Anterior Teeth Wear - Treat or Ignore?

Anterior teeth wear usually exhibits a classic pattern where the canines will get ground down first, followed by the front four teeth. It is a challenge to restore and maintain this kind of bite profile. If we go by the belief that enamel is sacred and that we should never grind away teeth to restore them with porcelain,  then allowing the teeth to destroy themselves to tiny short stumps goes against this belief.

If we restore early enough and the patient is diligent with night guard wear, then the treatment can be predictable and effective.

Anterior bite problems dictate length, shape, and position of the anterior teeth.  Hence, on occasion where dentists and patients may mistakenly violate the mechanical principle of the bite at the expense of esthetics, then one can expect the bite to fight off anything that is in its pathway.

By choosing not to treat an anterior bite case, the teeth will wear themselves away.  In the case below we can see the actual opening of the nerve canals on the front teeth.  Severe wear cases also leave us with very little tooth structure to work with.  Hence, anterior teeth wear should not be ignored.AnteriorTeethWear1Anterior Teeth Wear 2Anterior Teeth Wear 3

What Does it Mean when a Tooth Fractures?

When posterior teeth such as the molars fracture, there is usually a correlation with anterior teeth wear and fracture as well. In the ideal bite, the anterior teeth length, contour, and position help guide the joints to move properly.  This front teeth feature called "anterior guidance" also helps prevent the back teeth from contacting when the patient grinds on the teeth from side to side.  When the anterior teeth are misaligned and/or have been ground down by the bite force, the posterior teeth can begin to come into contact during the grinding movements.  The excess bite force on the back teeth can then create fracture lines on the teeth over time, and eventually can cause the tooth to fracture.

In the case below, a patient presents with a fractured molar.  A close up look at the anterior teeth reveals multiple wear facets and fracture lines on the front teeth as well.  The bite force has taken a told on this patient's dentition, and fractures on the teeth and his restorations are inevitable.

FracturedMolar1IMG_2577

In another case below the patient's bite simply split the molar into two halves:

Fractured Molar2

In a different case below, the patient also presents with molars ground down significantly. The old porcelain crowns also have been ground down to expose the metal core inside.  A close up look of the anterior teeth profile allows us to match the shape of wear facets of upper and lower teeth together like pieces of a jig saw puzzle.

Uncontrolled bite force is one of many causes for the destruction of people's teeth throughout their life time.  If the above cases remain untreated, the teeth can eventually wear themselves down to little nubs over time.  If the cases are treated, they must be recognized as scenarios which require careful monitoring and adjustments during the patient's regular check-up appointments. Moreover, additional preventive measures such as night guards are crucial in helping the teeth from being destroyed when the patients grind uncontrollably in their sleep.

It is important to understand that bite related cases require a life time of maintenance and handling by the right clinician.  The over all picture of the bite must be evaluated and treated comprehensively rather than simple tooth by tooth treatment.

 

Teeth Grinding

Teeth grinding is one problem that will determine how long your dentition will last in your life time.  In many instances,  our patients are not aware of their grinding problems.  Some patients do not even believe the diagnosis that they do grind their teeth. In any event, teeth grinding problems do not manifest until much later in life when wear facets, fractures, bone loss, and pain become more apparent.  Many root canals and crowns are overly prescribed to solve a patient's tooth pain.  Sometime, the solution lies undetected in the foundation of the bite stability.

The link below is an interesting article about night guards design which incorporates technology to alert patients of their teeth grinding activity.

Smart mouthguard to tackle dental wear and tear.