Occlusion denotes the contact patterns between the upper and lower teeth. The word functional refers to the most healthy relationship that can exist between the teeth during their functioning. The most prominent role of occlusion is during the first phase of digestion. If performed optimally, mastication (the function of processing food orally i.e.; chewing) allows for the natural progression of the digestive system. If mastication is dysfunctional it alters the effectiveness of the entire digestive system. This has a dramatic effect on the entire body’s health from nutrient absorption to the body’s ability to handle environmental stress.
The keys to a Functional Occlusion are threefold:
- optimal positioning of the teeth relative to one another which in turn provides
- optimal positioning of the jaw joint (condyle) within its “socket” of fossa while
- maintaining efficient functioning of the muscles, ligaments and tendons that support the operation of the entire masticatory (chewing) system. A functional occlusion requires all three parts of the system to be in harmony with one another. In the presence of a discrepancy between optimal positioning of the teeth and optimal positioning of the jaw the teeth win and force a positional shift of the jaw, while demanding constant work from the ligaments, muscles and tendons of the jaw to keep the tooth to tooth position at all costs. This means fatigue and breakdown of the muscles and all the other supporting structures. When the keys to a functional occlusuion are missing we call it a Dysfunctional Occlusion.
Prominent determinants that can affect the development and maintenance of a functional occlusion are:
- Genetics – for whatever reason, certain sub-optimal growth patterns of the jaws can be handed down from one generation to another promoting the development of a less than ideal occlusion
- Environmental stress – especially dietary stress during early growth and development can alter the growth of the bones of the face and jaws. This is most prominent in individuals who develop difficulty with the ability to breathe through the nose. This challenges the occlusal relationships in the growing individual and can throw optimal growth and development of the occlusion “off the track” (see Chronic Nasal Obstruction/Orthodontics)
- Trauma – to the growth centers of the jaw during growth and development or after growth is complete without recognizing the problem and providing correction
- Habits – such as thumb/finger sucking and use of a pacifier past the age of 1 year, as well as grinding and clenching of the teeth at any age, can affect the development and attainment of a functional occlusion.
- Unintended alteration – of the development of the occlusion by dental therapies (poorly designed fillings, crowns, partials, dentures and bridges, as well as orthodontic therapy that overlooks the development of a functional occlusion). If left unrecognized and untreated these can promote a dysfunctional occlusion.
Potential risk factors that can lead to a dysfunctional occlusion:
- Certain orthodontic therapies, whether treating adults or children, that don’t include achieving an optimal functional occlusion as a treatment goal.
- Early loss of baby teeth or permanent teeth thereby promoting collapse of the occlusion surrounding the vacant areas in the mouth
- Extensive destruction of the occlusal surfaces (top surfaces) of the teeth due to decay and/or trauma and the lack of proper dental correction (poorly shaped fillings, crowns, bridges and dentures)
- Any dental treatment that attempts to correct the above mentioned problems without diagnosing for the existence of a dysfunctional occlusion. New fillings, crowns, bridges, partials and full dentures that are placed in a dysfunctional occlusal arrangement run a risk of making the problems of a dysfunctional occlusion worse.
Signs and symptoms of a dysfunctional occlusion:
- Spontaneous tooth or teeth sensitivity that comes and goes and may change location
- Worn teeth (a history of clenching and/or grinding)
- A consistent history of sensitive teeth, following any routine dental procedure, requiring return trips to the dentist in order for the “bite” to be adjusted
- A history of broken/fractured teeth and multiple crowns to correct this problem
- An unexplainable need for root canals, especially on the large teeth in the back of your mouth
- Poorly functioning dentures
- Chronic headaches and/or neck aches
- Chronic neck, shoulder and/or back pain that requires constant attention by other health professionals, never seeming to have the treatment last more than hours or days
- Inability to keep your balance
- Tired or sore jaw after routine dental appointments
- Poor gum health, receding gums and root sensitivity in the presence of continued good oral hygiene
- Adrenal stress syndrome – Recent research shows that artificially induced dysfunctional occlusion raises cortisol (stress hormone of the adrenal gland) levels in the blood of test animals
- A feeling of not knowing where to bring your teeth together properly
- Clicking, popping and/or grinding sounds coming from your jaw joint
- Jaw locking, facial soreness
- Ear pain, sinus pain without an organic cause for these symptoms
In the presence of these signs and symptoms it will be necessary for us to ask the questions: Do you have a dysfunctional occlusion? Is there a risk of making your symptoms worse by providing you with dental care? It is foolish for us, as holistic dental practitioners, to provide a service such as replacing your dental restorations with biologically compatible dental material that may perpetuate or worsen an existing dysfunctional occlusion.
As part of every comprehensive dental examination your occlusion will be evaluated and depending on the findings, further tests and analysis may be performed. First, with the help of one of our staff, a questionnaire will be completed. From your responses a clearer picture of your condition is established and additional testing may be performed in order to objectively measure the degree of your occlusal stress. Examples of testing would be:
- An Occlusal Analysis – this is a comprehensive screening of your occlusion by evaluating very accurate impressions of your teeth in our laboratory following an exact recording of your jaw position and a measurement of the discrepancy between your optimal (healthy) jaw position and where your teeth fit best. The magnitude of this discrepancy is measured and possible correction scenarios are discussed at a separate office visit. In most cases biological dental procedures will be able to be performed with the use of a functional occlusal splint that will fit over the lower teeth to provide a stable jaw position while removal of harmful materials is completed.
- A Forensic Orthodontic Assessment – may be performed especially if you have had previous orthodontic treatment. This helps us to understand where you ended after therapy and/or after growth had stopped. This allows us to select the best therapy to restore your functional occlusion. These tests will be in addition to your Occlusal Analysis and will require digital radiographs of your skull as well as computer analysis of jaw growth and relative tooth size proportions.
Once this is accomplished it may be necessary that a Comprehensive Occlusal Adjustment be performed in order to coordinate your occlusion with optimum jaw and soft tissue health. This is a procedure where minor amounts of tooth structure are reshaped and/or removed to achieve an optimum occlusal relationship that is in harmony with the jaw joints, muscles, ligaments and tendons that support the jaw. In other words, the process by which a functional, occlusion is achieved. If the discrepancy between optimum jaw position and occlusal position is too far apart, a preliminary orthodontic procedure via conventional orthodontics (braces) or invisible braces (Invisalign) may need to be performed prior to the final comprehensive occlusal adjustment procedure.
In extreme cases of a dysfunctional occlusion, TMJD may be present and would require diagnosis and therapy prior to any further dental work. View TMJD