The first step in treating the bite (occlusion) is performing an occlusal evaluation. An individual is taken through different movements of the lower jaw to determine the relationship of the upper teeth to the lower teeth. Also, evaluation of wear on the surfaces of the teeth, mobility of the teeth, muscles used for chewing, and the joints (TMJ) of the lower jaw are evaluated.
This evaluation will determine if treatment of the occlusion is needed. This could involve:
1. Localized Occlusal Trauma
2. Clenching or bruxism (Grinding)
3. Occlusal adjustment of both dentitions.
Localized Occlusal Trauma
In treating isolated occlusal trauma (fremitis) on one or two teeth that have increased mobility or soreness, a minor adjustment of the occlusal surfaces is undertaken to resolve the discomfort and decrease the mobility.
Clenching or Bruxism (Grinding)
With clenching and bruxism, the entire upper and lower teeth are involved. A contributing factor with this condition is stress. Symptoms associated with this condition involve muscle soreness, enlarged cheek muscles ,tired feeling in the jaws in the morning, occipital headaches (back of the head), neck aches, mobility, pain in front of the ears, ringing in the ears, limited opening, and wear facets on the front teeth and canines.
This is a stress related habit which may be unknown to an individual unless it is brought to their attention.
During the day, this habit usually occurs when one is focused on a certain situation for a period of time or during stressful times such as driving. If one is aware of this habit during the day, they will have some control of limiting the times this occurs. However, at night, bruxism/clenching is more severe, especially if one is under stress.
In treatment of this bruxism/clenching, a bite splint or night guard is recommended. This appliance is made of a high grade acrylic for long term use. Preferably the splint should be made for the upper teeth only. The bite splint should be designed where the surface of the splint is smooth with slight ramping near the front part of the splint. The design of this splint allows the lower teeth to rest evenly on the splint and prevents grinding on the front teeth. The design of this splint allows the muscles for chewing to relax, which in turn relieves stress on the joints (TMJ) of the lower jaw.
Usually within two weeks one will start to notice the symptoms from this habit start to improve. However, the bite splint does not cure this habit, but controls the effects of bruxism/clenching. For this reason, bite splints are for long term use.
Occlusal Adjustment of Both Dentitions
This treatment involves an overall adjustment of the bite. Slight reshaping of precise areas on the surfaces of the teeth is undertaken to stabilize the bite. Following this procedure, which could take several appointments, no fillings or crowns will be needed to replace the minimal amount of tooth structure removed. Also, this procedure can be undertaken without being numbed. However, this treatment should not be performed on individuals who grind or clench teeth unless bite splint treatment is undertaken first.
Occlusal Trauma and Periodontal Disease
In the past and even today, some dentists believe occlusal trauma causes gum disease. In spite of being shown through several scientific studies that bite trauma does not cause gum disease, it is still stated today by some general dentists as a cause of gum disease. However, it has been shown in the presence of gum disease, bite trauma can contribute to further loss of support for teeth.
There are two types of occlusal trauma:
1. Primary Occlusal Trauma
This type of bite trauma is seen in an individual without gum disease. However, the teeth are mobile without bone loss or support for the teeth.
2. Secondary Occlusal Trauma
This type of bite trauma is seen when an individual has gum disease with bone loss and support loss around the teeth. This bite trauma can contribute to further loss of support and bone around teeth.
If you have any questions about occlusal treatment, please ask your periodontist.