Your bite in specific dental treatments/procedures

Once we have determined where your new bite should be, you will have various treatment options depending on the type of adjustments that need to be made to your bite. These options will de discussed with you and explained in more detail as they relate to your specific treatment by the dentist.

For most patients, treatment is divided into two phases: the diagnostic phase and the treatment phase.

Diagnostic Phase

This phase is designed to properly diagnose the patient's problem and to try to reduce the signs and symptoms of the dysfunction. The diagnosis is made using a TMJ health questionnaire, range of motion measurements, palpatation of the muscles of the head and neck, postural evaluation, psychological assessment, x-rays of the TM joints (tomograms), various other x-rays of the head and neck area, joint vibration analysis to assess the severity of the TM joint noises, medical and dental history, and an examination of the teeth and the dental arches and cranial examination.

Sometimes it will be necessary to refer patients to other health car practitioners to help relieve some of the muscle spasms including chiropractors, massage therapists, physical therapists, cranio-sacral therapists, etc. The patient must be made aware of the fact that although the majority of patients do improve substantially, there are still a small number of patients whose treatment is not effective. The longer the disc is out of position anteriorly, the more the posterior ligaments repositioning the disc to its correct position on the head of the condyle are stretched. Some of these patients may have suffered traumatic injuries such as a blow to the head or have been involved in a car accident which causes a whiplash injury. If the posterior ligaments which help position the disc between the condyle and the temporal bone have become stretched or torn as a result of a serious injury, then the prognosis for successful treatment is diminished. Obviously, the sooner the patient can be treated, the higher the success rate.

Treatment Phase

Since the teeth, jaw joints and muscles can all be involved, treatment for this condition varies. Typically, treatment will involve several phases. The first goal is to relieve muscle spasm and pain. Then, your dentist must correct the way the teeth fit together. Often a temporary device known as an orthotic or splint is worn over the teeth until the bite is stabilized. Permanent correction may involve selective reshaping of the teeth, building crowns on the teeth, orthodontics or a permanent appliance to lay over the teeth. If the jaw joint itself is damaged, it must be specifically treated. Though infrequent, surgery is sometimes required to correct a damaged joint. Ultimately your dentist will stabilize your bite so that the teeth, muscles and joints all work together without strain. The important aim of correcting your bite is to ensure long-term health.

Initial Treatment Coronoplasty

If after a thorough evaluation the dentist determines that your bite needs only minor adjustments, one option might be to correct it through a process called Coronoplasty. The whole bite mechanism is extremely sensitive and in some cases a very slight high spot on a tooth (or a crown or filling) can be the cause of substantial problems such as improper occlusion or dysfunction. In these cases, the dentist will ever so slightly grind off the high spot or shape the tooth to permit the teeth to come into proper occlusion without interference (Coronoplastly may also be used to “fine tune” your occlusion once more extensive procedures have been completed).

Provisional or Interim Treatment LVI Orthotic

Once the dentist had determined the position of neuromuscular occlusion, an orthotic is fabricated to maintain that bite position. An orthotic is simply an appliance, custom fitted to your teeth that will maintain your bite in a precise relationship determined to be your neuromuscular occlusion. It may be either fixed in place or removable. It is worn for a period of time prescribed by the dentist as a method to treat TMJ symptoms or as an interim step to verify that the diagnosed new bite is correct before anything permanent is done to your teeth. Once you and your dentist are satisfied with the new bite, permanent alteration of your bite may be considered. The following section describes some of the specific treatments that apply to different procedures.

Final or Long-Term Treatment Procedures

The following procedures could be used to position your bite in your neuromuscular occlusion so that an orthotic does not need to be worn indefinitely.

The Bite in Major Dental Reconstruction

In major reconstruction (often called full-mouth reconstruction if all teeth are involved) the natural teeth are ground down and “caps” or crowns are placed on what is left of the natural tooth, leaving the root and some of the tooth structure intact.

The neuromuscular dentist does not use habitual bite (jaw position) as the basis for treatment planning. As a matter of fact, the neuromuscular dentist wants to determine (among other things) if the habitual bite was possibly the cause of the problems in the first place and, if so, be sure not to reconstruct that position.

Because in this instance the dentist is not trying to maintain the original habitual bite, all of the teeth may be prepared and crowned at once, rather than doing them by one-fourths (or quadrants as they are called). This sometimes means that all of the crowns may be prepared at one appointment and delivered at a second one, rather than going through multiple series of appointments where only one quadrant is done at a time.

The Bite in Orthodontics

A variety of muscles can impact orthodontic treatment. The teeth of the upper and lower dental arches are affected by two sets of strong muscles that surround them. If your upper airway (nose) is partially blocked, it can result in mouth breathing. This in turn leads to a variety of possible muscle forces harmful to your occlusion, particularly from the tongue. The dentist knows that if these forces are ignored, they will have a major negative effect on the orthodontic treatment.

Neuromuscular dentists use all of the traditional methods of orthodontic diagnosis and treatment planning. Additionally, they believe that these powerful muscle forces must be considered in treatment planning and moving teeth. Consequently, the neuromuscular dentist studies the status of the muscles and the joints in an attempt to develop a fully balanced treatment plan. This plan will consider all of these factors and results in a finished bite that is not only functional and aesthetically pleasing, but neutral from the neuromuscular perspective.

Bite in Denture Fabrication

When you have lost all of your teeth, the dilemma facing traditional dentistry is where to establish your bite. Without any teeth, there is no natural or habitual bite as a reference so the dentist must arbitrarily choose a jaw position and fabricate the dentures to that position. Looking around at people who wear dentures, it is quite common to see them with an unnatural look. Often a condition dentists call overclosed results from the lower jaw being positioned too close to the upper. This jaw position not only has a negative effect on the appearance of the denture wearer, but also can lead to significant functional problems and/or pain.

Not faced with the same dilemma, the neuromuscular dentist identifies jaw position in a denture patient by determining the neuromuscular occlusion. This is the jaw position determined by the relaxed state of the muscles. Denture patients treated to this jaw position generally have much improved appearance and function.

Learn more about TMJ:

• TMJ Disorder
• TMJ Symptoms