Time for a new set of teeth?

April 2, 2007 2:28 PM

My teeth are a mess. I have a major lifelong grinding and chewing problem. The bottom set are very worn down, the top front teeth have crumbled in the past from chewing and I have crowns. I have numerous fillings and root canals and there are ominous cracks in several others. Is there a way I could solve this problem once and for all? I'm talking about fixing the teeth falling apart, not curbing the grinding. Assume cost is not an obstacle.
posted by vizsla to health & fitness (19 answers total)

If cost isn't an obstacle, then find the best damn dentist you can, and make sure it's one you trust and get them to give you realistic options (either therapies, treatments, technologies).

You may very well have run the course with your current dentist. It may sound ageist, but find a young dentist with his/her own practice that is trying to distinguish themselves. They may be more open to newer solutions and technologies and therapies than an older dentist. (Or find an older dentist that's trying to distinguish him/her self the same way. Age isn't the issue as much as education on new stuff is.)

Once I found a great dentist, the money part became almost irrelevant. I've got a $400 night guard custom made for my teeth now that I wear every night to lessen the impact of grinding.
posted by smallerdemon at 3:03 PM on April 2, 2007

IANAD, but I don't much see the point in doing repairs if the cause of damage is still occurring.

That said, I concur with smallerdemon: find a younger dentist (but not so young that s/he is fresh out of school), discuss options.
posted by dirtynumbangelboy at 3:10 PM on April 2, 2007

Get dental implants, they last far longer than crowns, bridgework, and root canals.They feel just like real teeth.
posted by hortense at 3:14 PM on April 2, 2007

Get them all yanked and get dentures. My dad did it in his 30s b/c his teeth were a total mess, and he's never regretted it, and basically never went to the dentist again!
posted by tristeza at 3:23 PM on April 2, 2007

Get dental implants, they last far longer than crowns, bridgework, and root canals.They feel just like real teeth.

The dentists usually say your real teeth are better -- but why? I agree with hortense, the implants seems like a good solution, but I wonder why these seem to be viewed as a 'last resort' by some dentists.
posted by yohko at 3:24 PM on April 2, 2007

From what I've read, implants are problematic if your jaw is weak. Also, having implants put in is a reasonably large procedure. And expensive. Otoh, in some cases they can be a damn good idea. See this thread.
Disclaimer: I don't have implants, it's just something I've read up on in a "that sounds like it could be a useful idea" manner.
posted by anaelith at 3:30 PM on April 2, 2007

If you're going for implants, the tooth grinding reduces the chances of success. From the Wikipedia page on dental implants, under contraindications:

Bruxism (tooth clenching or grinding) is another contraindication. The forces generated during bruxism are particularly detrimental to implants while bone is healing; micromovements in the implant positioning are associated with increased rates of implant failure. Bruxism continues to pose a threat to implants throughout the life of the recipient. Natural teeth contain a periodontal ligament allowing each tooth to move and absorb shock in response to vertical and horizontal forces. Once replaced by dental implants, this ligament is lost and teeth are immovably anchored directly into the jaw bone. This problem can be minimized by wearing a custom made mouthguard (such an NTI appliance) at night.

Like dirtynumbangelboy says above, sounds like stopping the grinding has to be the first step before laying out money for other options.
posted by hangashore at 3:42 PM on April 2, 2007

I know you said to assume that cost isn't an issue. Nevertheless, once you get the options here, I know that many people go to Costa Rica (and I'm sure other places) to work with US trained dentists to get lots of work done over several weeks rolled in with a tropical vacation for far cheaper than in the US. Many insurance companies with co-pay will still pay for this (pre-approve) because it's cheaper for them too. You can contact the embassy in the country and ask for recommendations for dentists.
posted by kch at 3:46 PM on April 2, 2007

The dentists usually say your real teeth are better -- but why?

Because they can get a lot more money from a real tooth than they can an implant.
posted by Solomon at 4:08 PM on April 2, 2007

Yank the lot and get new you-beauty ones titanium screwed into your head. About 2 grand per tooth.
posted by mu~ha~ha~ha~har at 4:15 PM on April 2, 2007

I don't know anything about implants/damage, but I have major TMJ and a mouthguard helps immensely. There are a number of different kinds. I had one that went on my upper teeth that was really thick. It gave a ton of cushion but I hated the way it felt and would take it out in the middle of the night! Then I got a lower one that is thinner and rubbery and it is great. It is discreet enough that I can wear it during the day if my jaw is really bothering me.
posted by radioamy at 4:36 PM on April 2, 2007

I am not a dentist, you must discuss these issues with your dentist. You may not be a candidate for implants due to any number of issues.

If you are truly interested in all your options, set up a consultation with your dentist. Ideally this would be free, but it may not. If it's not free, you might get them to apply the cost of the consultation to the potentially hefty fee for the restoration. If your dentist declines to consult, find another dentist. If your dentist does consult, get a second opinion, and let that second dentist take their own diagnostic films. Make sure your current dentist has a set of current films on record as well. No FMX from more than three years ago. If you have had major work done in the last three years (crowns, bridges, perio surgery, etc) get new films taken.

If any offices discuss implants without seeing a panoramic film of your head, run away.

If implants are suggested by your dentist, ask who will place the implants. This is generally done by a periodontist, but because there is big money in it, we see it more often done by DMD and DDS these days.

If you do go forward with a major course of action, I do suggest looking into an office that uses a dental laser. The office I used to manage had a Waterlase MD and it was awesome, but the learning curve for the doctor, was, well, curved. Try to get into an office that has been using it for at least 6 months.

That's all I can think of at the moment. Feel free to email me if you have any other questions.

One more thing. I'm generally not a fan of dental tourism, because for some procedures the healing time is so variable. And because air travel immediately post dental trauma is, uh, not such a good idea. And because there aren't a whole lot of dentists who want anything to do with fixing up botched overseas dental care. And I've seen it happen, the botched overseas dental care. The records kept in another language. The xrays not sent along with the patient.
posted by bilabial at 7:19 PM on April 2, 2007

You might try porcelain veneers. My teeth were just about in the same shape as yours. My wife called them "brown chicklets" as I had ground them down to nothing. I was finally forced to do something when I busted my front tooth while swinging my car keys around on a pencil. They flew off, cracked my front tooth and the rest is history.

I am glad I had it done. The procedure thus far has been pretty simple but cost a pile of cash. They place the veneers on your front teeth and then fit your mouth for a high tech night guard that has really improved things. The number of teeth they fix depends on how big your smile is. If cost is not an object take this route. You will be amazed by the transformation and how much better your mouth feels.
posted by bkeene12 at 7:55 PM on April 2, 2007

The dentists usually say your real teeth are better -- but why?

It's like if you chopped your limbs off and replaced them all with prosthetics. Sure, you can still walk, but it's not the same. You don't feel connected to them. People who wear dentures can have the same complaint. You don't really feel connected to the process, and some people even find it extremely unnerving.

Your real teeth are definitely better just by definition of them being 'real'. They're alive, they're natural, and, if looked after properly, are as strong as you'll need.
posted by wackybrit at 8:14 PM on April 2, 2007

wackybrit, some people really do brush and floss and do all the things they're supposed to do to "properly care for" their teeth and loose them despite the effort, for a variety of different reasons (genetics and accidents being a major factor).

Other people don't brush or floss and somehow maintain pretty ok oral health.

It is better to take care of them. But, while taking care of them greatly increases the odds that you'll get to keep your teeth, it's no guarantee.
posted by bilabial at 8:45 PM on April 2, 2007

What you want to look for specifically, to piggyback onto bilabial's great advice, is a prosthodontist. While general dentists may be fine to do a complete full-mouth reconstruction, a prosthodontist is trained to do so in more difficult situations. There may be mixed dental work: natural teeth and implant retained crowns or bridges involved, or removable traditional dentures or partial dentures, or implant retained removable appliances.

A prosthodontist will work in conjunction with a periodontist or oral surgeon to place implants where warranted and with a periodontist, keep the supporting gum and bone healthy with regular cleanings.

In your case, with the wear you describe, going with a prosthodontist is important because he will need to increase your vertical dimension. A general dentist may be hesitant in this area. You've probably brought your jaws together several millimeters over the years. This can lead to joint pain, opening you back up will relieve that. You will (IMO) most definitely be getting a nightguard to protect the final product.
posted by Jazz Hands at 9:29 PM on April 2, 2007

Get as educated as possible on all options - Implants are fantastic ---if you are going to lose the tooth. It's a HUGE deal - financially & timewise. With many potential problems lurking....Infection, bone integrity, etc. Based on personal experience I would try to stay with the original tooth - via veneers or crowns although I do have an implant. It is no small feat - big, big, time-consuming ordeal. Not to be taken lightly but sooooo much better than a bridge. An implant does feel like a real tooth. But to off handedly pull teeth & go with implants instead of veneers or crowns????? Are you insane?!?! Please get educated on all options. Please. If you want more info on my experience with an implant - just let me know. Best of luck.
posted by ranchgirl7 at 10:36 PM on April 2, 2007

I vote for treating the bruxism first, then fixing up your teeth. Though the metal teeth sound neat! In a 007/Jaws sort of way anyway.

I have bruxism and have been wearing (and wearing out, at a rate of about 1 every 3 or 4 months), the SleepRight type of mouthguard (It must be noted that CVS.com sells these for far cheaper than the Splintek folks - who manufacture them). I chose this one because it doesn't interfere with my breathing (I am a mouth-breather) like the ones that cover the entire upper/lower jaw.

I think I've been wearing the night guards for about 6-8 months now, and am showing improvement. A couple nights ago, I forgot to wear the night guard and ended up grinding only once, and in sharp contrast to my bruxism history, the grinding actually woke me up (so I stopped)!

As far as night guards go, I have also heard/read good things about the NTI device, which is made to fit the front teeth and act against physiology to decrease tension provided by your jaw. It's an acrylic night guard, like the ones that are custom-fit to your whole upper or lower jaw, and I think because of the lab fees, it tends to be as expensive as the traditional ones. I'm curious, but not that curious, given that I'm seeing improvement with these SleepRight guards.
posted by kalessin at 11:56 AM on April 3, 2007 [1 favorite]

I had jaw surgery to fix an overbite. I was told that good jaw alignment would also prevent me from grinding my teeth as well. I also still wear a very thin acrylic mouth guard at night.

I'm not sure if the surgery helped my grinding that much (considering I did it when I was sleeping), but I'm very happy with my stronger jaw.
posted by robofunk at 12:09 PM on April 3, 2007