Clayton A. Chan, DDS, MICCMO
Master International College of Craniomandibular Orthopedics
All of these bites presented with severe TMJ/TMD pain symptoms. How does the dental profession diagnose the problem? How do they treat the problem?
Each patient had seen numerous health care professionals attempting to resolve their TMD symptoms with limited results. Finding the bite/occlusion “PHYSIOLOGICALLY”, objetively is scientifically important and cost effective! Most dentists attempt to “best guess” and try to manipulate the bite that is not good enough for the human jaw. It knows when it is off and it knows when it is right on!
Dental Treatment Risks
Dentists have historically recognized that providing routine care to the unsuspecting patient who presents with occlusal restorative needs may pose risks when treating to the existing accommodated bite. Such risks may not be obviously apparent to either the treating dentist and or patient who desires a simple teeth cleaning and check up. Most dentists examine the periodontal condition and will also focus their attention on restorative deficiencies, such as breaking down amalgam fillings, discolored restorations, leaking margins of crowns and any structural problem with a particular emphasis toward making the teeth look esthetically pleasing. Tooth wear, notches (abfactions) at the neck of the teeth, mobility, tooth sensitivities and/ or pains are common conditions most dentists feel comfortable with treating. Less common is the dentist’s awareness of the postural problems of the jaw as they relate to the surrounding musculature that bring the upper and lower teeth together into a bite. The bite may not always be properly aligned or balanced to a proper occlusion from a structural and musculoskeletal physiologic perspective. This is where the next level of dental challenges can occur, resulting in feelings of sensations of being twisted, torqued, unbalanced, and/or asymmetric. When presenting these concerns to their dentist and physician, many may not be able to relate to these concerns since they might not immediately appear as medical or dental in nature. Patient’s frustrations insue, not finding professionals who understand the various levels of their complaint!
Advanced clinicians are recognizing that by first establishing a physiologic neutral and balanced relationship between the various body parts and systems is key to overall health and well being. Having a balanced bite (occlusion) that supports a properly aligned cervical neck (spinal column) as well as a properly aligned sacral-occipital relationship from head to pelvis down to the feet is an integral component to balance, stability, and function of the complete postural system.
Considerations Before Dental Treatment
- If the patient finds themselves confronted with tooth pain and/ or sensitivities from a traumatic bite, consider whether that particular tooth is getting pounded more than the other teeth. Root canal (endodontic) therapy is the first and immediate response commonly considered by most dentists rather than consider the cause of the toothache. Removing the nerve from the tooth does not always guarantee that the occlusal forces have been removed.
- If the lower jaw is retrusive when putting the teeth together and the patient finds that while speaking and talking that the lower jaw (mandible) likes to function more forward (anteriorly), consider whether the front teeth are blocking freedom of movement of the jaw and or whether the back (posterior) teeth are not supporting the bite vertically and sufficiently. Teeth that have not developed vertically into the mouth to their full potential during the stage of early childhood growth and development, will in later adult years exhibit deep bite patterns, such as over closed bites, short lower one third of the face, retruded mandibles, forward head posture tendencies, narrow arch forms (V shaped), vaulted palates, lower anterior teeth crowding to name a few. Orthodontic treatment to straighten and align the jaws and teeth should be considered, but only after your dentist has “Physiologically” assessed and determined your jaw position without guessing! The dentist should recognize that moving teeth to make them straight does not always mean that they have straightened the teeth to the correct “happy muscle” position (Muscles of mastication should be comfortable and not tender, teeth should support the lower one third of the face, no clicking and popping jaw joints with a solid bite (centric).
- Having a dentist adjust or equilibrate your bite in a supine (laying down position) may not always result in the most optimal occlusion, especially when the upper and lower jaw muscles are unstrained and desire to function more anteriorly. Most dentists will assume or guess that your bite is closing to a certain repeatable position, but in fact the repeated closing path of the jaw may only be repeating a pathologic repeatable relationship that continues to trigger muscular/ TMD symptoms, further exacerbating the condition.
- When the patient is faced with concerns and doubt as to whether their bite and or symptoms are being treated from a physiologic jaw relationship perspective versus to a habitual accommodated jaw relationship position (often pathologic when surrounding musculature are tender and paining), have your dentist establish a jaw relationship in a sitting upright position to test the unstrained closing path. Establishing a stable centric terminal bite position with minimal to no strain of the musculature during function is important to your health and posture. Low frequency TENS (transcutaneous neural stimulation, (J5 Myomonitor TENS by Myotronics, Inc.) has been found to be a very predictable and physiologic means for the dentist to find and or re-establish a lost bite or jaw position. Low frequency TENS (not high frequency) can assist the dentist to relax the spastic muscles and find your bite physiologically to avoid the syndrome of guessing your bite position. More advance and trained dentist also combine the use of TENS with the K7 Kineseograph (Computerized mandibular scanning – jaw tracking and EMGs) to visualize the patient’s jaw position and function. It is very scientific and objective!
Your bite is very important! Don’t lose it! Because trying to get it back is not always easy for any dentist and or patient to find….It is costly!