Expert: Dr. Randolph Myerson - 6/1/2005

Question
I'm a 41 year old woman. My upper front teeth have become so thin, they almost seem transparent. My dentist said it is caused by my lower teeth rubbing against the back of my upper front teeth. He offered no solution saying braces may damage my bone at my age. I've also had a cracking sound from my jaw for years when I chew. Others can hear it. Never bothered me, but now painful. Can it be related? I feel like crying because my dentist said my upper front teeth will be gone by age 50. Can you offer any suggestions?

Answer
From your description it seems that you've been grinding the inner aspects of the upper front teeth for quite some time resulting in the damage to those teeth.  It is not surprising that your jaw joints have sustained some damage as well.  I would not be surprised if the lower front teeth have been worn down significantly in the process.  All this is related and you should seek treatment.

There is probably no truth to the adage that braces may damage bone at your age.  I have sucessfully treated individuals in their 60s and 70s without damage to the bone.  The critical element is to maintain excellent periodontal health during orthodontic treatment and, of course, to start out with healthy bone support around the teeth.  But that's not the biggest problem.

First of all you will require an evaluation of your jaw joints (TMJ) to determine what damage has been sustained and what needs to be done with your bite to relieve the pain and cracking and prevent further damage.  You will also require a periodontal evaluation to determine the status of your gum and supporting bone around the teeth.  Finally, you will need a complete orthodontic evaluation to determine what will be necessary to correct your bite so that you are no longer grinding your teeth and disturbing your jaw joints.  As you can imagine, all this will require close consultation between each of the different specialists and your dentist.

As a start I would suggest that you find an orthodontist and initiate the process.  Sometimes the orthodontist will manage the tmj or will refer you to a dentist who can do so.  Unless you have already sustained particularly severe damage to your teeth, bone, or jaw joints there is every reason to believe that your condition can be treated and I would encourage you to pursue that before things get worse for you.  Good luck.