Bite Correction (What You See Isn’t What’s Right For You)
When your bite is optimal it will allow you to function with whole solid teeth for virtually a lifetime. When not correct it can give rise to many a malady. There are 50 recognized different conditions of ill being that are directly (but not exclusively) due to a bad bite (see TMJ Problems).
An occlusion (bite) can be thrown into disarray by natural growth and development or unnatural means. For example, a slip and fall injury, motor vehicle accident, dental care or lack thereof. It can be definitively shown that something as fine and small as a popcorn hull or the skin of a pea on a tooth will alter the muscle firing pattern causing a malpositioning of the muscles each time the teeth are brought together (occluded).
In the following pictures, you will see examples of the damage that can be wrought of a dentition from the parafunctional (other than normal) habits or chronic off loading of the teeth. These areas are lesions known as abfractions. They can occur on any area of a tooth or teeth. Many times they are non painful. It is truly a “cavity” but not one that is identified with the classic cavity caused or attributed to bacteria. For these reasons they are more insidious. Severe destruction can occur before an individual may be moved to action.
In facially abfracted teeth, as in the picture to the left, back teeth push on each other when the jaw moves sideways. This causes a repeated push of the “crown” of the involved teeth, into a bending moment that causes the crown to rotate laterally away from the long axis of the tooth and down towards the neck of the tooth. This rotation of the crown compresses it onto the facial aspect of the neck resulting in piezoelectric sparks and then microfractures of the enamel and cementum. The restoration of an abfraction requires a combination of restorative adhesion dentistry with occlusal adjustment therapy. The restorative treatment fill in the exposed root structure with a safe bonded composite, while the occlusal adjustment then stops the microfracture formation. Without performing the occlusal adjustment, the bonded restoration will be subject to the same bending moment as the unrestored abfraction, leading to marginal breakdown and restoration dislodgement.
The middle picture above shows a “dimple” on the cusp of the tooth. This is the same phenomenon as just described but a different part of the tooth.
The right hand picture shows MASSIVE destruction of tooth structure along with deposition of bone all around the upper jaw. This type of situation is likely entwined in with an airway disturbance in what is known as Sleep Disordered Breathing (SDB). See further information under Sleep Apnea.
Another manifestation of a bad bite is isolated bone loss. Let’s face it. Oral/dental bone loss is a disease process happening. Many are due primarily to bacteria (gum disease) but a good number of cases are from excess force on the tooth. In a chronic longstanding situation where, on x-ray, all bone/teeth look good except for one isolated area, you will likely have a problem of excess force.
In the far lower figure you will see bars that represent an identification of location of the relative intensity of force being placed on teeth. The higher the spike, the greater the force. This picture is only one frame in a “movie” made of a real time series of bitings. This high force area will cause a cascade of forces through the teeth like the clacking balls, pictured to the left. Where the first ball strikes a series of balls and the opposite end ball takes off with close to the same intensity (force) as the striking ball.
I’m sure you have seen these ball clackers. They represent, a great way of showing how teeth from one area can have such a far reaching effect on the other teeth. This goes a long way to explaining how some of the bizarre erosive patterns appear on teeth.
The tool that is used is to obtain this data is the TekScan. It is a computer based diagnostic tool for measuring tooth contact sequence as well as the relative force generated during a bite. Here a person bites on a mylar wafer. This is an input device that captures the force intensity as well as sequence of hitting. By reading this image, the doctor is able to have a solid visual of a particular offending area of a tooth or teeth and becomes a compass pointing where to go when making treatment decisions..
To the left is an example of just such a scan.
Treatment decisions are then made based on the results. Our goal would be to have an even pressure distribution over all of the biting surfaces.