A disease of the chewing structures, hidden & destructive, movement disorder, multiple behaviors, unique patterns, occurring day or night.

Restorative failures after age 50 caused by DESTRUCTIVE GRINDING.

CHASING PAIN GHOST: If patient requires root canal, crown, extraction, and implant in same tooth or teeth, not caused by cavities or gum disease, you have missed diagnosis of atypical toothache. In 7- 12 % teeth, the outside nerve, not inside nerve, is cause pain. The outside nerve is irritated by powerful frequent grind & clench.

TREATMENT SYMPTOM NOT CAUSE: The diagnosis of destructive disease grinding-clenching requires dentist look at teeth and other 3 damaged tissues (bone support, muscle, joint). Reconstruction is treating one of symptoms of the disease (tooth damage), totally ignoring cause and solution. The destruction will continue until you loose your teeth or you request referral to specialist of destructive grinding OROFACIAL PAIN SPECIALIST.

Three levels of destructive power: 1) Mild 2) Moderate 3) Destructive

Different levels grinding-clenching prescribe different appliances: 1) Mild = soft biteguard 2) Moderate = hard nightguard 3) Destructive = orthotic

Different Tools for each level: 1) Mild = appliance 2) Moderate = nightguard & conservative therapies 3) Destructive = orthotic & orthopedic team & 11 different tools

Sensitivity is early hint of destructive grinding: Escalate level care if sensitivity persist: 1) Sensitivity toothpaste 2) Sensitivity varnish 3) Occlusal adjustment 4) Nightguard Appliance 5) Referral Orofacial Pain Specialist before they destroy chewing system

Let's do some simple logic for Atypical Toothache: 1) If frequent repetitive tooth discomfort is not cavities or gums disease, only disease left is destructive grind 2) After 2-3 restorative procedures on a tooth, think about referral Orofacial Pain Specialist 3) Continue treat symptom, TOOTH DISCOMFORT, or treat cause, DESTRUCTIVE GRIND 4) Diagnostic testing at "OROFACIAL SPECIALIST, determines cause "ATYPICAL TOOTHACHE" 5) Prevent patient wasting tooth structure and money by treating cause pain

Diagnosing Grinding/clenching: 1. Wear 2. Tori 3. Recession 3. Cracks   4. Sensitivity 5. Bone Buttressing 6. Mobility 7. Broken crowns 8.. Cervical erosion 9. Bone loss 10. Failed implant 11. Toothache 12. Microfracture 13. Broken filling 14. Chip teeth 15. Broke teeth. 16. Root canals 17. Post open bite 18. Asymmetry 19. Disc displace 20. Tension HA 21. Arthritis TMD 22. Restricted open 23. Atypical Earache 24. Trigger Points 25. Enlarged Masseter 26. Decrease airway 27. Broken retainers 28. Worn bite guards 29. Scallop tongue 30. chip front teeth 31. Open contact 32. Moving teeth 33. Post operative pain 34. Margin breakdown 35. Snoring 36. Esthetics destroy 35. Enlarge M. Pterygoid

Destructive Parafunction Damages all 4 structures of chewing system: 1) TEETH 2) JOINT 3) MUSCLE 4) BONE SUPPORT

The third disease, “destructive parafunction” is movement disorder for which dentistry has little to offer against its destructive power.

In fact the dental profession has fallen to "Titanic Thinking"= mankind will invent a crown that can't be destroyed, so meet the Zirconia crown. The destructive grinding will destroy joint and muscle since it can't destroy crown.

Nightguard should be prescribed first to protect crown-bridge-implants against destructive grind-clench. For mild to moderate grinding, the nightguard is typically done after restorations.

Consumer & Dental bias with grind/clench

1. Grinding/clenching is same EACH PERSON
2. Diagnose is made by observing SEVERE WEAR
3. Grinding damages only TEETH  
4. Behaviors are only CLENCH-GRIND
5. Grinding is same FORCE-DURATION-FREQUENCY 
6. Crown a crack tooth FIXES the problem
7. Grinding is caused by OCCLUSION
8. Treating crack/broken tooth is DENTAL FOCUS
9. Fix crack tooth, forget how it cracked
10. Management grind/clench is SUPERVISED NEGLECT
11. Dentistry answer to grinding is APPLIANCES
12. Severe grinding is not a DISEASE

Level grinding verses type appliance

1. Mild grinding    =   biteguard
2. Moderate grinding  =  nightguard or hybrid
3. Destructive grinding = orthotic & 10 other tools

Destructive forms Behavior:

• Clenching day 2) Grinding night
• Tooth Bracing 4) Tooth posturing
• Muscle bracing 6) Tongue biting
• Side to side grinding 8) Rubbing front teeth
• Clenching night 10) Grinding-front to back
• Gnashing 12) Grinding all directions
• Pencil biting

Things to remember: 1) Manage destructive parafunction before you buy expensive dental care 2) Orofacial pain specialist is only specialty that treats/manages movement disorder 3) Utilizes 11 tools to manage movement disorder 4) Utilizes orthotic to reduce power destructive grind/clenc 5) No appliance cures destructive grind 4) If destructive grind destroys teeth, it will destroy your work ? 5) Dentist have no training movement disorder 6) Mild grinding/clenching should be treated by dentist 7) Dental appliances treat early grinding 8) Anxiety is fuel for increase grind/clench

Prevention grinding/clenching is one most important jobs of dentistry; yet, dentist will not prevent grinding until public gets mad enough at all reconstructive cost to repair damage.

1. Why develop dental materials to oppose a force that breaks everything.   2. Why not reduce force, frequency, and duration of the destructive habit
   3. Why choose to reduce grinding when you can get indestructible porcelain 4. The invention of new indestructible porcelain is same as invention of Titanic

DESTRUCTIVE PARAFUNCTION CAUSES: 1) Most restorative failures 2. Lost teeth after age 50 3. Cost in Billions 4. Is 2/3 revenue dentistry

GRIND ON THIS:

1. Grinding uses energy, instead of restoring energy
2. Sleep is for healing, not damaging chew system
3. Power goes up 6X at night
4. Not classified as a “disease”
5. It is not taught, researched, nor prevented
6.  Dentist trained see teeth, not joint & muscle & disc
7. Dentist are reconstructionist
8. Dentist treat occlusion, not anxiety

HIDDEN DESTRUCTION

1. Dentist are trained see teeth, not symptoms in muscle-joint-disc
2. Awareness low: Asleep we do not perceive grind/clench
3. We are not aware clenching when stressed due distractions
4. Grinding dissipates as we awaken to am headache
5. Parafunction behaviors are different for different patients
6. Cannot measure enamel lost-bone loss-ligament tearing-muscle over contract at recall
7. Dentist diagnosed when wear is terminal by reconstructing
8. Dentist diagnose joint is destroyed when you ask about restricted opening
9. Muscle on side face enlarges slowly as do my biceps in gym

 Names for Destructive Grinding: 1) Movement disorder 2.. Grind/Clench 3) Restless mouth syndrome 4) Bruxism 5) Gnashing

How can you loose your teeth ? 1. Cavities 2. Gum 3. Grind/clench 4) Trauma

Why does dentistry have such a problem with grinding ?

1. Cavities & gum disease are bacterial
2. Grinding is a movement disorder
3. Grinding reconstruction produces revenue
4. Most appliances are declined
5. OTC appliances are uncomfortable
6. Dentistry treats movement disorder with appliance

Why do you need an orofacial specialist for destructive parafunction

1. Causes Severe damages 4 structures
2. Damages:  a) muscle     b) joint    c) ligament     d) disc
3. Treating Movement disorder (MMD)
4. Damage is joint & muscles, not just teeth
5. Requires knowledge all appliances
6. Requires understanding anxiety relationship to grinding
7. Movement disorder requires team of professionals
8. Management requires 11 tools from various fields
9. Orthotic requires high degree accuracy

SIGNS DESTRUCTIVE PARAFUNCTION 1) Chewing system malfunction: pleasure eating, poor nutrition, mechanical efficiency 2) Muscle damage: trigger points, enlarge muscle, muscle pain, cramping 3) Joint damage: tear lateral ligament disc, displaced disc, restricted open 4) Early Wear teeth: baby tooth wear, 1st molar wear, were anterior teeth 5) Mod/Sev Wear: loss 6 mm enamel, flatten occlusion, missing teeth, 6) Recession/bone loss: w/o infection, mechanical loss, sensitivity, expose root, cervical erosion 7. Bone enlargement: palatal or mandibular tori, buccal bone buttressing maxilla & mandible

Dentistry & Parafunction: @@@@

1. Prevent damage to the teeth 2. Hands on Training: biteguards & nightguards 3. Science appliances in dental school 4. Utilized conservative therapies 5. Implement appliances earlier 6. Collecting all the hints in all tissues 7. Look for early warning signals 8. Communicate parafunction to patient 9. Diagnose destructive parafunctional 10. Awareness Children & Teens DP

Look for Early warning signs: child & teen:

1. Grinding noises 2. Enlarged Masseter 3. Trigger points 4. Breaking Hawleys-retainers 5. Wears through biteguards 6. Tension Headaches 7. Wear 1^st molars 8. Wear primary teeth 9. Atypical earache 10. Atypical Toothache 11. Sensitivity 12. Cracked broken fillings

Atypical Toothache: damage to outside nerve

A. How can a tooth hurt after root canal ?
      1. Inside nerve is treated w/ root canal
      2. Outside nerve is still very much alive
B. Why does tooth hurt after root canal
      1. the outside nerve is damage by clenching/grinding
      2. Occlusion can aggravate outside nerve
      3. Outside Ligament stretch & compress 100 time hour setting off nerve
      5. This nerve travels in same bundle of inside nerve to same area brain
      6. The brain cannot discriminate difference outside vs inside nerve
      7. Tooth still hurts after root canal, choice: outside nerve or crack
C. How you can cause the same type pain ?
      1. Tap on your front tooth for 3 minutes = sensitivity
      2. Tap on your front tooth for 5 minutes = discomfort
      3. Tap on your front tooth for 7 minutes = pain

Outside nerve Analogy: kick a mailbox post every day, the dirt loosens, and rain washes dirt away,

Case I Destructive grinder

1) Parafunction Exam:

• tooth wear: mild anterior, moderate posterior, 
• moderate Masseter hypertrophy, 
• moderate Medial Pterygoid hypertrophy, 
• two small dome-like mandibular tori, 
• broad with midline groove mid palatal tori, 
• mild maxillary bone buttressing, 
• moderate antegonial notch, 
• broken several teeth (2,14,18,19,30), 
• significant frontal temple headaches, 
• trigger points in Masseter

2) Parafunctional History:

• in 1997 right jaw stiff,
• in 1997 right restricted opening,
• in 1997 1st hard upper nightguard (1)
• in 2003 broke 1st nightguard,
• in 2003 2nd hard thinner nightguard (2)
• in 2005 jaw tight stiff sore,
• in 09-09 broke inlay part cantilever bridge,
• in 2010 difficulty with crown due limited opening right jaw,
• in 2011 awoke from sleep with tooth pain #19,
• in 2011 on BW showed significant inc. PDL-LD posterior teeth,
• in 2012 microfractures in teeth,
• in 2013 broke tooth #14,
• in 11-13 broke Nightguard (2)
• in 01-14 dentist made new nightguard (3)
• in 03-15 broke tooth #18
• in 01-19 broke nightguard (3)
• in 02-19 adj crack nightguard
• in 12-19 at cleaning noted microfractures in #30
• in 05-20 crown came off #18 

Case II Destructive grinder

• Dentist #1 3 unit lower posterior bridge 3 times, broke 3X 
• Dentist #2 3 unit redo bridge, 4th bridge- broke temp bridge, move abutments
• Dentist #2 3 unit bridge broke 4th bridge
• Dentist #2 3 unit 5th bridge porcelain, broke
• Dentist #2 3 unit bridge metal, broke
• Dentist #2 extract #18, oral surg place implants, double abuted,
• Dentist #2 broke implant 2X
• Dentist #2 oral surgeon removed implants, left w/ no molars
• Dentist #2 made nightguard (1), broke
• Dentist #2 made him nightguard thicker (2), broke
• Dentist #2 made him nightguard wire mesh (3) &
• Dentist #2 cemented retainer bar around front, broke
• Dentist #2 research grinding, taught few tools
• Dentist #2 reduce grind power, remade Nightguard (4)
• Dentist #2 Patient broke 2 teeth due nap w/o NG, Rebuilt 2 teeth
• Dentist #2 Made new Nightguard (5) due rebuilt 2 teeth

Broken nightguards or worn through biteguards are strong hints of destructive grinding & clenching. To caring dentist, a referral to orofacial pain specialist gets orthopedic team to implement 11 tools to reduce movement disorder to nondestructive level.