Occlusion

Occlusion dentist is the dentist who specialized in dental occlusion and is the one who is able to coordinate and refer the patient to the health service provider for appropriate treatment.

Dental occlusion means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

When the mandibular teeth's cusps come to full interaction with the cusps of the upper teeth, the occlusal position is called maximum intercuspation. The cusps of a tooth are the protruding parts at the top of the tooth, as opposed to the center groove at the top of the tooth. The natural position achieved during maximum intercuspation is called centric occlusion, or the habitual bite. This occlusion may also be called the bite of convenience, or intercuspation position (ICP), and in simple terms, means the natural position of the teeth when the teeth fully bite. Dental occlusion depends on bone structure, muscles, nerves, teeth structure, and sometimes posture.

An ideal bite should also have proper centric relation, the resting position of the temporomandibular joint (TMJ), or jaw joint. This means that the ball of the joint is in a central location in the socket. The individual positions of the teeth may vary from person.

Malocclusion is the misalignment of teeth and jaws, or more simply, a "bad bite". It occurs when the teeth and jaws are misaligned in the habitual bite. Though most people have a slight degree of malocclusion and do not require treatment, this condition can cause health issues in the temporomandibular joint, teeth, jaw muscle, and gums.

Malocclusions are problems with the mouth that cause the teeth to be misaligned in one way or another. In addition to being unattractive, malocclusions can impair proper mouth function and make it more difficult to clean the teeth. As a result, people with malocclusions are more prone to developing cavities and other oral health problems.

Malocclusions can be caused by a variety of factors. In some cases, they are genetically linked and caused by improper skeletal growth. Trauma to the jaw and baby teeth that stay in the mouth for too long can also cause malocclusions. Baby teeth that stay in the mouth too long can cause the new teeth to be misguided as they grow in. Therefore, some malocclusions can be avoided by removing the baby teeth so the adult teeth can grow properly.

There are at least six abnormal conditions related to occlusion that appear to be pathologic.


Bruxism

Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep.

People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

 

Occlusal splints a treatment method that helps the bruxing patient to reduce or eliminate the damage caused by bruxism. Splints are worn primarily at night, and also during times of psychological stress. Occlusal splints should be a routine treatment in every general practice. Occlusal equilibration also is thought to reduce the tendency of bruxing patients to grind their teeth.

 


Clenching

Clenching has been called "centric bruxing." A patient who clenches his or her teeth does not grind them in lateral excursive movements; rather, he or she places the upper and lower teeth together and places pressure on them in centric occlusion, the most interdigitated position. The result of this abusive tooth contact is excessive wear in the centric-occlusion position. Canine rise and incisal guidance become steeper, rather than less inclined as in bruxism. The teeth of a clenching patient have the same quantity of destruction as those of a bruxing patient, but the wear is in centric occlusion instead of in eccentric positions.

On a routine basis, every dentist inadvertently causes primary occlusal trauma when placing restorations in teeth.

Treatment of clenching is similar to that of bruxism. Education of patients is essential to obtain their assistance in preventing further tooth destruction. Occlusal splints worn at night and at times of psychological stress during the waking hours can reduce or eliminate the tooth destruction caused by excessive tooth grinding. Occlusal equilibration often is indicated to reduce the tendency to clench the teeth. If a dentist merely "watches" patients as they wear their teeth down, he or she is practicing supervised neglect and contributing to continued tooth destruction.

 


Primary Occlusal Trauma

is a tooth injury caused by abnormal loads on otherwise healthy teeth. On a routine basis, every dentist inadvertently causes primary occlusal trauma when placing restorations in teeth. It is nearly impossible to place a restoration, crown, or fixed or removable prosthesis so as to re-create the exact anatomy that the teeth had before the treatment. As a result, the restored teeth and the opposing teeth occlude in a slightly different manner from that in which they did previously. This condition also can be caused by orthodontic therapy, trauma and increased bruxism or clenching in a stressful time, or by the natural physiological movement of teeth over time. Teeth in primary occlusal trauma are painful and mobile, and they cause patients concern. Treatment of primary occlusal trauma is simple and effective. It generally consists of occlusal equilibration or occlusal adjustment (shaping down the high spots on chewing surfaces of teeth) to evenly redistribute the stress placed on the teeth during chewing or during abnormal contact of the teeth.


Secondary Occlusal Trauma

In the presence of periodontal disease, there is loss of support for the teeth and subsequent drifting of teeth into different locations. The occlusal and incisal surfaces of the teeth meet in abnormal relationships, and the same type of occlusal trauma begins again.

The periodontal treatment must be carried out before any long-term stabilization of the occlusion can be expected. Occlusal equilibration may be performed before, during or after periodontal treatment.


Temporomandibular Dysfuntion

Everybody talks about temporo-mandibular joint dysfunction, or TMD, but only a few dentists treat it. The reason for non-treatment is the condition's multifaceted nature and psychological overlay. Most dentists would agree that most short-term TMD is muscular in nature. These muscular TMD cases are the ones that general practitioners should be treating. Usually, pain is present in the muscles of mastication; there is limitation of mouth opening, and a generalized feeling of worry and helplessness on the part of the patient.

Most dentists use occlusal splints as the first and foremost therapy for TMD. After a period of observation, and reduction of the muscle pain, an occlusal equilibration is accomplished to make the teeth come together in a harmonious interdigitated position. Usually, muscular TMD cases can be treated in this manner in a few weeks. More complicated cases involving bone degeneration or chronic long-term pain are far more difficult to treat. Some require surgery, long-term physical therapy or drug administration.

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