Doctor: …with teeth, they do. All of our teeth are going to wear down. If you’re eating, they are going to wear to some extent. What we want to determine is, is it pathological, is something wrong and they’re wearing at a premature rate or is it just natural wearing that’s happening?
Natural wear by and large isn’t going to be that detrimental for the patient long term. It shouldn’t be anything really bad happening. It shouldn’t be cracks or anything. But pathological wear, where this destructive to the dentition needs to be diagnosed properly. And generally, the reason for wear on a person’s teeth are…there’s really only two reasons for that. One, is either something is wrong with the patient’s bite which means how the teeth come together when they chew, which can be an orthodontic problem.
Some people, even though they have orthodontics, they still chew kind of funny. And the easiest way I can think of that is that the bite is out of alignment somehow. And this comes a lot with my studies with temporomandibular joints and facial pain. A lot of patients will come and say, “Yeah, I was diagnosed with TMJ as a kid. I know I have TMJ.” But when I asked them what the diagnosis was, they just said TMJ. Well, that’s okay. I can understand but that, but that’s sort of a blank statement and it doesn’t really say what’s wrong with the individual, because what we’ll do is we’ll do a workup then and we’ll find out, “Oh guess what. You’re TMJ joints are fine, but your bite isn’t balance properly. It’s out of alignment.”
And the way I explain this to my patients, “It’s like your car. You’re driving down the road, right, and one tire is out of alignment. Well, guess what happens the other three if you don’t go in and get that rotated? Something eventually wears out. Can you still drive? Yeah. Can you still eat with your teeth out of the line? Yeah. But things are going to wear funny.”
Once solution for some patients that are wearing down their teeth, or they feel like their bite has changed, or maybe only a couple of teeth hit now. A lot of times that might be complicated. It might be something who…they might need orthodontics. But a lot of times what it is, is it’s just a simple what’s called an equilibration, which going back to my tire analogy is just fixing the teeth and getting them adjusted. Maybe it means adding a little bonding to this tooth, and maybe taken away a little sharp edge on another tooth.
That’s a real easy appointment. It doesn’t require anesthetic or anything, and it’s a great service. We do this pretty much on all patients when we are doing fillings or any kind of restorative work on a person’s mouth, or crowns or anything. But we do it with patients sometimes just at their hygiene checked. And the reason is it because we want everything to be balanced. And patients will notice it right away. A lot of times they’ll say, “Oh I think my bite is fine. But yeah, and you know, once in a while this one wears a little bit.” But after we adjust them when they come back, they’re always like, “Man, my bite feels so good. I can feel actually all my teeth.” And that’s a real simple service that can be done and probably 90% of the scenarios with people they’re wearing down their teeth.
So the first step is to diagnose. Is it a bite issues? It’s something that needs to be realigned? And that can be real simple to just adjusting a couple of teeth, to something maybe more complex where we need some orthodontic treatment or maybe we need to rebuild actually all the teeth.
The other reason for problems with wearing down the teeth is something called parafunction, which is just a fancy word, basically, that means the person is grinding their teeth like that, gnashing them, clenching them, where they’re doing some sort of destructive habit like chewing ice or chewing plastic or weird things that people do. That’s a little more insidious, in a sense, because what is happening there is a lot of times the person is unconscious. They don’t realize this is happening. Most things with grinding the teeth, clenching the teeth is caused unconsciously. They’re usually doing it either when they’re asleep, or they’re mind is elsewhere.
A lot of my patients commute over Highway 17, over on to Silicon Valley, and they’re in bumper-to-bumper traffic, and so they’re clenching their teeth the whole way over. Then they jaw muscles are sores. On the way back, they grind them the whole way back. Now that’s not because their bite is bad, but they’re slowly grinding their teeth away. The person that grinds their teeth generally is putting their teeth together 2-3,000 times a day, whereas the person who doesn’t is showing like putting 2-300 times a day. So you can see how that exponentially increases how much wear is going on.
The other thing about grinding the teeth and clenching, is it’s generally caused from stress. But stress comes in different forms. One form of stress is emotional. Stress out about the day, “I’m late to work.” The other stress, though, is physical. Some sort of something, they have a bad neck, bad back. We’ve all stub their toe. And what’s the first thing we do? “Oh, that hurt so bad.” That kind of thing.
But the other thing, which is really serious is, is it could be a sign if they’re doing it at night. It could be a sign of something called sleep apnea, which is where a patient stops breathing. If a person stops breathing at night, the body will then wake itself up by starting to clench their teeth. And that really needs to be diagnosed properly because that is something that can affect their overall health. So the main thing is to get the proper diagnosis and treat it.