Expert: Mark Bornfeld DDS - 6/21/2005

Question
this dentist said i need to remove one of my wisdom teeth that has a cavity because ti may help alleviate my bruxism and the wisdom teet werent fully erupted  in any case

is this true
is this really gonna help?

or  make matters worse what r other possible comp,licatons?/options

and also they wanna do a crown
where as  another dentist said a filling was enuf i mean  is it wise to get  second and third opiions before   extractions and crowns?  

Answer
Dear Yom,

In my experience, impacted wisdom teeth seldom contribute anything significant, either positive or negative, to the bite or chewing function. As such, they are not a causative factor in bruxism, and removal would not be expected to have any effect on this habit: it would not make matters either better or worse. Of course, there may be other legitimate reasons why extraction of this tooth is justified. There is some risk involved in any surgical intervention-- risk of excessive bleeding, postoperative pain, etc., which would depend on several local and systemic factors which cannot be properly assessed in this forum. I would advise you to consult with your dentist for more information regarding benefits and risks of this procedure.

As a means of management of bruxism, a common, conservative alternative would be the use of a night guard appliance. This device is worn while sleeping, and is intended to keep the upper and lower teeth separated so that damaging forces are reduced on both the teeth and the temporomandibular joint/muscle apparatus. Although such an appliance is not always tolerated by the patient, the risks of such a device are negligible. You might consider discussing this option with your dentist if your bruxism is sufficiently severe to require management.

The decision as to the proper means of structural restoration of a tooth is based on both objective matters and the treatment philosophy/experience of the dentist. Conflicting opinions can sometimes seem contradictory to the patient when in fact they are not; it largely depends on the dentist's and the patient's tolerance of uncertainty. A filling may have a 40% chance of 5-year survival, where a crown might have a 95% probability of surviving for 5 years under the same circumstances. Neither option is wrong If a patient and doctor are willing to accept that option's risk/reward profile. The caveat is that a doctor must be honest with a patient-- if a simple filling does not present any real advantage over a crown in a given situation, there is little justification in steering a patient to a crown.

If you have doubts about your dentist's integrity or competence, you might consider obtaining a second opinion. While there is the logical question of which doctor to believe when the opinions are at odds with each other, a concurrence might afford you more confidence in the assumption that your doctors are guiding you in the correct way.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY