People lose their teeth to three primary processes: periodontal disease (gum and bone deterioration), tooth decay (or cavities) and unstable chewing systems.
Gum disease and dental decay are primarily caused by the presence of bacterial plaque. So plaque control is at the center of preventing these diseases. There is some risk beyond your control for the first two diseases because some people have softer, more penetrable enamel. Some people can also have a stronger immune response to the bacteria, and that reaction causes periodontal breakdown.
An unstable chewing system is different from the first two categories in that you, as the patient, don’t have any real ability to control its effects. A person suffering from an unstable chewing system must rely on a dentist with training and expertise in functional dentistry.
The human chewing system is supported by the jaw joints, the muscles that support the joints and the teeth. You probably have noticed that your back teeth have peaks (cusps) and valleys (fossae). In an ideal bite, the peaks of your back teeth fit snugly into the valleys of the opposing teeth, while the two jaw joints seat completely in their sockets. We know that this is the least stressful and least destructive relationship for your teeth, supportive bone and gums, jaw joints and jaw muscles.
The front teeth are also very important in guiding the functional process. Like guardrails on a highway, the overlap of the upper front teeth over the lower front teeth guide our lateral chewing motion and protect the back teeth by limiting excessive stress during chewing. When these front teeth are not in proper alignment or are worn down, they lose this protective function and the destructive risks accelerate for the teeth, bone, gums, jaw joints and muscles.
By studying healthy human chewing systems, we know that most people don’t always exhibit the ideal position. The majority of the population has a discrepancy between the two. When most people’s jaw joints are seated in an ideal position, the teeth don’t align comfortably or efficiently. So what do we do? We unconsciously adapt by shifting our jaw forward, out of its socket, so that the teeth can meet comfortably and function most efficiently.
Signs and symptoms
This adaptation comes at a price and can manifest in many different ways. Some signs and symptoms include:
• Damage to the jaw joint itself. This can be heard in the joints clicking or popping when you open and close your mouth. It can also be seen by deviation of the entire hinging system to the right or left.
• Symptoms in the supportive muscles and/or tension headaches, neck aches or even back aches.
These manifestations within the joint or supportive muscles can become a chronically experienced condition, commonly referred to as temporomandibular dysfunction (TMD). While some people with TMD have experienced trauma to the jaw (for example, in a car accident), many sufferers of TMD don’t realize that it’s the malpositioning of the bite actually causing their problems.
An unbalanced bite can cause:
• Teeth to crack and break.
• Fillings to prematurely fail.
• Supportive bone and gums to recede.
• Excessive tooth wear.
• Loose teeth and even tooth loss.
An unstable chewing system is often overlooked or dismissed as part of the “natural aging process.” Analogous to a set of auto tires that aren’t aligned properly and are wearing down and losing their peak performance at an accelerated rate, an unbalanced bite leads to myriad problems, some of which occur slowly over time, without symptoms and thus without patient awareness.
When someone experiences an acute toothache, he or she may have a root canal treatment rendered and the symptoms go away. Both the dentist and the patient may feel that the problem is solved – but is it? What caused the need for that root canal (or crown, gum graft or extraction)?
So often, the etiology of a dental problem is due to an unstable chewing system and the patient has no awareness. The majority of dental treatments rendered in this country are reactive, treating the manifestations of disease as it occurs with no real focus on the underlying cause. Reactive dental treatment after reactive dental treatment leads to patient disempowerment and frustration. They often aren’t aware that the long-term risks associated with an unstable chewing system can be reversed.
If you have experienced any of the above signs and symptoms, I would encourage you to consider a more detailed evaluation of your bite. This involves taking impressions (molds) of your teeth, mounting them on a jaw simulator and taking detailed records of your current condition. In many cases, patients with unstable chewing systems can undergo a predictable, reversible process utilizing splint therapy that allows your jaw joints to ideally seat in their sockets and relax overworked chewing muscles.
A “splint” is an orthotic appliance that looks much like a nightguard, but unlike a conventional nightguard that’s simply designed to protect your teeth from frictional wear damage, the splint is designed to create a temporary idealized bite and allows the joints to return to their healthy position without interference from the teeth. While protecting your teeth from the harmful effects of clenching and grinding much like a nightguard, it also allows your jaw joints to realign to a comfortable, stable position, and your muscles are deprogrammed to relax and release tension.
Additionally, splint therapy serves as a predictable, diagnostic tool for determining what’s causing the instability in the chewing system so that more definitive treatment can be offered. In essence, the restorative goals are to eliminate the discrepancies between a patient’s current unstable system and the ideal system created with the splint. Those restorative options are different for each patient and cannot be predicted in advance of splint therapy. Some patients can have their unstable chewing systems corrected quite conservatively with minimally invasive bonding techniques. Others might require more extensive restorative processes to re-establish healthy cusp/fossa relationships on the back teeth and guidance patterns on the front teeth.
Ken Schweifler, D.D.S., practices dentistry at 802 Altos Oaks Drive. For more information, call 941-2166 or visit dentistlos-altos.com.