I had every tooth crowned because I am a tooth grinder. The results were terribly unattractive but I know I needed teeth and not nubs. I’m not sure they were placed properly because my jaw ended up slanted a bit and I’ve had jaw clicking ever since. Somehow I managed to grind those down too. My pain worsened so I went to someone who said he was a neuromuscular specialist. He had me in an orthotic for a few years and that ended up opening my bite too much. Now I am worse off than ever. I feel like after all of this “treatment” I have gone backward. Is there any way to actually fix this? If I get another treatment, is there a way to get a functional AND attractive smile, or does it have to be one or the other?

Kelly

Dear Kelly,

You have been through so much. Both the dentists you went to were either in over their head or just plain incompetent. Most teeth grinding, also known as bruxism, happens at night while you are sleeping. It doesn’t sound to me like either dentist provided you with a night guard, which is specifically designed to protect your teeth from nighttime grinding. This is such a basic solution, I am floored it never happened.

The second dentist who called himself a neuromuscular specialist was being deceitful. There isn’t a recognized specialty in neuromuscular dentistry. I’ll try and give him the benefit of the doubt that he meant he had a lot of training in neuromuscular care, but based on how your treatment went I am having my doubts.

Full-Mouth Reconstructions are Advanced Procedures

Crowning every tooth is known as a full-mouth reconstruction. Though, every dentist is trained in doing a dental crown, crowning every tooth takes more specialized knowledge and training. This type of training in how the teeth occlude together can only be gain post-doctorally. You need a dentist who has invested in that type of training. I’d like you to take a look at Dr. Marion’s training credentials. You absolutely need a dentist who has invested in this type of reconstructive and TMJ Disorder training. Without that, things will not improve and could actually get worse.

You asked an interesting question about your bite being both functional and attractive. Absolutely it can, but you have to go to the right dentist. Most dentists, especially those who do a lot of crowns and other reconstructive work have a strictly engineering mindset. You want a dentist who is also appearance oriented.

How to get both Form and Function in your Full-Mouth Reconstruction

These procedures need to be done with temporaries first. Your dentist should make up provisionals and have you try them in. You need to have your jaw in a comfortable position, have no trouble speaking, and barely notice the crowns. Everything should feel like there are natural teeth there. You also want to make sure it is easy for your mouth to close when you are in your natural “rest” position. In addition, you need to love the way the temporaries look. Don’t let them tell you the permanent ones will look better or that they can change the appearance after they’re bonded. Those are not true. If you’re not pleased with the temporaries, the dentist needs to go back to the drawing board.

Once the permanent crowns arrive, the dentist needs to first put them on with a temporary try-in paste, so you can see and feel them in your mouth before they are bonded. If you’re still pleased and comfortable, you can have them bonded.

I hope this helps.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.