Bruxism is synonymous with worn teeth. When a tooth is new at 7 to 13 years of age it is all beautiful, but after years thanks to use and stress the tooth begins to wear. The dentina is the strongest structure in the human body but is also subject to wear after years of chewing and stress. This dentine wears when a hard tooth collides with another on a constant basis. This is caused by the muscles which help close our mouths when we chew. There are many muscles but the most important one is the masseter muscle. This is the strongest muscle in our body and creates an amazing amount of pressure when we chew or close our mouths. Of course if we are stressed this force is multiplied.
So if we have a big, strong patient who has worn out his or her teeth and then we fix them all for them… What will happen? If they have worn out their teeth by biting and chewing so hard for years, what makes you think they will not ruin the new teeth you give them? You can use porcelain or zirconium, put in dentures or crowns or whatever but it’s still the same patient with the same stress so they will most likely do the same thing to the new ones. The problem is they will be back and blame you as a dentist. You can fix their teeth real nice but unless you get it on paper that you cannot be responsible if they wear the new ones out because of bruxism, you are going to have problems. They will want a guarantee but if they have a hard stressful bite they are going to end up breaking, chipping or ruining the new teeth and they will blame you. So tell them you cannot guarantee the work in such a case and get it on paper signed by them. There is no material known to man that can resist such force without wearing out. The problem is their occlusion, their bite.
An extreme bruxist has lost that vertical dimension, they have lost that dimension between the nose and the chin as it diminishes. You can do whatever you want and charge whatever you want but if they have bad chewing habits, they will destroy those new teeth. As a dentist you may be tempted to fix their mouths, but I warn you to be careful as this can turn in to a nightmare for you when they come back with problems. Sure you can give them night guards, but besides the fact that they chew by day, they may not even use the night guards and they will wear out the new teeth. Get it all on paper for their good and your own. We dentists offer solutions, we work with engineering and technology, but we do NOT perform miracles.
Also bruxists can be very apprehensive, nervous and controlling people. Like imagine the stress a policeman or even a doctor deals with. As a dentist for the last 25 years I share this advice. Stay away from patients with extreme bruxism unless you are really prepared for such cases. Once you have had 2 or 3 similar cases you will know what I mean. This is just one of those things you learn as you go and they don’t teach in school. Anyway I just wanted to share that with you in case it helps.
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