According to one dental school professor, “Every little filling will grow up to be a crown.”

“Unless” (quoting from “The Lorax” now) …
… Steps are taken to outsmart and outmaneuver the forces that make first molars — the ones that come in about age 6 — “money teeth.”

The disease cascade that turns first molars into “money teeth” has three components: Decay, excessive stress and gum disease.

Decay typically sets the first ambush for these teeth. The best defensive strategy against decay includes excellent dental hygiene habits that begins when you bring your baby home. Start getting the child familiar with your fingers around their lips and gums. At the first sign of a tooth, introduce a toothbrush in the mouth.

Don’t leave the important job of brushing teeth to your two-year-old or even to your six-year-old. Teach them by brushing their teeth for them. Make wise food and drink choices for yourself and your children. Water is the only smart drink choice for non-meal times. Do your best to have regular dental checkups and ask for sealants to be placed.

Sealants provide a shield against the decay-causing bacteria that crawl into the microscopic grooves in teeth. Once the bacteria are ensconced in the grooves, bad things begin to happen. First, the bacteria need to defecate so they poop all over the tooth. This poop is acid and interacts with the tooth enamel and weakens it. Bacteria then crawl into the weakened enamel and take the battle into the dentin of the tooth. So, the quicker sealants can get placed, the better.

If the grooves are sealed before there is detectable damage, bacteria that get trapped under the sealant starve to death and bacteria left outside the sealant cannot get in. Sealants sometimes need to be replaced due to de-bonding or chipping. One of the things dentists do at checkups is evaluate the condition of sealants.

The second item in the disease cascade is excessive stress. Teeth are meant to touch each other for only brief periods during the day, the time that we spend swallowing and chewing. Actual chewing forces are directed at the teeth for only about nine minutes per day. During chewing, these forces range from 5 to 44 lbs. per square inch. Eating a raw carrot, for example, requires 28 psi. So, if we touch our teeth together only for swallowing and chewing, we should have no dental disease that results from excessive stress.

However, up to 80 percent of people suffer from some degree of excessive stress on the teeth, often called “bruxism.”

Bruxism is defined as the unconscious gnashing, grinding, or clenching of the teeth. It is the most common dental disease and is rarely addressed. Two hundred sixty-five lbs of force can be generated on the first and second molars as a result of bruxism. As a result, patients who brux develop a greater maximum bite force than nonbruxers. For bruxers, the preasure placed on teeth may exceed 500 psi.

Perhaps your dentist has asked if you are aware of grinding your teeth. Some will recognize that they brux because they have sore muscles and or sore teeth in the morning. A dentist can usually spot a bruxer immediately and can show you why they asked about it. Flat teeth, short teeth, pitted teeth, gum-line erosion, chipped edges on front teeth and teeth that are sensitive are all signs of bruxism.

While the causes of bruxism are not completely understood, several contributing factors are recognized. Teeth that are not aligned properly and do not come together in a balanced and organized way are one factor. Psychological stress, some medications, and certain physical conditions can contribute to bruxism.

Bruxism is addressed less often because it is less well understood by patients and their dentists. It is harder to explain than cavities and gum disease and patients are less inclined to manage it because it often does not cause pain. However, bruxism is a huge contributor to the “money teeth” condition. If excessive stress on teeth is not managed, chips and fractures can necessitate crowns, root canals and even removals.

The first line of defense against bruxing is typically an occlusal guard, a protective covering over either your upper or lower arch that is carefully adjusted to facilitate smooth interaction of your upper and lower teeth.

Often when an occlusal guard is advised, the patient declines because “my insurance does not pay for it.” What seems difficult to explain and or comprehend is that an occlusal guard, even without insurance, is much less expensive than the results of not wearing one.

Other interventions can include equilibration, stress management, evaluation of medications that you may be taking, botulinum toxin or orthodontics.

The third item in the disease cascade is periodontal disease. The best defenses are immaculate oral hygiene and avoidance of tobacco. Unless you plan to see your dental hygienist daily, you are the most important defender of your periodontal health. At your regularly scheduled hygiene visits, ask your hygienest to critique your oral hygiene skills and take their advice to heart. There are genetic factors in the perio world, as well, but as yet we cannot alter them, so concentrate on the factors that can be controlled.

Nobody wants to have money teeth. Wherever you are in life, implement the defenses against money teeth that are available to you. Consult your dentist and hygienist regarding your particular vulnerabilities and what to do about them. You can make a difference with the help of your oral health professionals.

Polly Nichols, DDS., practices dentistry at Topsham Dental Arts along with her brother, Gregory Sprague, D.D.S., and her father, J. Howard Sprague, D.D.S. Topsham Dental Arts is located at 37 Foreside Road. For more information, call 798-6700 or visit