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Tooth Wear: Bruxing Attrition

Severe Attrition

If you are worried about grinding your teeth away, see the TMJ section of this website.

Attrition

This is a 76 year old man who has been Bruxing (in this case, grinding) his teeth all his adult life. He presented because his teeth were too sharp and were cutting his tongue, which was easily dealt with by gently reducing the sharp edges with a diamond bur.

The question arises as to how a dentist would actually restore a case like this, if the patient so desired. The answer is "with a great deal to difficulty, time, and money". In the first place, the patient has ground his teeth down to the nerve. Note the holes in the center of some of the teeth. These holes represent the pulp chamber, which is the space in the tooth where the nerve used to live.

Virtually all the teeth here would require root canal therapy, followed by Posts and cores and crowns. Furthermore, the posts, cores and crowns would all have to be fabricated beforehand and inserted in one sitting. This is because it would necessitate "opening the bite" which means that the amount of space between the top and bottom teeth would have to be increased in order to accommodate the increased length of the new crowns. It would not be possible to restore this case one or two teeth at a time. If only one or two teeth were making contact with the lower teeth, those teeth would bear the entire force of the patient's bite. The crowns, and the teeth upon which they were placed would quickly be destroyed due to "occlusal trauma" before the other crowns could be inserted.

Cases like this are generally restored by specialists called prosthodontists. The prosthodontist would begin by building a temporary splint, which is an entire roundhouse of temporary crowns made out of plastic, all attached together. This would allow him to restore each tooth separately while allowing the jaw to be supported by the plastic temporary splint.

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