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TMJ - Malocclusion Of The Mouth

The term malocclusion literally means "bad bite." It is a generalized dental care term that refers to many different types of mal-relationships of the lower teeth to the upper teeth. In popular usage, any arrangement of the teeth that is at variance with a prescribed ideal is considered to be a malocclusion in dentistry. But that is an oversimplification because some occlusions that appear to be ideal may be in disharmony with the jaw joints (the TMJs). Such disharmony can be a source of many different problems with the teeth, the TMJs, or the jaw muscles. Even minute disharmonies of the bite can be a major factor in loosening the teeth, wearing away of the enamel, or fracturing off cusps. Other malocclusions can cause headaches or cause the teeth to be sore or sensitive to cold. Some malocclusions may be most noticeable because they result in an unattractive smile. Some severe malocclusions cause no discomfort whatsoever, while some minor bite problems can be a major source of pain.

Perhaps the best way to understand malocclusion is to understand what an ideal occlusion is. This understanding starts with a basic appreciation for how the jaw joints (the TMJs) function. The TMJs are important because they form the hinge for opening or closing the jaw. During closure in an ideal occlusion, the teeth should all contact simultaneously and with equal pressure when the jaw joints are fully seated up in their sockets. This harmony between the TMJs and the teeth is the most important requirement for a comfortable, stable bite. Any disharmony between the TMJs and the teeth requires the jaw muscles to hold the jaw joint out of its socket in order to completely close the teeth together. This type of malocclusion can cause many different problems but unfortunately the disharmony is easily missed unless the dentist is very careful in examining for it. It is commonly missed because the occlusion is examined visually without first verifying that the jaw joints are completely seated when the bite relationship is examined.

Depending on the type of malocclusion, correction of a bite disharmony requires careful selection from a variety of different treatment procedures. Even though principles of bite correction have been established with enough clarity to permit highly predictable results of comfort and stability, some dental educators claim that occlusal harmony is unimportant because the body can adapt. This viewpoint has resulted from a profuse amount of misinformation that has found its way into the literature. Patients with bite problems should feel free to ask the dentist to show them the problems that are resulting from the bad bite such as loose teeth, excessive tooth wear, or other visible signs, in addition to an understandable explanation of why the recommended treatment was selected.

The most common, and also the most practical methods for correcting most minor occlusal disharmonies is called occlusal equilibration. It involves direct reshaping of the biting surfaces by grinding and polishing selected tooth surfaces that interfere with comfortable jaw movements. When correctly done on properly selected patients, it is a conservative and effective treatment.

Some malocclusions may require more extensive treatment such as orthodontics. Teeth that are badly worn or that need the biting surfaces re-shaped may need dental crowns or other types of restorations. Surgical correction may be needed in some severe jaw misalignments to achieve the best result and appearance.

Most malocclusions can be corrected in a reversible trial approach by making a plastic appliance that fits over the teeth to change the biting surfaces so the jaw can close with even tooth contacts. These appliances are referred to as occlusal splints. A fancier name for them is "orthosis" but it means the same thing.

The important thing to understand about your bite is that you should be able to close your teeth together and squeeze very hard without causing any sign of tenderness or pain in any tooth or in the jaw joint. If you can't do this you probably have a malocclusion. You should know that the discomfort is almost always correctable with the right selection of treatment. Your dentist must also examine for other possible causes of pain that may exist in combination with your bite disorder. Nothing takes the place of a carefully made examination to determine the specific cause (or causes) for your discomfort.

By Peter E. Dawson, DDS

Diabetes and Dental Care: Learn Everything You Need To Know

Diabetes, affecting millions of Americans, increases the risk for multiple dental problems. If you are diabetic, be sure your health condition is reflected in your dental records. Your dentist will want to carefully monitor your oral health needs.

Diabetics must pay special attention to the following conditions related to oral health:

Tooth Decay

High glucose levels in saliva help bacteria to thrive, repeatedly attacking teeth with cavity-causing acids. Brushing at least twice a day with fluoride toothpaste and flossing daily is vital.

Gum Disease

Diabetes reduces the body's resistance to infection and gum tissues are frequently affected. Diabetics may experience more frequent and severe cases of periodontal disease. See your dentist if you notice any of these symptoms: your gums are tender, red, swollen, or bleed easily; your gums have pulled away from the teeth; or you notice any pus between the teeth and gums when the gums are pressed. Other indicators are chronic bad breath or a bad taste in your mouth; any changes in your bite or fit of partial dentures; or permanent teeth that become loose. Since diabetes can impair the healing process, abscesses can develop, so it is important to schedule regular periodontal exams.

Oral Fungal Infections

People with high glucose levels who smoke or frequently take antibiotics are more prone to develop oral candidiasis, or thrush. This is a condition where white or red patches in the mouth become ulcerated and attack the tongue with a painful, burning sensation. Swallowing can be difficult and your ability to taste can be impaired. Antifungal medications can be prescribed by your dentist.

Taste Impairment

A diminished sense of taste can influence food choices. Diabetics have reported that their perception of sweetness is lessened. As a result, selecting sweet-tasting, refined carbohydrate foods puts diabetics at greater risk for developing both general health and dental problems.

Dry Mouth: Diabetic patients often complain about dry mouth due to salivary gland dysfunction related to the disease. Constant dryness irritates the soft tissues causing inflammation and pain. It can also increase the likelihood of tooth decay and gum disease.

Saliva substitutes available in pharmacies can relieve discomfort. Sugarless gum, sugarless mints, and drinking plenty of water also are useful in combating dry mouth. Additionally, restrict consumption of caffeine and alcohol.

Mouth Lesions

Pimple-like sores, generally painless, dot the mouth tissues. In a more severe condition, the tissue becomes painfully ulcerated. No permanent cure is available, but your dentist can prescribe medication to relieve the condition.

Since diabetics are more prone to conditions that jeopardize oral health, regular dental check-ups and periodontal screenings are essential. More frequent evaluations may be needed to ensure optimum oral health.

Bad breath, or halitosis, is a signal that something is not right inside your mouth. It may be as simple as the need to pay more attention to your daily oral hygiene, or it may indicate tooth decay, gum disease, or another medical problem. Whichever it is, bad breath is a red flag: take another look at your mouth!

Bad breath is a social problem; if you have bad breath, you may notice that people actually back away as you talk to them. Mouth odors are embarrassing, and they tell other people that you aren't taking care of yourself. Sometimes people are not aware that their breath smells bad; be alert to how other people react when they're close to you, and be grateful if a friend or family member lets you know about the problem.

Commercial products claim they will make your breath fresher, but the only way to make sure your breath permanently fresh is to practice good oral hygiene. In fact, too many breath mints and hard candies with sugar will lead to tooth decay. If you are constantly using breath mints, breath sprays, or mouth rinses in an effort to cover up your bad breath, realize that you may have a dental or medical problem that needs addressing.

There are a number of reasons you may experience a bad taste in your mouth, and even be able to smell your own breath. Food may be lodged between your teeth if you are not brushing at least twice daily and flossing regularly. Food particles can be very tiny and can wedge themselves between teeth and below the gum line; brushing after meals is important and flossing is imperative to get at the particles that the brush can't reach. Brush your tongue or use a tongue scraper. As odd as it will feel at first, bacteria collects on the tongue and can contribute to bad breath. If you wear removable dentures, take them out at night and clean them thoroughly before you wear them again.

If you neglect your daily hygiene over time, bad breath can become a symptom of more serious dental problems. Teeth that are not cleaned properly become a place for bacteria to reside as food particles stay in your mouth and decay. Bacteria attack your teeth and gums and cause cavities and gum disease. If this is happening, gum disease will cause an unpleasant odor.

Perhaps you believe that you are brushing and flossing on a regular basis, but are still experiencing bad breath. If you have teeth that are crooked or crowded, it may be hard for you to clean between them. If you wear dentures that are not fit properly, they may be trapping food or irritating your mouth. Or perhaps your bad breath is caused by another medical problem: drainage from your sinuses, gastrointestinal problems, kidney or liver problems, or other medical conditions.

Here's what you can do to "investigate" on your own. Write down what you're eating and notice whether your breath smells bad because of certain foods. Garlic and onions actually cause odor, but the odor is coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.

Are you dieting? Hunger can contribute to bad breath, because of the chemical changes as your body turns fat and protein into the energy it needs. Taking prescription or over-the-counter medications? Add these to the record of what you're eating to see whether there's a relationship between your medications and your bad breath. And don't forget to tell your dentist if there's been a change in your overall health since your last visit.

Suffering from dry mouth? Saliva provides constant rinsing in our mouths and washes away food particles. Your dentist may recommend more liquids, sugarless candy to stimulate natural saliva, and perhaps some of the commercial products that are available to combat dry mouth.

If bad breath continues after you have done your best job of regular brushing and flossing, start with your dentist. He or she can tell you whether the odor is caused by an oral problem; if it is not, then your dentist will suggest you see your doctor for a physical check-up.

Regular dental check-ups will help keep your mouth healthy and working well. Your dentist can spot dental problems before they cause trouble, including problems that cause bad breath.

By Brian J. Gray, DDS, MAGD, FICO