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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

What Is a Mouth Sore or Canker Sore and What Are the Causes?

People often use the terms "canker sores" and "cold sores" interchangeably. While both are very painful, a canker mouth sore is found on the inside of the mouth and is not contagious; cold sores are located on the inside or outside of the mouth and are contagious.

Canker Sores:

These sores are found inside the cheeks, on your tongue or the bottom of your mouth, and sometimes on your gums. They range from the size of a tiny pinhead to a penny. The sores are grayish-white in the center and circled with a red inflammation. Since it's an open mouth sore, it hurts when touched by anything, including saliva. They can burn and itch, too.

Canker sores might be called the "stress sores," because they are caused by different types of stress:

• Emotional stress;
• Physical stress, such as biting your tongue, burning your mouth, or an abrasion from braces or loose dentures; or
• Chemical stress producing changes in your body, perhaps resulting from an illness or change in eating habits (such as medications, or too much of acidic foods such as tomatoes, grapefruit, or lemons).

About one in five people get them. Women in the 20-to-50 year age group get them more often. Once you get them, you're likely to experience them again. However, they usually go away after seven to ten days, although some can be longer-lasting.

An antimicrobial mouth rinse may lessen the irritation. Temporary relief can be provided by over-the-counter topical anesthetics. Pain relief varies with different products. Some medications provide a protective film that physically blocks contact with food and saliva, lessening irritation.

Good oral hygiene and a healthy diet are preventive measures for reducing the frequency of outbreaks.

Cold Sores

Also known as fever blisters, cold sores are caused by the virus herpes simplex. These are painful blisters that usually break out around the lips and sometimes under the nose or chin and normally heal within one week. They are very contagious. The virus stays in the body, causing recurrent lesions prompted from a fever, sunburn, skin abrasions, or stress.

They can be treated by your dentist with the same topical anesthetics to relieve pain and irritation as for canker sores. Prescription antiviral drugs can be effective in reducing viral infections that cause flare-ups.

Additionally, there are new topical medications (ointments) now available that shorten the duration of a breakout, when applied immediately after the cold mouth sore is noticed. All antiviral medications work best in the prodromal or early stage of the lesion. If the wound is open and sore, these medications are of little use as the healing time is still the same.

Be sure to consult with your dentist when any mouth sores do not heal.

By Brian J. Gray, DDS, MAGD, FICO