Treatment for Bruxism

To minimize and control attrition (tooth-tooth wear) we need to keep the teeth apart during sleeping hours and create a daytime bite that is comfortable and well balanced.
For nighttime control of attrition a night guard (also called occlusal guard, biteguard, or splint) can be used. They are custom-made hard acrylic mouth pieces fabricated to order by the dental office. They can be made to fit over the upper or lower teeth, can cover two teeth or all the teeth in that arch. In extreme cases, they can also be worn during the day. Without the mouthpiece in place, the teeth worn by attrition will continue their destructive process.
To overcome this, an individualized treatment plan is indicated. The plan must realign the biting position of the upper and lower jaws to be in harmony with each other, with the muscles, and with the jaw joints. To accomplish this, we take impressions for study models as well as wax registrations to determine the best course of treatment. The more common treatments include bite adjustment, restoring the worn teeth, orthodontics to realign the upper and lower teeth, jaw surgery to reposition and realign the two arches, joint surgery, or a combination of several of these. The most common treatment in our office is bite adjustment and restoration of some or all of the teeth. Orthodontics is another common treatment. (For more dental information, see my website at www.lajolladental.com)
It is important to note, many dentists don’t understand attrition and how to realign the upper and lower arches and restore the teeth in harmony with each other, with the muscles, and with the jaw joints. Too many crowns get placed on worn teeth without correcting the cause of the attrition. No surprise, then, the wear continues on the new crown(s)!

Bruxism

One of the three major causes of tooth wear is attrition. Attrition is caused by tooth to tooth contact. The back teeth become flatter while the front teeth become shorter. In a healthy well-balanced bite the rate of attrition is minimal throughout life. When that rate is dramatically increased, wear will appear on some or all of the teeth. (See my website at www.lajolladental.com)
One of the conditions that accelerate the attrition or wear is bruxism. Bruxism is an involuntary clenching-grinding of the teeth. It is believed to be caused by stress, anxiety, and an imbalance in the biting position of the upper and lower jaws – malocclusion. Bruxism can occur subconsciously during the day or while sleeping.
Moderate to severe attrition of the front teeth can leave a patient with short and unpleasant looking teeth and an aged smile. It is possible to have attrition accompanied by acid erosion and/or abrasion.

Tooth Wear – Attrition, Erosion, and Abrasion

We are saving more teeth these days through gum treatments, root canals, and better patient awareness. As such, with more teeth in patient’s mouths than we saw 20 years ago, we are finding more wear on the teeth. The wear is not simply a sign of age, it is an indication of other conditions.
Wear has three causes, and it is important for the dental team to identify which of the three causes has affected your teeth, because the treatments will differ. (See my website for more dental information)
The three causes are:
1. Attrition – which is true tooth-to-tooth grinding.
2. Erosion – which causes tooth wear by demineralizing the tooth structure with acid and demineralized tooth areas getting rubbed away.
3. Abrasion – which is when a person aggressively brushes his or her teeth over a period of time and that abrades portions of the teeth. Another abrasion cause is when older over-contoured porcelain crowns abrade the opposing teeth, wearing them away.