Dental mishaps of this nature can create a cosmetic crisis and quite possibly a very sensitive, if not outright painful, situation that leads to the dreaded emergency dental visit. At my office we handle a broken or chipped front tooth with a similar sense of scheduling priority as a toothache – namely, we try to get you in as soon as you can get here.
Nobody Likes Having A Chipped Front Tooth
Sudden damage to a front tooth tends to create a greater sense of urgency than say, a chipped back tooth. Even a relatively small chip in your front tooth can lead to an outsized sense of panic. After all, your smile is front and center for the world to see. And, to your tongue and lips, the jagged gap is a tremendous inconvenience.
The remedy for a chipped front tooth can be a simple, elegant bonding procedure, porcelain veneer, a ceramic crown, or more involved treatment such as root canal. Sometimes a tooth replacement with a dental implant is required, depending on how severe is the chip, fracture, or break.
According to researchers Robert Wassell, Amar Naru, Jimmy Steele, and Francis Nohl, bruxism is defined as “the excessive grinding, gnashing, and/or the clenching of one’s teeth.”
Bruxism is what’s referred to as a parafunctional habit. Unlike eating, talking or swallowing, bruxism itself has no functional purpose. But, it causes systematic rubbing of the upper and lower teeth together with varying degrees of force during the night (nocturnal bruxism) or during the day (awake bruxism).
Bruxism Causes A Myriad Of Teeth Problems
- Accelerated wear – on the biting surfaces of your teeth.
abfractions– notches along the gum line that looklike someone took a mini-hatchet to the base of your tooth as if it were a tree trunk.
- Sensitive teeth – when tooth enamel wears so thin that the sensitive dentin underneath becomes exposed.
- Loose teeth – very common amongst bruxers.
- Sore jaw muscles – some bruxers can generate forces in excess of 500 lbs. per square inch – more than enough power to wreak severe damage over time.
- Enlarged jaw – your jaw muscles are like any other muscle in your body; the more you use it, the more developed, larger and stronger it can become and actually change the shape of your jaw.
Why Do You Brux?
The exact cause of bruxism is not entirely understood, but many factors contribute to its frequency and intensity including (but not limited to):
- Irregularities in your bite
- An imbalance in the neurotransmitters that affect nerve-mediated muscular activity
- Sleep disturbances
- Emotional disorders
- Medications (certain antidepressants may increase the frequency of tooth grinding)
Now back to the original premise of this discourse. Besides a sudden encounter of the hard kind, the leading cause of a cracked, broken, or chipped front tooth is bruxism. Minor chipping that occurs over a long period of time can result in your teeth getting shorter.
(Look at some photos of your smile taken when you were younger – do your teeth look shorter?)
Tooth Enamel Cannot Withstand The Forces Of Bruxism
Enamel is the hardest substance in your body, but the tooth structure underneath it is soft. When your teeth grind and gnash against each other continuously over an extended period with an increasingly stronger force, enamel become thinner and thinner. Once the tooth enamel is worn through, wear accelerates even faster. Acidic foods make the situation even worse because they demineralize and further soften the tooth.
Imagine what would happen if you rubbed two large, pieces of chalk together. Chalkdust sprinkles and the chalk pieces gradually get thinner and thinner. Little pieces chip off or even an entire section
As wear continues, the incisal edges of your front teeth (upper and lower) become irregular in shape and rougher. As your teeth glide against each other, such irregularities in structure make them vulnerable to literally “catching an edge,” which causes the enamel to chip. Usually, the chip is located at a corner of the tooth, but sometimes an entire piece of enamel cleaves off.
I often see patients who come in with a chipped front tooth and can’t figure out why it happened. They tell me, “I was just eating a salad!” or “I was only eating a piece of soft bread – why did this happen?”
My answer? “I will restore your tooth so it looks as if nothing happened. But, it will happen again if your bruxism isn’t addressed.”
How To Figure Out If You Have Bruxism
Many people who brux are not aware they have the problem until symptoms appear. It can go undetected for years because the wear is subtle and happens over a long period of time.
An effective way to demonstrate this phenomenon to the unknowing bruxer is to demonstrate how the chips in their upper front teeth fit into the irregularities and chips in their lower teeth like two pieces of a jigsaw puzzle. The precise matching of tooth wear patterns reflect the pathway of the lower teeth against the upper teeth as they machine each other over time.
I’ve seen many patients whose bed partner told them about an awful grating sound that emanates from their mouth while they’re asleep. That’s the sound of enamel scouring enamel.
Bruxism Can Wear Down Your Back Teeth, Too
As bruxism continues over time your back teeth can be affected, as well. Chipping and pitting (the development of shallow craters on chewing surfaces) will occur. As the tooth becomes thinner and the nerve gets closer to the surface, back teeth begin to fracture and become more sensitive.
How To Reduce The Tooth Destruction Caused By Bruxism
Sadly, we do not yet have a miracle cure for bruxism. But we do have numerous ways to treat it. Your dentist may recommend braces or remove an “offending” tooth. Botox injections can decrease the force of your jaw muscles. Biofeedback, meditation, and at-home exercises have been found to have a positive impact for some people.
However, the most common and universally successful treatment for bruxism involves the fabrication of a well-designed occlusal night guard (sometimes called occlusal splint). It is a dental appliance you wear while you sleep. It won’t stop bruxism, but it protects your teeth from wear and lessens the force of the clenching and grinding, which also eases sore or enlarged muscles. Occlusal night guards also diminish the strain on your TM joints (commonly known as your “TMJs.”)
If you have a distinct chipped front tooth, if you have irregular edges and they feel flatter or sharper to your tongue than they once did, or if they look shorter, there’s a pretty good chance you have bruxism. Please see your dentist right away or discuss it at your next dental check-up (you do have an appointment, right?).
This old adage is particularly apt when it comes to early intervention for bruxism: “An ounce of prevention is worth a pound of cure.”
Thank you for reading!
Michael Sinkin practices cosmetic, implant, and restorative dentistry in New York City. He is known for the wonderful care he provides to his patients, and for his wicked sense of humor! To contact Dr. Sinkin, link here.