Bite issues, anxiety, no solutions seem practical

[Dental Impatient]

This is a long story. I didn't go to a dentist for a while (from 18 to 25) and I ended up with a lot of large cavities. I'm 35 now. I went to a dentist who did all the filling work (19 teeth) at once, and ever since I've had bite issues. Over the years I would go back to him complaining of tooth pain, and he would do a bite adjustment and I'd be fine for a while. Over time, I feel like this made my bite worse. There are other factors that have led to bite issues, like nail biting and general anxiety. I'm more vigilant about care now, and have less general issues like fillings being needs, mostly I'm fighting the damage that was already done. Over the years my situation has gotten worse. I have three crowns on the upper and a lot of large fillings. I had a lower tooth, that had had two root canals, three crowns, over past 10 years and was finally pulled two months ago.

After I needed my third root canal, I left that dentist and tried new options. The next place I went to proposed a grand plan to replace my bite. He wanted to crown all of my back teeth (16 at the time, 15 now) at once, giving me a new bite. Total for that would be around 13000 dollars, which is reasonable for what it is, but obviously I wanted some second opinions. This place boasted the CEREC machine and same day crowns, etc. He even claimed he could crown all the teeth in one session. This is neither here nor there, but I found him to be cocky and off putting, his billing department was very pushy, and he often delegated to dental assistants things I feel that he should have been doing. Anyway, needless to say I left and sought another option.

The place I'm at currently, his plan sounds more reasonable, but I'm still wary about it. I want to get an implant (for tooth 19 which was recently pulled). He made me a retainer to wear in the meantime. He feels that my bite issues are complicated, and is proposing a 4000 dollar plan to adjust all my back teeth in one session to better alleviate my bite, but this would be "stage 1". He says that the last guy's plan to raise and crown all the back teeth was terrible, because my front teeth don't touch each other. "Stage 2" would be around 6000 dollars (and not at all covered by insurance since it's semi-healthy front teeth) and would involve some sort of crowning/veneering on the front teeth to allow them to touch and guide for the bite. On top of all this, I need to get the implant sooner than later to avoid bone loss. He doesn't want to do a crown for 19 with my current bite though.

The tidal force of my bite is extreme. Multiple dentists have been shocked by it. I've bitten off crowns, I've bitten through the porcelain on the one that was on 19. I broke part of an empress crown almost immediately. I certainly believe I could loosen an implant.

I'm at a loss for what to do. This guy certainly seems like he knows more what he's talking about, but my fear is I'll go in and have 12000 dollars worth of work, and in the process there will be new complications and new work needed, and it's going to just continue to cause anxiety and dental pain until I eventually lose all my teeth anyway.

Is this new guy on the level? Are there any options for me that don't involve tons of work and tons of money?

 

[Busybee]

HI Dental impatient. You have my sympathies. I too have a bite problem that's been extremely difficult to fix. I too have always had a hard bite. I haven't damaged any back teeth myself but dentists have damaged them. I'd say from my own experience that your current dentist is right about the first guy. Sticking all those crowns in same day would have caused no end of trauma. Plus all that crown work could lead to more root canals and lost teeth. I'm not a fan of adjustments because it's extremely difficult to replicate the natural bite that you grew into. It's really the dentist who did the fillings that's at fault for ruining yours. I don't know the state of your front teeth, but crowning natural teeth that are healthy would weaken them. Veneers to help bite sounds odd to me. He should try to build them up with composite temporarily to see how your bite tolerates the change. He sounds sensible because although I don't have an implant I've read that you cannot put too much load on one. But in terms of the bite adjustment I'd ask him if you can have it done very very slowly, maybe one or two teeth at a time and to stop if it's not helping. The retainer is a good idea. Do you grind at night or get ringing in your ears? Do you have a clicky jaw?

 

[Dental Impatient]

I grind a lot. I do grind when I sleep. I do not believe that I have TMJ. I'm still getting adjusted to the retainer. The main reason he wants to hit the front teeth it because they don't touch each other, and they don't "guide" the bite well. I think the veneers were more a "while we're here let's make them look better" suggestion. If bite adjustments could be done peace-meal I would have done it via insurance over the years, but the only answer I ever get from dentists is that it has to be done all at once.

 

[Busybee]

Veneers are not a great suggestion if you have a bite problem. They weaken the tooth.