Tooth Grinding – Bruxism

May 10, 2017

Some people can do significant damage to their teeth from grinding them in their sleep.  Sometimes it is a daytime habit.  This can lead to abnormal wear, cracked teeth, pain in the teeth and even tooth loss.

Bruxing

Below are pictures of a person I saw not long ago and you can see how far over they move the jaw.

Parafunction cParafunction a

Parafunction b

This movement outside the normal range of chewing is called Parafunction.  We know this must be from habitual chewing  (like nail biting) or from bruxing during sleep, because people just don’t chew their food on the front teeth in such an uncomfortable position.

A night splint can help protect the teeth from damage while the patient is asleep.

sPLINT (1)

 


Tooth Extraction – What happens next?

May 9, 2017

Overeruption

What happens when you lose tooth?  Well, it’s not the end of the world, but your teeth all have a reason for being and there are consequences when one is lost.

Firstly the bone around the area is lost because there is no stimulation anymore.  In the above photograph you can see the gum has shrunk away.  This can be mild as above, or extreme as in the photograph below:

3bx

The bone progressively wastes away.  Once the bone is lost it is very hard to replace this missing tooth, as the bone needs to be rebuilt before a dental implant can be utilized.   Also the remaining teeth start to move and shift into the space as shown below:

Overeruption2

2cxMolar move

Drift X2

The extra load can lead to further cracks and splitting of the remaining teeth:

1Fracturetooth1

Eventually the straw on the camels back reaches breaking point and multiple tooth failures occur.  If this also results in bone loss the end result can be catastrophic:

DSC_0030

3nohealth

I am reminded of the old tale – for the want of a nail the shoe was lost, for the want of a shoe the horse was lost, for the want of a horse the battle was lost, for the want of a battle the kingdom was lost.


Should I get my wisdom teeth out? Part 2

December 19, 2011

I have already given a detailed blog about various wisdom teeth and the pros and cons about their removal.  Basically, a wisdom tooth is like any other tooth – if it erupts normally into the mouth it is fine but at risk of decay.  If decay gets into the nerve area it causes pain, swelling and infection.  It is often inaccesable to treat, so the wisdom tooth to be removed.  If this risk appears high, or the teeth are not erupting normally and your dentist suspects future problems – he or she may recommend the tooths removal to reduce the risk to you of a serious infection or complications.  The older you get, the more the wisdom teeth roots can grow towards the nerve in the jaw, and the harder your jawbone can get, increasing the risks of complications of surgery (such as permanent lip numbness or tingling – called paraesthesia).  Your dentist is always trying to wiegh up the best alternative based on the information at hand.

I have taken some random photos of wisdom teeth we have seen in our practice.  Some were fine, others were at risk, some were removed, and some required specilaist intervention.  Don’t let anyone say you should or should not remove wisdom teeth without knowing your specific case – everybody is different.

To the right of each photo I have drawn and approximate line showing the roots of the teeth in black, the nerve in the jaw in blue, any obvious infection in the bone in yellow, and obvious decay in red.


Dark Root Filled Tooth

October 30, 2011

This fellow’s tooth was wacked when he was young. Wear a mouthguard when playing sport please guys! The existing filling was leaking and broken and the tooth had gone dark.  The blood in teeth stains when the nerve dies, and also the medicaments used in root fillings may stain the tooth.  Ideally the tooth would be bleached as a conservative option.  The filling was failing so the next best option would be a crown.  Unfortunately this tooth is on its way out – it is so hollowed an weak it wont hold a crown but we had to do something because the current filling is failing.

We built him a new tooth using a carbon fibre post into the root, and bonding dental composite resin over the top.  It is much cheaper than a crown, and if the tooth fails he is looking at a gap, denture, or implant.  Hopefully we have delayed these options for some time to come and given back a smile.


Composite Bonding Rehabilitation

October 30, 2011

This lady had worn and chipped her upper teeth on the inside until they were so thin they were about to break. The yellow tooth on the right second from the middle is an old crown which the patient couldn’t afford to redo so we had to match it in colour and shape. Crowns are hard and durable but bonding often means less tooth needs to be removed and they are cheaper. Because all of this patients teeth had worn we were needed to build them all up (or at least 10 of them) – compare $250-$300 per tooth for bonding vs. $1500 per tooth for crowns. They may not last as long or be quite as perfect in appearance but they can be a great low cost option without losing teeth and getting dentures. It was done in one day and crowns would take weeks or even months.  I would be happy to get 5 years up to 10 years for this kind of procedure.  Despite the cost, in the long term I would still prefer porcelain crowns.


More on Wisdom Teeth

June 23, 2011

Wisdom Teeth – Why do we need to remove wisdom teeth?  Often we don’t, but because they are hard to reach, they are harder to clean and more likely to get decay.  Some wisdom teeth may be growing in the wrong direction and get stuck (impacted) and this leads to problems as well.

 

This  young   patient    has  an impacted lower wisdom tooth causing no pain.  It is under the gum and can’t be seen in the mouth.  Sadly, the lower picture  shows the decay highlighted in black – there is decay in the upper and lower wisdom tooth, but also the  second  back  tooth  has decayed almost to the  nerve.  This tooth may now need very expensive root canal therapy or extraction.  The pink line shows that the lower wisdom tooth is touching the nerve in the jaw and will need specialist attention.  This will require time and careful planning but unfortunately the decay has made the  situation urgent. 

Even older patients can  have wisdom teeth problems.  Not long ago  one  of  our dentists removed a wisdom tooth from an 89 year old! 

This picture shows how a cyst is damaging the jaw.

  Many people have wisdom teeth come through perfectly just like any other molar.  Thank goodness we are all different.  If you have any queries see your dentist and get an Xray to check.


Loose Dentures? No worries

June 6, 2011

Over the years I have been grateful to have studied under some great professors regarding denture making because full dentures.  Many newer graduates are seeing fewer cases of full dentures and find it harder to gain experience.  Nevertheless, even well made full dentures are often a nightmare for both dentist and patient.  Bottom dentures especially have little going for them – the jaw atrophies when you loss teeth which leaves no support to bite against, no jawbone left to hold the dentures firm, and the end result is poor diet, discomfort, ulcers and unhappy people.

I have been excited to see mini dental implants as another option for us to help retain full dentures.  Traditionally, full implants were required at great cost, and many patients don’t have enough bone to support these implants, or the money to pay for them.  The mini dental implant is an in between option – aimed at stabalising the denture against loosening or falling out, but still being removable.  I have just finished a case and the patient is thrilled.  he lost his teeth 3 years ago and hasn’t been able to wear a denture since – now he is regained his confidence an smile.