Tooth Grinding is the Culprit

 
 
 
A male patient in his late 60s came in  earlier this week with three things that he wanted me to look at.
 
The first was an odd feeling on one of his upper canines. This turned out to be an area where he has worn the enamel off of his tooth and was feeling a ledge.
 
The second problem was that his lower front teeth were sore in the morning. In addition he has worn off some of the enamel on the edge of these teeth and he is close to exposing the dentin underneath.
 
His third question was more interesting. He had experienced multiple episodes of pain when chewing on one of his teeth, an upper left premolar. On the x-ray he has had a root canal, a post and core, and a crown placed on this tooth in the past. The x-ray revealed that the distance between the post and the outside surface of the tooth is very thin, making this tooth subject to fracture at that point. Although there was no sign of root fracture  there could actually be one that just hasn’t shown up. On the x-ray I’m looking for a radiolucency (dark area) at the site of fracture. The additional choice, which I decided to do, is to refer this patient to my surgeon for a CT scan. The root fracture will show up on that much earlier. In the past, without the aid of this technology, I would just give this some time to see if the symptoms go away. If the fracture can be verified, the recommended treatment is to have an extraction of the affected tooth followed by a dental implant
 
The conservative treatment for all of these issues is to wear a bite guard. This will protect the teeth from the grinding that patients do so routinely when they sleep. In this case, the patient has been told about this in the past and is finally ready to do this recommended procedure.