Because a person’s smile has such a big impact on how they are perceived by others and themselves, most people want their smile to look as beautiful as possible. If a person’s teeth are not perfect, either from cavities, staining or erosion, or if they just want to change their appearance, restorative dental work and elective esthetic dental work can be excellent solutions.
The combination of a good dentist, a good dental lab, and good dental materials can produce incredibly lifelike and beautiful dental work. However, there are of course costs associated with this level of excellence.
It takes years of study and practice to acquire the skills involved in outstanding dental esthetics, and high-quality materials are relatively expensive too. For many people, this is still a good value. A beautiful smile gives you confidence and improves your overall appearance. So investing in good dental work is often a smart and emotionally-fulfilling decision.
But it’s important to remember to protect your investment after you make it. And, if you are already happy with your smile, you most likely still want to take smart steps to prevent future damage to your teeth that might then require repair.
Luckily, night guards offer conservative and cost-effective protection of your teeth. Night guards can help prevent expensive dental work in the first place, and can also preserve it once you’ve had it completed.
In this article, we’d like to review some of the most common dental procedures, and offer some considerations of their costs, benefits, and the ways in which night guards can either prevent needing the procedure in the first place, or protect the esthetic results after you’ve already had the procedure completed.
Dental “fillings” are probably one of the first things that come to mind when you think of a dentist’s office. This is partially because they are so common - the number of fillings completed in the US each year is counted in the hundreds of millions. Furthermore, it is estimated that over 90% of adults in the US have some form of tooth decay. Not all decay needs to be treated, but this means that there are many, many people that either have or are good candidates for dental fillings.
When a dentist completes a filling, she will first remove unhealthy tooth structure compromised by decay, then place a filling material to protect the inner surface of the tooth and restore normal function for things like chewing.
While people of a certain age may immediately think of metal amalgam fillings, the vast majority of fillings completed today are made with restorative composite, which is a mixture of barium glass (along with other specialty fillers) and photosensitive resin.
Commonly referred to as restorative composites, these materials look much more natural, and in the most skilled hands can be made virtually indistinguishable from natural tooth structure. Dentists achieve this by matching the restorative composite to the tooth color and adding lifelike details with special tints.
Composites range from about $150-$250 on average - and can be as much as $450 in the most expensive markets. Even if you have dental benefits, there is usually some out of pocket expense (in the range of $50-$100 or more). These costs can really begin to add up if two or more fillings are required, which is very common.
Fillings also need to be replaced frequently - usually about every 7 years - but teeth grinding habits can wear out composites at a much faster rate, requiring more frequent replacement. It's also worth noting that the process for bonding the composite to the tooth is both time-consuming and technique-sensitive, which means it can be a point where errors do occur. If they do, the bond between the tooth and the restorative material may not be as good as it could be.
Compromised bonds to the tooth can especially be a problem with teeth grinding, because the weaker bond is more susceptible to further damage from teeth grinding forces. This could mean that the restoration will be dislodged or will fracture. Also, the failed bond decreases the cohesive strength of the tooth, which could lead to part of the remaining tooth fracturing off or cracking through the root. If this happens, the tooth will most likely need a crown at least, or if the damage is more severe, an extraction which should then be followed by an implant.
Crowns (also referred to as “caps”) are needed when significant natural tooth structure needs to be removed due to decay or damage. In these situations, a filling material does not provide the strength or stability required to sustain normal activity like chewing, and the tooth needs to be completely covered with a hard material.
Common choices are porcelain, and more recently a porcelain-like material known as zirconia. These materials can be made to look nearly identical to natural tooth structure, and can also be very strong. However, they still must be bonded to the tooth, and this represents a potential failure point associated with teeth grinding.
Once a crown is in place, if it is subjected to heavy teeth grinding forces, the bond/cement layer may fail (similar to a filling) and the crown may come out. Again, the materials used for adhering restorative materials to tooth structure perform well under normal conditions, but the forces from teeth grinding can far exceed what would be considered “normal”.
Usually the crown can be recemented, though dentists have to be careful to properly bond the remaining tooth to the crown again so that no contamination interferes with the integrity of the bond. In any case, if there is no intervention in the teeth grinding habit, the debond may recur, and the crown could fall out again.
Crowns are significantly more expensive than a filling, ranging in price from about $1000 to $1600 or more.
If the tooth is too cracked or decayed to accommodate a crown, then it will most likely need to be extracted. Dentists will usually recommend an implant if this happens.
While expensive, implants will provide the best esthetic outcome for patients, and will help preserve adjacent teeth and reinforce the strength and presence of bone in the jaw near the extraction site.
An implant is a metal socket planted in the jaw at the extraction site. This socket can accommodate a small screw, attached to a post (referred to as an “abutment”) that can in turn accommodate a crown. If you do require an implant, then wearing a night guard can become even more important. While implants are quite strong and do help reinforce the inherent strength of the bone in the jaw, they do not perform well when subjected to persistent forces from teeth grinding.
First, the same risk from debonding the crown is present. Although, a growing trend is the use of screw-retained implants, which significantly reduce the chances that a crown could be separated from an implant abutment. However, a teeth grinding habit can also prevent the implant from properly integrating with the jaw, causing it to fail. This is not a pleasant experience and may significantly complicate further stages of treatment.
Implants are quite expensive, ranging from $3000 to $6000 each, inclusive of the implant and restorative crown.
For the most part, all of these procedures are restorative in nature. That means that they are completed to return teeth to the best possible working condition after some form of damage, while also maximizing the esthetic appearance of the teeth.
But both resin composites and crowns, along with another type of procedure - veneers - may be done mostly or entirely for cosmetic reasons. In contrast to fillings and crowns, veneers are placed only on the visible side of teeth, since they are only for appearance.
While this helps maximize the preservation of healthy tooth structure, it tends to reduce the strength of the bonded interface between the tooth and the porcelain veneer because the bonded surface area is also reduced.
Veneers can also be completed with restorative composite instead of porcelain. The esthetic results can be excellent, though not as spectacular as the best porcelain veneers, which rise to the level of fine art when made by the most talented ceramists.
Once again, a teeth grinding habit can compromise this procedure because of this excess force placed on the cement holding the veneer to the tooth. Unlike a crown, if a veneer does fall off, it is not likely that it can successfully be re-cemented in place.
Because veneers tend to be very expensive - between $1000 and $3000 per tooth, many dentists will insist that patients wear a teeth grinding guard every night to protect the veneers from damage.
It’s important to remember that teeth are not the only things that need to be “fixed” in the mouth. Beyond having healthy teeth, we also want the soft tissue in our mouths, the gingiva (more commonly referred to as “gums”) to be healthy. This means that the gingiva should be firm and not have a red, inflamed appearance as is common in patients with gum disease (usually referred to as periodontitis). The gums should also surround teeth snugly, and protect the lower part of the tooth, the root, from being exposed.
In addition to other problems, gum disease can cause your gums to recede away from the tooth, exposing the root. This will make the tooth less stable in the mouth.
Usually periodontal problems are caused by poor hygiene - a failure to brush and floss regularly or correctly. Ironically sometimes overzealous hygiene - brushing or flossing too hard - can cause gum recession.
Teeth grinding also causes gingival recession as the intense pressure from these forces is transferred from the teeth to the gums. Teeth grinding can also loosen teeth in the sockets, creating room for bacteria between the teeth and gums which can create or exacerbate periodontal disease.
Once a gum recedes, it will not grow back. It is possible to use grafting techniques to attach more givigival tissue to the recession site, but this requires harvesting tissue from the roof of the mouth, or a donor, and can be $3000 or more per grafting site.
Whether you are thrilled with the appearance of your natural teeth, or have made a valuable investment in esthetic or restorative dental work to improve your appearance, you certainly want to protect your beautiful smile once you are happy with how it looks. As you can see from some of the examples here, restorative dental therapy becomes progressively more complex and expensive if teeth are not protected.
As with so many things in dentistry, you get a lot of mileage out of simple, preventive maintenance, especially brushing and flossing.
Remember to floss daily. We recommend the tape-style floss from Glide. The wide surface is excellent at removing plaque and food particles from the spaces between teeth. The texture is soft and gentle, and we find that this brand is more resistant to shredding than other similar products.
For a brush, you should definitely consider using an automatic toothbrush; they are much more effective at cleaning teeth than manual toothbrushes, and tend to be better for your gums too. There are many great brands and products in this category; some of them quite expensive.
However, professional dental review sites have found that even the lower-priced products in the $20-30 range perform well compared to the most expensive options, which can exceed $200. Make sure you also use a very soft brush head, regardless of whether it is automatic or manual.
And of course one of the best ways to protect both your dental restorative work and your natural teeth is using a professionally-made, custom fit night guard.
Night guards help eliminate the risk from many of the problems described here, like debonded restorations, fractures in crowns or veneers and gingival recession. And even better, night guards can help prevent needing some of these procedures in the first place.
Dental restorative and esthetic procedures are a great investment in your health and appearance; just make sure to protect your investment once you make it :).
