Aftermath of Bruxism - Do I need crowns?

[tsullins92]

I used to have bad bruxism. I wore my six top front teeth down pretty significantly. I got invisalign to correct the issue, so now there is no further wear, but I still have exposed dentin from the previous grinding, and my dentist wants to crown my top front six teeth.

Is this procedure necessary to protect my teeth from further damage? Or is it primarily cosmetic? Attaching photos - my teeth aren't really this yellow.

Thank you.

 

[Dr M]

Good day

Crowns in your case will definitely protect the remaining tooth structure as well as provide a more aesthetic outcome. You can consider composite filling material build ups, or veneers as well. Bruxism cases can sometimes be very difficult to rehabilitate. Invisalign treatment does not guarantee that you won't ever grind again. Post treatment retainer wear is important since there is a continuous movement of teeth throughout your lifetime. The bruxism could also be related to TMJ issues.
If you are really worried, you can get an opinion from from a prosthodontist, which will give you all the options in order to rehabilitate your teeth, with the best possible solutions.

 

[MattKW]

Invisalign as a treatment for bruxism??? What, to supposedly get your teeth out of contact? Balderdash.
You look relatively young, and bruxism per se does not cause much tooth damage. It usually has to be accompanied by an acidic intake (e.g. soft drinks, sports drinks, fruit juices, ...) to soften the teeth. If you haven't controlled your acidic diet, then ANY further treatment is unwise and unethical. I think I can see wear on the incisal edges of your upper premolars, and an amalgam sitting slightly proud on one side. Show me a photo of your lower teeth as far back as you can get.
I would also suggest that, yes, your teeth are yellow. Teeth are not naturally white, and you are about an average VITA A3 shade (mine are C4). Putting crowns on these teeth would be worthy of negligence.

 

[tsullins92]

Good day

Crowns in your case will definitely protect the remaining tooth structure as well as provide a more aesthetic outcome. You can consider composite filling material build ups, or veneers as well. Bruxism cases can sometimes be very difficult to rehabilitate. Invisalign treatment does not guarantee that you won't ever grind again. Post treatment retainer wear is important since there is a continuous movement of teeth throughout your lifetime. The bruxism could also be related to TMJ issues.
If you are really worried, you can get an opinion from from a prosthodontist, which will give you all the options in order to rehabilitate your teeth, with the best possible solutions.

Thanks for the reply. I will consider seeing the prosthodontist.

 

[tsullins92]

Invisalign as a treatment for bruxism??? What, to supposedly get your teeth out of contact? Balderdash.
You look relatively young, and bruxism per se does not cause much tooth damage. It usually has to be accompanied by an acidic intake (e.g. soft drinks, sports drinks, fruit juices, ...) to soften the teeth. If you haven't controlled your acidic diet, then ANY further treatment is unwise and unethical. I think I can see wear on the incisal edges of your upper premolars, and an amalgam sitting slightly proud on one side. Show me a photo of your lower teeth as far back as you can get.
I would also suggest that, yes, your teeth are yellow. Teeth are not naturally white, and you are about an average VITA A3 shade (mine are C4). Putting crowns on these teeth would be worthy of negligence.

Thanks for taking the time to reply.

Yes the idea was that my teeth hit straight on, so I was doing damage to them. Now my top teeth come down in front of my lower teeth when I bite down. I used to grind so bad that my jaw would hurt every day.

My thinking was that the exposed dentin is susceptible to damage, and that crowns might shield the teeth from further damage. Does this sound right to you? The dentists I've seen are only concerned with the cosmetic outcome - I don't care about how they look, I just don't want them to rot.

Attaching the photos you asked for.

 

[MattKW]

Thanks for taking the time to reply.

Yes the idea was that my teeth hit straight on, so I was doing damage to them. Now my top teeth come down in front of my lower teeth when I bite down. I used to grind so bad that my jaw would hurt every day.

My thinking was that the exposed dentin is susceptible to damage, and that crowns might shield the teeth from further damage. Does this sound right to you? The dentists I've seen are only concerned with the cosmetic outcome - I don't care about how they look, I just don't want them to rot.

Attaching the photos you asked for.

I can see cuspal wear on your lower teeth too.

1. Do you have a history of acidic foods or drinks as I mentioned?
2. Crowning your front teeth won't make then longer because they still have to function against the other natural teeth. It would be like putting 1 different size tyre on your car compared to the other 3.
3. There are only 2 ways to get longer-looking teeth: either composite rehabilitation to rebuild the height whilst opening your overall bite (my choice), or crown lengthening (has some distinct disadvantages). I'd suggest a prosthodontist opinion for comp rehab.
4. Crowning your upper front teeth at their current height might make stop them wearing down, but most likely your LOWER front teeth will now start wearing down! Also, crowning teeth carries risks of killing the "nerve", plus requiring replacement at some time in the future. This is not a path you should start down.
5. Your teeth are not about to rot due to this wearing down. However, they will chip occasionally and continue to gradually shorten, potentially to the point where the teeth become sensitive, or the nerves die, or they become un-fixable.

 

[tsullins92]

I can see cuspal wear on your lower teeth too.

1. Do you have a history of acidic foods or drinks as I mentioned?
2. Crowning your front teeth won't make then longer because they still have to function against the other natural teeth. It would be like putting 1 different size tyre on your car compared to the other 3.
3. There are only 2 ways to get longer-looking teeth: either composite rehabilitation to rebuild the height whilst opening your overall bite (my choice), or crown lengthening (has some distinct disadvantages). I'd suggest a prosthodontist opinion for comp rehab.
4. Crowning your upper front teeth at their current height might make stop them wearing down, but most likely your LOWER front teeth will now start wearing down! Also, crowning teeth carries risks of killing the "nerve", plus requiring replacement at some time in the future. This is not a path you should start down.
5. Your teeth are not about to rot due to this wearing down. However, they will chip occasionally and continue to gradually shorten, potentially to the point where the teeth become sensitive, or the nerves die, or they become un-fixable.

Thank you for the response, I really appreciate the time that you and Dr. M have taken to respond to me.

1. Do you have a history of acidic foods or drinks as I mentioned?
   Yes, but I don't drink them as much any more.
2. Crowning your front teeth won't make then longer because they still have to function against the other natural teeth. It would be like putting 1 different size tyre on your car compared to the other 3.
   For this, the logic is that the top-front six teeth were the ones with the primary wear, so it would be making them longer to be consistent with the other teeth (Maybe like blowing up deflated tires?)
3. There are only 2 ways to get longer-looking teeth: either composite rehabilitation to rebuild the height whilst opening your overall bite (my choice), or crown lengthening (has some distinct disadvantages). I'd suggest a prosthodontist opinion for comp rehab.
   I am not worried about how my teeth look - just with preserving what I have left.
4. Crowning your upper front teeth at their current height might make stop them wearing down, but most likely your LOWER front teeth will now start wearing down! Also, crowning teeth carries risks of killing the "nerve", plus requiring replacement at some time in the future. This is not a path you should start down.
   With the invisalign having corrected my bite, and the teeth no longer hitting, do you think that the lower front teeth would still wear?
5. Your teeth are not about to rot due to this wearing down. However, they will chip occasionally and continue to gradually shorten, potentially to the point where the teeth become sensitive, or the nerves die, or they become un-fixable.
   This is good to hear. I was starting to get weird feelings from the dentists I've seen - like they weren't being completely straight with me. They kept steering the conversation towards the aesthetics of the repair, when I am worried about preserving the health of my teeth. I basically don't want to wear them down until there is nothing left.

 

[MattKW]

1. OK, that resolves why you are wearing them down , and I can only strongly advise that you change your diet completely ASAP or you will keep having problems. Maybe you would benefit from the support of a dietician. Some dental schools have them on staff too.
2. Oh, so the Invisalign has left them unable to touch with the lower teeth? That's bizarre and short-sighted; it's not a good way to handle this problem. If you went to a prosthodontist I would expect them to be similarly aghast at the treatment you are receiving. Some people think we shouldn't criticise our colleagues, and sometimes that can be true because I don't have your full history etc, but I hate to see laypeople given limited and harmful options.
3. Composite rehab would aim at restoring the lost tooth structure on ALL your teeth (front and back) in the most conservative fashion. Crowning your teeth is an aggressive treatment. Sure, you might add a bit of length, but you have to grind off the front and sides of your teeth. Comp rehab is done simply adding to the length with MINIMAL tooth damage and minimal risk. Crowning is non-reversible; comp rehab is mostly reversible.
4. Question: How can you bite through food if your front teeth don't meet?
Answers: Either (a) you still are biting with your front teeth by sliding your jaw into an accommodating position, or (b) your front teeth are slowly growing back into contact again (the Dahl Concept), or (c) you are now eating more on your back teeth so they will start to wear down instead. All of theee possibilities are bad for you.
5. There's a saying, "Give a carpenter a hammer and he'll want to hit a nail." This narrow thinking also applies in medicine and dentistry for many people. Partly due to our limited training. One only gets to think outside the box by going to lots of seminars, getting lots of experience, and (sadly) working in this game long enough to see what happens to long-term health of our patients when we offer poor choices.
Case-in-point: 2 days ago I was teaching in the student clinics and a patient like you came in. The student could only think in terms of what their limited knowledge told them, so I sat down with student and patient and gave them nearly the same long talk I'm giving you. I wasn't taught any better in my training, but I'm not going to let the next generation of dentists make the same mistakes I made. It may not be that the dentists you are seeing are just looking to do a quick fix at your expense; it is more likely that they simply don't know any better.