Reconstructive dentistry is an essential part of completing TMJ treatment for many people. If you suffered significant tooth damage or wear as part of your TMJ or if you want to make the results of your bite splint permanent, then you will want or need reconstructive dentistry.
Reconstructive Dentistry for TMJ and Bruxism
There are common patterns of damage to your teeth that you might suffer if you have bruxism or TMJ, including traumatic damage, tooth wear, and stress-based erosion.
Traumatic damage occurs when excessive bite force causes a major fracture in a tooth. A cracked tooth may need immediate repair if the crack has exposed the tooth nerve or pulp. This is very painful and puts you at risk for an infected tooth. Typically, a root canal will be performed and the tooth will have a dental crown placed. This is the best short-term treatment, but we may recommend revision of the dental crown as part of your reconstructive dentistry treatment.
Tooth wear related to bruxism or TMJ may be concentrated in a small area, affecting a few teeth or even just one, or it can affect your entire mouth. You can identify tooth wear because:
- Incisors that used to be different lengths may now be the same length
- Sharps parts of the teeth become flat
- A darker color of material (dentin) is exposed
Tooth wear will gradually lead to the destruction of teeth. Worn teeth are more vulnerable to decay and traumatic fractures and wear will eventually expose the tooth nerve or pulp. Depending on the amount of wear, worn teeth may be repaired with porcelain veneers, dental onlays, or dental crowns.
Teeth can often sustain intense bite forces without breaking. Signs of stressed teeth include small cracks in the front teeth, called craze lines, and erosion of the teeth around the gum line, called cervical notching.
Cervical notching might seem like an unusual effect of bite forces coming from the top of the teeth, but here’s how it works. The tooth is made up of hard, rigid tooth enamel on the outside and softer, more flexible dentin inside. The dentin helps the tooth absorb high levels of force because it is able to flex, rather than break, under force. The enamel is actually designed to fracture under this force, and these fractures can actually make the enamel stronger, for a while. But when these microfractures reach a certain density, the tooth becomes vulnerable, especially to the type of back-and-forth motion we use when brushing our teeth, so the enamel that was weakened by the fracturing actually comes off when you brush. This effect is most pronounced where the tooth narrows between the crown and the root, called the neck of the tooth.
Make Your Bite Splint Results Permanent
After you have worn your bite splint for a while, and we have adjusted it so that your bite is comfortable and your symptoms are under control, you might decide that you want to make those results permanent, so you don’t have to wear your bite splint all the time — or replace worn out bite splints, because that can happen, too.
When you decide you want to have reconstructive dentistry so you can give up your bite splint, we will talk about your options and make recommendations. The goal will be to make your teeth so that they come together and hold in the same jaw position that the bite splint achieved. This may require reshaping your teeth either by removing enamel (uncommon) or by building up teeth with dental crowns (more common). This may involve putting restorations on some or all of your teeth, and can be combined with damage repair.