What Is A Dental Pothole

When Houston’s new mayor Sylvester Turner vowed to fix all the potholes on the city streets of Houston, Texas, it triggered a thought in me. As a dentist for over 21 years, I have been calling the worn-off tips of pointed cusps on teeth “potholes”. (Click here to see our fun video about “fixing potholes”).

So, the number one cause of a pothole on your tooth is actually similar to what can cause a pothole on the streets: UNDUE, MISDIRECTED FORCE!

Enamel is the hardest substance in the body (harder than bone) so it takes a great amount of FORCE to chip or break the enamel. Many people subconsciously clench due to stress or other triggers during the day or grind their teeth at night (Bruxism). Grinding and clenching are parafunctional habits meaning that they are not part of normal chewing or talking activity. You may have heard a child or loved one unknowingly grinding while they sleep! These patients may experience symptoms such as headaches, sore jaw muscles, sensitive teeth, “potholes” on their teeth, or even damaged or cracked teeth. Sore jaw muscles in nighttime bruxism will typically create more pain in the morning which improves or gets better throughout the day. Clenchers will typically clench during the day while concentrating on driving, typing, cooking or other activities and have more pain in the evening.

As a dentist, I typically treat patients who clench and grind their teeth by making hard, acrylic occlusal splints to protect the enamel from being worn down as well as to help relax the muscle force that can cause this damage.

Dental Nightguard

Dental Nightguard

I custom make each splint to the patient’s bite, and try to create a smooth pathway on the splint so that the lower jaw can move freely. The bite on a splint needs to be balanced periodically to ensure that there are no “speedbumps” in the appliance that can create more forces. The bite also needs to be aligned so that all teeth touch the appliance at the same time. As muscles relax, the bite on the splint can shift so patients in my office are seen periodically to balance the bite and remove “speedbumps” during the first few weeks of wearing the appliance at night or during the day. If a splint or nightguard has a hole in it, where teeth can contact, then it needs to be seen by a dentist and probably repaired. Anytime, there is tooth to tooth contact on a bruxism or clenching patient, muscles are triggered which create force. My treatment goal with a splint is to reduce the force on the teeth, create a smoother pathway so patients cannot generate the same amount of force, and to protect the TMJ (temperomandibular joint). Many times, patients wear the appliance on a long term basis. We often teach our patients relaxation techniques and we may work in conjunction with a chiropractor, massage therapist or a yoga instructor.

Often, minor changes can be made to the patients’ teeth to harmonize the way they bite and improve their chewing function (Teeth equilibration). This can involve restoring the worn teeth to provide ideal chewing function.

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