male in his early 50s, who has such a problem. First I treated his modest amount of decay on his back teeth, but the front teeth pose an interesting problem. He has stripped the enamel off the back of his upper front teeth, and his lower teeth are severely worn.

My first step was to send this patient to an orthodontist. He recommends 2 years of treatment to get the teeth into the correct position, then placing crowns on damaged teeth, minimally all 6 of his upper front teeth. The future problem with him is that his bite is still very strong and he may fracture the crowns, even if made out of zirconium (a very strong white metal material), and even wearing a bite guard. On top of that, this is a fairly costly treatment.

The minimal level of doing anything at all to slow this process down is to address the small cavities that exist on his upper front teeth and then fabricate an acrylic bite guard to place on his lower teeth. This should slow down the wear on the front teeth.

If money is no option, a prosthodontist can correct his bite with crowns on all of his teeth, changing his occlusion. This is very tricky business; there are different schools of thought on how to accomplish this, and someone who has additional study plus expertise is the one who can address this problem, and even he will have a challenging time of it. Often cases like this are referred to dental schools where several specialists can put their thoughts together.