Is a mouthguard the right treatment for bruxism?

Question

Hello doctor,

While looking at my teeth the other day, I noticed what looked like cracks in my molars (second from the back) on either side.

Recently, I went to the dentist for a cleaning and was also complaining about sensitive teeth to both hot and cold. On both these teeth, I have a bit of receding gums. Although the dentist did not find any cavities, he could not be sure if I needed a root canal treatment and referred me to an endodontist.

The endodontist determined that there was no infection in my gums or teeth and said I did not need a root canal treatment. But he did suggest that I wear a mouthguard at night. I told him I noticed sometimes that I clench my jaw, especially at night. He also suggested a mouth guard because the dentin is wearing away on some of the molars, the gums are receding, and there are a few periodontal pockets forming in those teeth.

These cracks in my teeth are vertical, straight lines. They do not look jagged like a crack in the sidewalk. They are dark in color and very thin. It looks like a small piece of hair is stuck in the tooth. I have one on my right side tooth that is on the front-facing part of my molar, and may be two on the left molar, but facing towards the back of my mouth.

When scratching my fingernail over the surface of the vertical line, it is difficult to tell if there is even a difference in the surface texture. I do not know if these lines appear inside my teeth or on the surface.

The endodontist did not say anything about these. It is hard to believe he missed them, considering I saw them with my naked eye, and he was wearing a microscope on his forehead and eyes. Maybe they are normal and not worth mentioning?

The reason I am asking is that the endodontist said that people who grind their teeth or clench their jaw can develop small fractures in their teeth, which, over time, would cause the need for a root canal.

What could this be?

Kindly suggest.

Answer 1

Hi,

Welcome to icliniq.com.

Your endodontist has diagnosed correctly. Based on your case history, it is evident that you are having a chronic habit of clenching your jaw, which is called 'bruxism' in medical terms. What happens in it is that, due to these unintentional excessive forces, microfractures occur in the inner or outer layers of teeth.

These fracture lines can be termed as cracks in layman's terms. So, if an endodontist talked about fracture lines, this automatically means he was referring to these cracked lines in your molars and the other tooth as well.

Mostly, they are like vertical straight-line microcracks (as evident in your case). Initially, they can be seen well through the microscope (that your endodontist was using) but not through the naked eye. At a later stage, after months or maybe after years, due to extrinsic stains (of coffee, tea, or sodas), these cracks become stained brown, black, or yellowish and hence become visible to your naked eye.

Now, when these cracks get stained, they become visible to you. According to you, they are present in two of your back teeth and in one next to the molar. These crack lines may be present in all teeth, but not stained, so they are not visible to you yet.

An endodontist would have seen it and addressed cracks in a generalized term because clenching of jaws is not a localized problem of one tooth only; it is generalized, and all teeth in the jaws are involved in it. Cracks in molars become apparent soon because they bear heavy chewing forces as well.

At further later stages of bruxism, if forces are not controlled, they may result in cracking down of the upper white layer (enamel) of the tooth or inner layers as well. If the problem reaches this severity, then the tooth may split or some part of the tooth, along with outer and inner layers, may chip off, and then root canal treatment or extraction are the only options you are left with.

Well, do not worry, your problem has been diagnosed at the right time, almost in the initial phase. You should not be negligent about it, and you should wear the mouthguard regularly. Try not to clench your jaw intentionally or unintentionally, and then this problem will subside soon, and these cracks will not propagate further.

As you were not able to feel cracks through your finger, it means that they are present in the inner layer of the tooth and stains leached into the cracks through micropores, giving them a black colour.

Feel free to ask any further questions. I am happy to help you.

I hope you find this helpful.

Thank you.