Question:
Every dentist I've been to gives me different stories. The latest dentist
says the following:
(1) Wisdom teeth can cause grinding. My top two WT were taken out years
ago, I still have the bottom two, which are level with the other teeth.
Supposedly my teeth can't find a comfortable closed position, so they grind
back and forth at night. I have signs of my teeth wearing down from
grinding too, and I get headaches and sinus pain (which other specialists
can't find reasons for).
So he wants to remove my remaining WT. (They also have some decay, and the
gums around them are more tender than around other teeth).
(2) There's no such thing as tooth brush abrasion. He says the tenderness
at the base of some teeth is due to grinding (every other dentist has blamed
TBA).
He wants to remove my WT in the hope that my grinding will stop. He'll
check again in a year or so whether the wear is continuing, and then I'd
need a mouth guard thing.
Any opinions about the above two claims would be appreciated, esp (1).
I found James Boyd's web site about his NTI device for preventing clenching
and grinding, and it all sounds great. I'd be interested to hear if there
are any side-effects or problems arrising from the use of this device. I
haven't seen any reports of problems yet.
Answer:
Wisdom teeth do not cause anything. If they are impacted (not enough room
and they either do not come in or are coming in part way) and giving you
trouble (which it appears they are), then getting them removed is helpful
and usually a good thing.
Tenderness at the "base" of teeth can be due too different factors,
including grinding or toothbrush abrasion.
With the long term absence of your
upper 3rd molars, your lower 3rd
molars may have supererupted into
a position causing abnomal closing.
This could be a one of the possible
sources for your grinding or clenching.
You may want ot ask your dentist
about a night guard to prevent the
wear and tear your grinding is causing
your teeth.
Headaches can be one of the symptoms
from grinding. True sinus pain unlikely.
However muscle tenderness around the jaw
is another symptom.
This could be a multifactorial problem.
Factors such as :
gum recession, abfractions, grinding,
TBA are but a few of the etiologies for
this symptom.
In either case seems like a lot of new
restorations. Have you been seing a
dentist regularly prior to the consultations?
How is your dental homecare? What
about your dietary habits? Certainly
prior to restoring these teeth, I would
want to know what can be done in the
future to prevent such significant additional
breakdown.
Criteria for restoring teeth may differ
from dentist to dentist and patient to patient.
Some Questions you may want to ask :
Are the restorations necessary due to existing
decay?
Are the restorations needed due to defective
existing fillings?
Are any of these restorations elective?
What are the risks and benfits of waiting on
some of these restorations?
Should have consulted two more dentists and you would have got the
tally down to one.
Some dentists are more conservative, some less conservative. Who is
right? Who knows!
I'd leave the lower wisdom teeth in in the absence of a clear reason
to remove them. I'd go for the NTI (it is least invasive procedure).
A number of my teeth have this. The sensitivity is on the base of the tooth
itself, not the gum, and seems to be because the gum has receded. Hasn't
been as bad in the last couple of years, maybe because I changed my brushing
technique. But then my dentist says TBA doesn't exist, seems to be
debatable.
The dentist prodded around the gums near the base of some teeth too, to show
that the gums around my wisdom teeth were more sensitive than the gums
around the other teeth (we're off on the gums now, not on the base of the
tooth itself). Why is this?
There's also some decay in both of them, so if I don't get them out, I'd
have to have them filled. Now I know generally a hole doesn't mean that the
tooth should come out, but if the remaining WT have nothing opposite them to
bite on, except the very edge of the upper back teeth (which the dentist
says are getting worn by the WT opposite), then the WT aren't much use
anyway.
Also, I had a filling in one of my WT already, and it really hurt! They'd
put in as much anaesthetic as they were allowed to, and I could still feel
that slow drill hurting. I thought at the time it was because WT nerves go
further down than other teeth and were out of range of the anaesthetic, but
after reading Jim Boyd's book I'm wondering if it's again due to grinding.
He mentioned that this can happen. Anyway, when I had my top two WT out it
was actually much nicer than having a filling! So if I have to choose, I
might prefer to just get them out.
Summary: The problems with my two remaining WT (on bottom of jaw):
* Dentist claims they might cause my grinding.
* There's some decay in them.
* There's no opposing WT to bite against, and they're wearing the existing
top back teeth.
* Sensitive gums (I hadn't noticed till he prodded them) around WT.
* He also thinks they might be crowding my bottom teeth. It is harder to
floss on the bottom than the top, and my centre bottom teeth do look kind of
squished together a little.
So what's the verdict? Get them out? (I know a true diagnosis can't be
given without really seeing them, just looking for opinions and comments,
since no two dentists seem to agree on anything! :-)).
