Tooth-Grinding Wear: Prevention and Repair

Posted on: July 13, 2009

 “I don’t grind my teeth, ┬áhonestly!”How many times have I heard that comment from a patient? Then, examining the same patient’s mouth, how often do I see yellow dentin between two layers of white enamel – the clear evidence of a “grinder”?Almost everyone grinds teeth a bit, a tendency that dentists call “bruxism.” But what most patients don’t understand is that grinding isn’t just a behavior – it also has to do with the “bite you were born with.” Some people have an even bite that preserves the enamel and keeps the tooth healthy, while others have a natural bite that doesn’t quite mesh together and, as a result, grinding gradually wears away enamel.Tooth enamel is the hardest substance in the human body, and yet it can be worn away over time, not by the chewing of food but by rubbing the teeth together. Some patients unknowingly have acid reflux and tooth-grinding in combination with stomach acid can have particularly severe damage.I tell “grinders” to think of the tooth as a tootsie roll lollypop, with hard enamel on the outside and a softer substance, dentin, on the inside. Once the softer dentin is exposed, the tooth wears away even more rapidly. This can cause the joints to the mandible to become irritated and painful.Several solutions for tooth-grinding have shown successful results. First, if I suspect that acid reflux is involved, I recommend that the patient consult a gastro-enterologist. Then, I often suggest a mouth guard with a hard outer surface. I have helped patients fit this guard with special planes built in that mimic the shape of the temporomandibular joint. When the jaw moves to the right, left, forward or backward, these planes lift the mandible, keeping teeth from touching and wearing down.Teeth-grinding is a subconscious habit that can continue during sleep. Because a sleeping patient is not conscious, this grinding can be more damaging to teeth than when awake Therefore, the fitted mouth guard usually should be worn at night. While some patients worry whether the guard will inhibit deep sleep, it usually becomes routine after a couple of nights.Caution: Athletic mouth guards or any other type of dental guard bought off the store shelf can actually injure the teeth and temporomandibular joints because they lack fitted planes to allow for free movement of these joints. Also, their rubbery grip can loosen the teeth and irritate the joints.If teeth already have been worn down by grinding, they can be rebuilt so that their natural inclines are restored, and this (along with more awareness of the problem) can protect patients from further grinding damage.In summary, while many patients worry about grinding, and some have already damaged their teeth because of it, effective treatments exist and can be implemented fairly easily. Nobody needs to go through life with short, stubby teeth with yellow tops. A good dentist can help to prevent or correct this problem, starting as soon as today.