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Question
I grind my teeth so hard that I destroy my many amalgam fillings as well as wear down the tooth surface as well, and I've even knocked off a crown a couple of times.

I recently went to a new dentist who uses a lot of newer technology. He showed me that all of my back teeth are smoothed out and don't interlock. He has quoted me a (very expensive) treatment plan of crowning my 16 backmost teeth in order to restore my bite. While what he says makes sense in a way, the part I am having trouble with is that he says this has to be done all at once. This would be over 12k dollars worth of work that my insurance would barely put anything toward, and few people can handle that financial burden all at once.

Are there alternatives to this method for people like me who have severe grinding issues? Why can't these crowns be done over a period of say 10 years? What guarantee do I have that even these 'EMax' crowns won't have issues with my grinding if I shell out the money? I've had two dentists in the past week tell me I won't have teeth when I'm 50.

Answer
Dear Jason:
Sorry to hear of your dilemma.  However, I am bothered by a couple of thing in your story.
1.  If you managed to flatten your teeth this early in life, you do have a severe occlusal problem.  The condition should be treated by a specialist, a Prosthodontist.  A correct diagnosis and cause should be established first as foremost as to the reason why your have damaged your teeth.  A plan should be established on arresting the process and setting up treatment so that you do not damage your teeth further and damage any other dental work to be done to repair your tooth structure.
2.  Any dental work to re-establish your bite has to be carefully planned and designed PRIOR to any work being done.
3.  If you are such a severe grinder, the material of choice for restoring your mouth is actually GOLD, either with, or without porcelain.  E-max (I LOVE E-max!) is NOT an appropriate material for someone with severe grinding condition.  The track record of E-max is still very short, it has only been on the market for a few years.  It is designed for aesthetic work and the results are spectacular if done right.  However, it is NOT appropriate for very high load cases.
4.  Cost.... I know nothing about your dentist or the quality of the work but the price of 16 crowns for only $12K is very low.  The price of anything outside New York City is generally less than what we charge, but it is usually not less than a third of what a prosthodontist charges here in New York.  In Missouri, I would expect a quality crown to cost at least $1200, material not-withstanding.
If the conversation was about one crown, I would say: go for it.  You haven't got much to loose.  However, your situation is not just getting 1 crown times 16.  The reconstruction of a bite is much more complex and demands certain expertise.  Done improperly and "on the cheep" will result in destroyed teeth that are not only worn out, but damaged by inappropriate dental work.
Since I cannot evaluate you directly, my advise is to locate a prosthodontist near you.  www.gotoapro.org will have a link to locating a prosthdontist near you, or just go to a local dental school and ask to be referred to the Department of Prosthodontics.  Go and seek a second opinion from an expert and find out the cost of the work if an expert is to do it.
There are ways to do this kind of work over time, but again, it is situation specific and requires proper planning and expertise to execute.  Again, since I cannot examine you, you should ask the prosthodontist about the process and the longevity of any restorations fabricated for you.
If $12K is expensive, think of how expensive it is to fix problems caused by compromised dental work.
Do not take any chances, go and get a second opinion from an expert first.
Best of luck,

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Zev Kaufman, D.D.S.

Expertise

I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.

Experience

Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Organizations
Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Education/Credentials
Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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