Teeth Grinding 2
Our son has been grinding his teeth for years, to the point where they say nerve is exposed. The dentist has recommended he have his teeth pulled. Mom wants to know if this should be done?
"Bruxism" or grinding of the teeth, is very common within our CdLS population. At 30+ years old, the problem has most assuredly been a longstanding one. Various dental mouthguards or night guards can help if the grinding is related to specific times during the day or night. To wear a mouthguard 24 hours a day would not be an answer for any patient. If grinding is at night or is strongest during the evening, then wearing the appliance would be of considerable help. If the nerves were exposed, I would be very surprised. Usually the nerves shrink away from the offending pressure of the grinding. They will protect themselves by fleeing the area and walling off sensitivity by laying down calcified tissue to separate the grinding surface from the nerve. Exposed nerves would send one up to the roof in excruciating pain.
Extracting the teeth might be an alternative, but unless self-inflicted damage is occurring to the tongue, cheeks, lips or other soft tissues, I would not automatically consider this rather aggressive approach to bruxism. One should also talk to the patient's physician to see if any muscle relaxation medications might help to relieve the tension and grinding.
RESPONSE: Regarding nerve exposure, root canal therapy can be completed on his teeth if he has had good periodontal health prior to considering extractions. I would like to see radiography films prior to this extreme. If he is cooperative enough for this, then a Panorex xray or a small series of xrays would be helpful. If he is uncooperative, then sedation would be necessary for this and then definitive treatment could be rendered (that being preferably root canal therapy so he can retain his teeth).
If his present dentist is not comfortable with this treatment recommendation, then a pediatric dentist who works in conjunction with an endodontist and anesthesiologist would be recommended. It is necessary to coordinate many people's schedules to pull it off. Extractions are easy, fast, final, not always best for patient if conditions are OK otherwise, so more information is needed to verify situation
DC/ TK 7-13-10
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