A problem as old as the Bible, “gnashing of teeth” continues to be a perplexing aspect of dentistry. Tooth structure is rapidly destroyed by bruxism and clenching and creates very difficult treatment situations.
Most dental restorations placed into the mouth of a patient with abusive chewing habits are short-lived because of breakage or wear.
Many patients do not realize they have a bruxism/clenching problem. Often, they have nearly destroyed their dentition before a dentist or dental hygienist educates them about their destructive chewing habit. What can be done to reduce the tooth destruction associated with bruxism or clenching?
This article presents several concepts to aid practitioners in the treatment of patients with bruxism or clenching. The suggestions are based on my 40 years of clinical experience, as well as on pertinent research observations.
This subject is highly controversial, and the research is conflicting. I fully expect to stimulate discussion on differences of opinion.
BRUXISM AND CLENCHING
In vivo research data show that natural enamel wears about 30 micrometers per year or about 0.3 millimeter in 10 years.
It is difficult to measure the amount of tooth structure destroyed by patients with bruxism and clenching, but in my observations, it is not uncommon to see 2 mm of tooth wear by the mid-20s in abusive chewers.
Based on potential nocturnal grinding, it is logical to assume that patients with abusive chewing habits destroy enamel at a rate up to 10 times faster than that for people without abusive chewing patterns.
Bruxism. People with bruxism are considered to grind their teeth together in eccentric positions (right and left working and nonworking, as well as canine and incisal guidance).
It is extremely difficult to restore teeth in these patients, because a chewing position (centric occlusion) must be established at a location that is somewhat difficult to predict.
Many practitioners provide patients with bruxism with a long centric and wide centric occlusion without much incisal guidance or canine rise. My most successful rehabilitations of patients with bruxism have used this concept.
Clenching. People with clenching tend to bite into centric occlusion and clench their teeth together without significant right, left or forward movement.
In my observations, people who clench on a long-term basis often wear their anterior teeth severely and leave the posterior teeth less destroyed.
Such worn dentitions have very steep incisal and canine guidance.
These patients are relatively easy to rehabilitate; this requires opening and “retreading” of the dentition while maintaining the “worn-in” chewing position and incisal and canine guidance at the same angles as those that were present preoperatively.
For more information about our treatment of Bruxism and Clenching