Shifting Mandible, Office Adjustment Visits and Patient Frustrations

I believe as muscles are improving the mandible will alter its relationship causing the occlusal contacts to alter. Because of these alterations the teeth may begin to contact in certain areas earlier than others, resulting in muscles to strain. When the strain begins to occur the pain and spasm begin to irritate and one begins to doubt if what was delivered in the mouth is working or not.

I think it is a good approach if the treating dentist can find the more optimal jaw position possible by helping to get the spastic muscles to calm when recording a bite relationship. By doing this it will certainly help the many follow up visits – the mandible will not be having to shift as much if a homeostatic neutral position was achieved early on in treatment. Second, the dentist would need to really know how to design and adjust the appliance to support a homeostatic state in the best manner possible at each adjustment visit in order to reduce the continual changes of the masticatory system which is aiming to shift as quickly as possible to this neutral homestatic state of comfort and calm.

This is why I believe it is valuable for any treating clinician to objectively measure and find this neutral state as soon as possible. If one can’t find it than it just will take longer with more follow up office visits. Does that make sense?

The mandible can be like a moving target when the muscles are all spastic. Teeth are connected to this lower moving body part…and dentists are trying to land the gears (the bite precisely)…but if the muscles are not in a happy comfortable position then all the occlusal contact marks will naturally shift and go off…thus patient and doctors get frustrated with this shift and naturally will make excuses and blame things.

– Clayton A. Chan, D.D.S. – Las Vegas, NV

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