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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

Oral Health Care And Menopause

When women enter menopause, changing hormone levels bring about a variety of symptoms and raise new oral health issues. Women and their doctors must consider the entire range of physical and emotional health implications, including their oral health.

Bone Loss and Oral Health

As natural levels of estrogen decline, women may find themselves at risk for loss of bone density. Jawbones are no different; these structures hold our teeth in place, and loss of jawbone density can lead to tooth loss.

When women lose teeth, there are other immediate considerations. One is the potential loss of nutrition, as people with fewer teeth or with problem teeth tend not to eat well. Second is the loss of confidence or self-esteem that results from any cosmetic changes to our bodies. And third, the financial cost of replacing one or more teeth can stretch even the best-planned budget.

Gum Disease and Tooth Decay

Hormonal changes also can have an impact on the health of gums and teeth. Women may find that their gums become inflamed and bleed easily, and may discover that their teeth are more cavity-prone. Both gum disease and tooth decay can result in losing teeth, another good reason to consider your oral health during this significant time of your life.

Signals of Change

Women may notice a burning sensation or dryness in their mouths. They also may discover that these changes cause food to taste different, leading to a loss of appetite. Be alert to an appetite loss that persists, particularly if you begin to lose weight.

If gums become inflamed or bleed easily, alert your dentist who will check for early signs of gum disease. A receding gum line may indicate bone loss in your jaw, so ask your dentist to examine your mouth and jaw carefully.

Preventive Medicine

Both you and your doctor should discuss prevention techniques, including calcium and vitamin D supplements, and replacement therapy for hormones. These are personal decisions that vary from woman to woman, and your doctor is best equipped to advise you.

What you can do is pay attention to your nutritional needs. Make sure you eat a wide assortment of healthy foods. Fruits and vegetables provide essential vitamins, minerals, and other nutrients. Exercise also is important to maintain your oral health and a healthy lifestyle.

Finally, keeping tabs on your emotional health as you enter menopause is important. A healthy outlook on life enables women to value themselves and seek the care required including: maintaining good oral health, seeing the doctor and dentist regularly, and focusing on healthy eating and exercise.

By Brian J. Gray, DDS, MAGD, FICO