The challenges and stresses of today may have all of us gritting our teeth. The ups and downs of the economy and the persistence fluctuations in our personal lives make us realize that nothing is routine any more. For many, the impact is evident in our mouths. Although teeth are designed to contact, in most normal function, they never actually touch. Typically when we are eating, there is a bolus of food between the teeth that is being crushed or torn to aid in digestion. The amount of “normal wear and tear” on the tooth surfaces due to actual chewing is relatively mind in most situations. It would take many decades of abusive chewing to appreciate any significant attrition of tooth surfaces. However during parafunctional habits, like clenching and grinding, our teeth are in direct contact. The destructive forces applied to the teeth can exceed several hundred pounds of force per square inch. The cumulative effects on the teeth can be devastating.
Enamel is the hardest substance in our bodies and is designed to be incredibly durable in normal function. In areas of the tooth where functional contact is typically anticipated, the enamel is approximately 2mm thick. In a healthy mouth with balanced tooth contact, this enamel can last a lifetime. If this enamel is lost, then the next layer of the tooth, the dentin, is not nearly as resilient. The dentin can be up to 8 times softer and therefore will begin to melt like butter, if it is asked to perform in an environment that was destructive enough to break down enamel. Initially, the evidence of parafunctional habits is insidious to identify. Although persistent, the damage is slow. Then, as the enamel is lost, and the dentine is exposed, the teeth begin chipping and wearing at an accelerated rate.
The signs of clenching and grinding can vary from patient to patient. These may include:
• Worn and chipped teeth
• Teeth that look shorter or square
• Sensitivity to temperature or biting pressure
• Recession of the gums
• Teeth that drift or move
• Sore jaw muscles
• Joint pain
So how do you know if you are destroying your teeth by clenching and grinding? Studies tell us that at least 10% of the population are active persistent grinders or clenchers, and probably as many as 50% have recurring periodic episodes of parafunction. Our goal is to identify those at risk early, before the damage is too extensive. Many, unfortunately, are un-aware of their damaging habits. Although some individuals may actually grind their teeth in daily activities, most will do it when sleeping. Typically parafunctional habits are associated with REM sleep and may last 15-20 minutes, recurring many times through the evening. Sometimes a sleeping partner can hear the gnashing and grinding of the teeth. Sometimes, as in the case of clenchers, there may not be any noise at all. Sleep studies or even small monitors that measure facial muscular activity can verify the occurrence. The end result, however, can be readily identified from forensic evidence in a complete dental exam. Through the process of a thorough exam, which would involve an occlusal analysis and photographic documentation, the dentist can quantify the impact of the condition and begin to recommend solutions. In our next article we will discuss some of the causes and treatment solutions in managing this problem.
Dr. Scott Finlay is restorative and cosmetic dentist in the Annapolis Area. He is an Accredited member dentist of the American Academy of Cosmetic Dentistry and an Examiner for the American Board of Cosmetic Dentistry. He is also a lead faculty member of the Dawson Academy and teaches dentists across the country and in Europe in postgraduate settings, the management of occlusal disease in relationship to the restoration of anterior teeth. Information about Dr. Finlay and his practice can be found at www.AnnapolisSmiles.com.