Lurfysma wrote:

"Over the last 15 years or so, I have had 2-3
root canals that I was told were because of vertical fractures that
went all the way to the root. Most likely cause, bruxism.

Three years ago, I lost a tooth (#15) because it had become loose and
then infected. It had had a root canal some time earlier. This was
also attributed to bruxism."

With these symptoms, it would be prudent to have a anti-bruxism
appliance.

"Now a few days ago, the gold crown on #19 fell out at breakfast.
Fractured just below the gum line. It also had a root canal
previously. Tooth cannot be saved. I am looking at another extraction
and, since it is not the last tooth, as #15 was, either a bridge or an
implant. Again, most probable cause, bruxism.

About 15-20 years ago, I started fracturing teeth vertically and
getting root canals. The dentist at that time (I have since moved),
blamed bruxism and gave me a hard plastic night guard. There were no
more fractures. I was a happy camper."

So far, so good. This would seem to indicate that the hard plastic
guard had a very positive effect. (The NTI is also hard plastic.)

But the following part is a bit confusing:

"Within the the past 4 years, I have lost 2 teeth to extractions. The
cause is again bruxism. So, either the night guard is no longer
working, or it is not working well enough.

Two different dentists (actually 4, counting their associates) have
told me that the likely cause is bruxism and all of them recommend the
full night guard (hard plastic)."

Do I understand this passage correctly -- that you already have a
full-mouth night guard that is not working well enough, so they are
recommending the same? I don't understand that.

"It's not that they haven't heard of the NTI.
They have. They just don't like it."

WHY don't they like it? If you read W_B's message earlier, that
addressed the concerns that many dentists had in the 1990s when the NTI
was new. Many dentists had concerns like that. (I know, I was one of
them!)  But now we know better, due to many years of research and
experience. (See the NTI website.)

"My dentist even brought the orthodontist from next door over to talk
to me. She also recommended the regular nightguard over the NTI."

Orthodontists do not receive training or education in the NTI in
school, so it is unfamiliar to them. Orthodontists move teeth, but do
not generally use ANY sort of guard, as that is usually left for the
general dentist to make.

Orthodontists are wonderful resources for information on tooth
movement, but the use of nightguards, whether full-coverage or the NTI,
falls outside their area of experience.

"I would like know what to believe. I don't doubt that the dentists
here are telling the truth, but I have 4-5 dentists who are telling me
otherwise. It's disturbing."

Of course it's disturbing. I'll bet that the dentists who are telling
you otherwise have no real experience in NTI use or construction.
Standard dental education usually covers only the old standard type of
nightguard, because when the dental professors went to school twenty or
thirty years ago, the NTI did not yet exist.

Back then, the old type of nightguard was all we had, so we had to use
it. There was no choice. But as time went on, too many patients still
had problems like yours. The development of the NTI was an improvement
on the quest to treat such problems.

Now we have a choice in designs for bruxism appliances. The question is
which of the two major designs is best for you? You have already tried
one, yet you still have catastrophic fractures. Do you think it is time
to try the other design? Are there really any technical or dental
reasons not to?

There is no evidence that the old full-mouth nightguard can lessen
clenching the way it can lessen grinding. There is a LOT of evidence
that the NTI can lessen both problems.

In fact, there is evidence that the full-mouth guard actually allows
for an increase in clenching, as the back teeth can grip and clench on
the plastic. Since the NTI does not allow the back teeth to contact
when it is worn, the back teeth cannot clench.

If there are any actual reasons not to try the NTI, please post them
here -- I'm sure that W_B and others will be able to address each point
one by one. Or, just check at the NTI website, as these questions have
been asked and addressed many times before.

"Interestingly, I have almost no wearing down of my teeth. I just
fracture them. One dentist told me that he had never seen anyone with
stronger (more overdeveloped) jaw muscles. Apparently, I am clenching
more than grinding, right?"

That's very insightful of you -- some dentists miss this important
point. Grinding can result in worn-down teeth, with bad fractures.
Clenching can result in almost no wear on the teeth, but with bad
fractures.

So if the problem is suspected to be clenching, what can be done?

Some sort of appliance is needed to stem the tide of fractures. The NTI
is not just an appliance, but is more of a supervised treatment
program, as the positive changes in clenching may require periodic
adjustment of the appliance. A good dentist familiar with the NTI
system should be able to help you.

Best regards,
- dentaldoc