Should I get occlusal equalibrium treatment?
February 4, 2012 11:58 AM   Subscribe

Dentistry question: I am a savage night-grinder. Should I have my bite reshaped to help with my bruxism?

I saw a new dentist to get my hard acrylic occlusal splint (night guard) repaired. This is the third time it's been patched, and the next time I wear through it I will probably need a new one. The dentist suggested occlusal equilibrium treatment, which is grinding down bits of my teeth to reshape my bite. According to him, my bite is a poor fit and it is causing a whole host of problems, from bruxism and the related damage and soreness, to lower teeth that don't touch the top ones and therefore protrude unimpeded, exposing sensitive areas near the gums. As part of orthodontic work when I was young, I had four premolars removed and the teeth further pulled up. This, he says, contributes to my poor bite and has left the repositioned teeth tilted at an angle, again exposing sensitive areas and causing my poor teeth to actually bend under the force of my bite.

I have an appointment on Monday to discuss the procedure. It sounds like it could be great! My reshaped bite, according to my dentist, would distribute stresses evenly as I bite or chew, protecting my teeth. I'd have more range to a comfortable bite instead of the restrained position I always close in. I'd clench less during the day, feel less stress and maybe not have to wear the night guard. It could be cheaper in the long run than having to replace night guards. (The guard, even with insurance, is the most expensive thing I own. The cheap boil-and-bite kind didn't help.)

However, there are a few things I'm worried about. Unlike, say, getting a filling, there's no guarantee the treatment will solve my problems. It's a permanent removal of small bits from my already damaged teeth. The dentist seems to really be enamored with the procedure--many of my coworkers have gone to him and he has suggested the same thing. The list of possible benefits is so long that it seems like a cure-all. I did a little research and found one source saying that there isn't much evidence to support occlusal intervention, and another source saying a poor bite isn't the primary cause of bruxism anyway, and that I should reduce stress, cut out caffeine, and develop better sleep habits first.

I wondered if any Mefites have had experience with this treatment, good or bad. I might seek out a second opinion, so if anybody knows a Chicago dentist who's good with bruxism, I'd be glad to hear about that too.
posted by hydrophonic to Health & Fitness (12 answers total) 7 users marked this as a favorite
My understanding is that it doesn't cure bruxism (and that a bad bite isn't a cause of bruxism) but that it treats the symptoms and makes it less bad.

I've had it done and really didn't notice much.
posted by gjc at 12:18 PM on February 4, 2012

Best answer: I had this done about 7 years ago. It was extremely expensive (about $5,000 as I remember). I don't really feel like it did anything.

Afterwards, I started looking online (why I didn't do that before, I don't know -- normally I'd be all over it ahead of time. I guess I trusted my dentist when he said it was necessary.) Some of the things I found made me realize that it probably hadn't been necessary.

You could search on "bite balancing" and see what you find.

I found out after the procedure that my dentist had gone to some special seminar to learn how to do this and he was starting to do it to just about anybody who clenches or grinds their teeth.

So....if I had it to do over again, I'd absolutely get a second opinion (possibly from an orthodontist) before I'd have it done.
posted by la petite marie at 1:01 PM on February 4, 2012

Agreeing about getting a second opinion.

Have you tried any other sort of night guard? When I had a full night guard I continued to clench on it, but the NTI night guard prevents the problem pretty much completely. It covers only my top two front teeth. (As a bonus, it stops the tooth-clenching from giving me migraines, which the full night guard did not do.)
posted by artistic verisimilitude at 1:18 PM on February 4, 2012

FWIW, I grind my teeth terribly on days when I have alcohol and/or caffeine. I recently went on a short break from both of those and it stopped entirely during that time.
posted by fake at 1:32 PM on February 4, 2012

I've had problems with grinding my teeth since childhood. I had my bite reshaped about 12 years ago for treatment of severe TMJ issues. This included filing down some teeth and a year of wearing day and night guards and an additional 2 years with just the night guard). However, recently due to some work/life stress, I've been grinding my teeth again all the time, and it had gotten to the point where I was waking up with a cramp in my cheek. On a whim, I picked up these disposable night guards and they seem to be working. Maybe worth giving them a try before you try something more drastic and expensive.
posted by kaybdc at 2:35 PM on February 4, 2012 [1 favorite]

I also came here to suggest the NTI night guard.
posted by BibiRose at 3:14 PM on February 4, 2012

Best answer: There has never been a consensus in dentistry w/r/t equilibration. It sounds like, regardless of your past history with braces, your bite is not ideal, and therefore an ortho consult might be a good start in terms of another opinion.
The bite is a very complex system of movable, stress bearing parts, any of which can be a bit off and have a deleterious effect on the others.
If you have a good relationship with your dentist, he should not mind if you seek another opinion or ask a lot of questions before proceeding with alteration of natural surfaces of your teeth.
Seek to understand how your teeth, muscles and jaws relate and how your stress levels and sleep patterns fit into the equation. Look for patterns to your discomfort or breakdown that can help with the diagnosis. Neither appliances nor adjustments are a panacea for bruxism.
good luck.
posted by OHenryPacey at 3:23 PM on February 4, 2012

I seem to answer many of these questions (and have asked about bruxism in the past - take a look at my history). Anyways, I'm going through this procedure right now, I've had braces for about 4 months. I have a broken mollar for teeth grinding (which will be fixed with a crown when the braces are removed). Before getting the braces I spent 500 dollars on a night guard which I then shred to pieces at night over 8 months. Before the expensive night guard I used the ones from the pharmacy which lasted me about a month per piece.

When I went to the orthodontist he explained to me a few things:
- No, this procedure will not make me stop grinding my teeth (that is stress related and seems to have been better recently since I've been working out a lot, eating right, and getting a ton of sleep).
- Yes, my teeth/bite isn't correct (which I know because when I closed my mouth, the teeth were just off).
- Grinding my teeth with an incorrect bite is causing stress on the left side of my mouth (where my molar broke, and where I had a ton of pain every morning). If this continues, more of my teeth will get damaged and I will have a ton of issues in the future, more broken teeth, more crowns, etc.
- There was already damage to my left jaw (which he showed me using the 3D scans they took of my skull). I also had terrible, terrible pains in the left side of my jaw, especially in the mornings and when I ate.

So will braces stop you from grinding your teeth? No, they will not. Will they correct your bite and minimize stress on your jaw/teeth? Yes. That has thus far been my understanding, at least in my case. I will always wear a mouth guard - at this point I can't fall asleep without one. But once the procedure is done, I will have a correct bite - which means that the stress that is distributed on the jaw/teeth will hopefully be even across all my teeth, and not directed in one particular area (which in my case was the left back side of my mouth). This will consequently mean that my teeth will accure less damage over the years. It will also put less stress on the left side of my jaw.

Also, damn, I'm going to have some really nice straight teeth.

Feel free to contact me with specific questions about what I've been going through.
posted by carmel at 6:51 PM on February 4, 2012

I just wanted to add that the best thing for me to reduce my teeth grinding was really to reduce the stress in my life. For me that meant finally finding a job, eating right (huge, huge factor - I am an emotional wreck when I eat out a lot/eat junk food), and getting a lot of exercise.

I used to grind my teeth during the day too, and that was just plain horrible. I do still grind my teeth at night, but I think that it's much better these days because I rarely have jaw pain. I also no longer have headaches and I'm not dizzy (during the worst of my teeth grinding I would wake up and be dizzy for the first few hours of the day).

Being able to finally close my mouth and have the teeth align correctly is going to improve the quality of my life, and distribute the stress on the teeth evenly, as you already understand. I think that that combination, together with the reduction of stress (thus less teeth grinding) will mean that your teeth will accure less damage in the long term - which is the important part. As my orthodontist said, you don't want to end up with no teeth 10 years from now. On the other hand, I'm in my early 20s and he was just shocked that this is happening to a 20 year old (he said "20 year olds shouldn't have to sleep with a night guard), so YMMV.
posted by carmel at 7:00 PM on February 4, 2012

It was extremely expensive (about $5,000 as I remember)

My dentist charged $75 and I thought *that* was too much.
posted by gjc at 7:02 PM on February 4, 2012

The dentist seems to really be enamored with the procedure--many of my coworkers have gone to him and he has suggested the same thing.

Huge red flag, whatever the procedure. Second opinion needed for sure.

After a number of disappointing or counterproductive dental interventions, my general rule of thumb is to avoid any procedure that removes real teeth unless it's absolutely necessary. There's no substitute for the real thing.

The cure for my night grinding turned out to be to quit my stressful job and move away from NYC; YMMV
posted by ook at 5:20 AM on February 5, 2012

Response by poster: Ok, I cancelled my appointment and will find a new dentist, and seek out an orthodontist for a new opinion sometime in the future. Thanks, everyone!
posted by hydrophonic at 10:18 PM on February 6, 2012

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