Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

Case report

on March 20, 2012












This patient came in for treatment to restore the esthetic appeal of his smile. He felt his teeth were not visible enough and they had been neglected over the years. He wanted to be able to smile confidently again.

Dentist talk: The staining and severe wear you are seeing on this dentition is not caused from dental decay. The severe tooth wear is caused by attrition, abrasion and erosion. Abrasion is the loss of tooth structure by mechanical forces from a foreign element, namely a toothbrush. When your toothbrush is too hard and you use it too aggressively, it leads to gingival (gum) recession. Gingival recession exposes the root surface of the tooth, which is a lot softer than the tooth crown because it does not have a hard enamel covering. As you continue to brush in an abrasive manner, tooth structure is destroyed at the gumline. Attrition is the loss of tooth structure by mechanical forces from opposing teeth. Tooth grinding is directly related to stress levels. With the ever increasing stresses of daily life, jaw clenching and tooth grinding have become a common problem. The immediate problem is the vertical loss of tooth height as grinding continues. The flat occlusal plane (biting surface) seen in the above pictures is an excellent example of the results of years of tooth grinding when it goes untreated. Erosion is caused by excessive consumption of acidic foods and drinks ‘dissolving’ away the surface of the tooth, like fruit juice, coca cola and dried fruit. This is more commonly seen on the palatal surface of the teeth, however this patients’ diet did consist of a lot of acidic foods and it did contribute to the overall tooth wear.

Besides the obvious esthetic problem, the bigger dental issue is the loss of vertical tooth height. Due to the excessive grinding habit, the teeth are much shorter than they were originally. This leads to the bite becoming “closed”. As the vertical height gets shorter, the face will begin to collapse which ages the patient tremendously and adversely affects chewing functions and parafunction. In order to treat the problem, the vertical height needs to be restored to its original height. Therefore the “bite needs to be opened”. Opening the bite requires increasing the height of every tooth in the mouth with full crown coverage of the entire dentition. Because the patient is a chronic bruxer (grinder), porcelain fused to metal crowns are used as these are stronger. Dental implants will be placed into the areas where there are missing molar teeth.















There is one more lower mandibular tooth that requires a crown. This will be completed once the implants have been placed and all the molar teeth will be restored at one time. You will notice that this patient only has teeth up to his premolar teeth. This is in fact adequate for chewing and gives sufficient chewing surfaces for normal function. The molar teeth implants will complete the dentition for the perfect result. A bite plate was also made for the patient to wear at night to prevent porcelain fracture and ease the grinding habit. After opening the bite 3mm, the patient was extremely happy with the increased length of teeth that are now far more visible during speech, smiling and function. I was also very pleased with the good result.

With attention to fine detail and careful planning this type of case is very exciting to treat and so rewarding when patients’ lives are changed by their new smiles (:


3 responses to “Case report

  1. I wanted to say thank you to you for this great read!! I have you bookmarked to see fresh stuff you post.

  2. It is truly a great and useful piece of info. I’m satisfied that you simply shared this useful information with us. Please keep us informed like this. Thanks for sharing.

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