A Before-and-After NO ONE Wants to See
Recently, one of our patients called the office concerned that a filling had fallen out of one of his teeth. When these calls come in, my degree of alarm depends on which patient is on the phone. In this case, the patient was a prodigious grinder! Uh-Oh. Certainly grinding and excessive force on the teeth can cause fillings to leak and debond, but ferocious and persistent grinding increases the possibility of serious problems significantly.
When I went into the exam room and looked at the tooth in question, I was relieved to see an (apparently) intact tooth with a rather large filling missing from one side. I didn’t realize the full extent of the damage until I started feeling for new decay with my instruments. With minimal pressure, one half of the tooth swung to the side revealing a fracture that ran the entire length of the tooth and all the way down to the bottom of the tooth where the roots separate.
Although modern dental techniques make repair of severely-damaged teeth possible, we still have no way to repair a fracture that extends onto the root surface. All we can do is extract the tooth and discuss options for replacing it.
Unfortunately, this patient just began wearing a bite guard a few years ago and the tooth probably had a crack present before that time. Once a tooth is compromised, its ability to survive non-ideal or excessive forces is severely limited and small events (such as biting the wrong way or biting into something hard) can overload the tooth and cause serious or catastrophic problems.
If this patient had been treated with orthodontics (braces) and-or a properly-fitted bite guard earlier (even as long as 30 years ago), they may not have lost this tooth. Unfortunately, this is one more in a sequence of missing teeth caused primarily by a non-ideal bite and severe grinding.
The good news is that with consistent use of the guard, this patient had a good chance of saving the rest of the teeth, or at worst, delaying additional tooth loss. It’s never too late to treat a non-ideal bite or excessive forces on the teeth.
I discussed my findings with the patient and discussed various options for the replacement of the tooth. For a variety of reasons, this patient did not want to pursue implant treatment for this particular site and preferred not to replace the tooth. I extracted the tooth with no complications and the site healed as expected.