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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

Learn How Plaque And Gum Disease Relate To Older Adults

The proverbial way of referring to older people as being "long on the tooth" suggests that it is predetermined that as we get older our teeth get "longer" or "no longer." This is not true.

Periodontal disease, plaque and loss of teeth is not an inevitable aspect of aging. Loss of attachment or bone support around a tooth is the result of a bacterial infection. What is true is that as we get older, we have more exposures to these infectious organisms, and more probability of being infected and developing periodontal disease. Half of the people over 55 have periodontal disease.

Risk factors that make older adults more susceptible to periodontal disease include:

Systemic diseases: Certain systemic diseases such as diabetes may decrease the body's ability to fight infection and can result in more severe periodontal disease. Osteoporosis also can increase the amount and rate of bone loss around teeth. Systemic illnesses will affect periodontal disease if it is a pre-existing condition. To reduce the effects of systemic diseases on the oral cavity, maintain meticulous plaque control and visit your dental care provider routinely for examinations and professional cleanings.

Medications: Heart medications can have a direct effect on the gums by creating an exaggerated response to plaque and resulting in gum overgrowth. Antidepressants may create dry mouth and reduce the saliva's ability to neutralize plaque.

Immunosuppressants and other disease-fighting medications may reduce the body's ability to combat infection, increasing the risk for periodontal disease. The dental care provider needs to be aware of any medications you may be taking and you need to maintain meticulous plaque control and visit your dental care provider routinely for examinations and professional cleanings.

Dry mouth: Lack of saliva can result from the use of certain medications or as a result of illness. If there is not enough saliva available to neutralize plaque it can result in more cavities and periodontal disease.

Also, dry mouth, or xerostomia, can make dentures more difficult to wear and may also complicate eating, speaking, or swallowing of food. Oral rinses or artificial saliva can be very helpful with these problems.

Frequent sips of water or eating candy may be helpful as long as it doesn't contain sugar. Fluoride rinses and gels are helpful in reducing or preventing the cavities that can be caused by having a dry mouth.

Dexterity problems: Physical disabilities can reduce dexterity and the ability to remove plaque on a daily basis. Poor oral hygiene can increase the risk for cavities and periodontal disease.

Electric toothbrushes and floss holders are helpful in improving plaque control. Frequent professional cleanings combined with oral anti-microbial or fluoride rinses also may be helpful in reducing the incidence of cavities and periodontal disease.

Estrogen deficiency: Older women may have some special concerns in relation to periodontal disease. Scientific studies have suggested that the estrogen deficiency that occurs after menopause may increase the risk for severe periodontal disease and tooth loss. Estrogen replacement therapy may reverse these effects.

It is important to keep teeth as we age because every tooth has an important function in chewing and speaking. They affect our appearance and self esteem.

Having dentures or loose or missing teeth can restrict our diets, resulting in poor nutrition and systemic complications. With the advances in modern dentistry and with current prevention and treatment techniques, we must count on keeping our teeth for a lifetime -- no matter how "long" that may be!

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.