Making your practice a 'complete' one.
Dr. Peter Dawson once wrote that “If the importance of occlusion in dentistry was universally understood, no dentist would be permitted to graduate from dental school without a working knowledge of the principles and skills required for successful occlusal equilibration.” Well, the very same can be said about dental assistants. In fact, all dental professionals should be aware of the importance of both function and harmony in the masticatory system. If both function and harmony are overlooked when treating patients, it will most likely result in treatment failure. Therefore, it’s imperative for all members of a dental office to possess a thorough understanding of complete dentistry, specifically functional occlusal harmony. The following will provide you with the primary tenets of complete dentistry that every practicing dental professional must know and apply.
The first lesson you should share with your staff is that simply looking at a patient’s smile is not enough to determine their need for treatment. In fact, merely observing a person’s esthetic appearance is one of the biggest mistakes that dentists make today. Despite the surge in cosmetic dentistry that has been spurred by television talk shows and reality makeover programs, the truth is that focusing only on the appearance of teeth means you are ignoring the rest of the masticatory system, which is a major oversight that will only lead to long-term problems.
That’s why one of the primary tenets of complete dentistry is that all of the components of the masticatory system, particularly the temporomandibular joint (TMJ), the anterior teeth, posterior teeth, and masticator muscles, are all dependent on one another for optimal form and function. Therefore, you should make your staff aware of the four circles of complete dentistry, which are composed of the following:
1. TMJs: As research has proven, headaches, dizziness, earaches, and head, neck, shoulder, and back pain can all be attributed to a malocclusion. Since the temporomandibular joint holds the lower jaw in place, the fit of the teeth and function of surrounding muscles will be directly impacted by its placement. As a result, the jaw will automatically shift to a new position, attempting to compensate for any perceived lack in fit. To some degree, this is the body’s way of adjusting for the misalignment of the teeth. But as your patients with TMD will certainly attest, it can only lead to a world of trouble.
That’s why it’s important for your entire staff to be aware of the importance of the TMJ to overall oral health. Even though a smile may appear to be in good health, a malocclusion could be causing the jaw to shift to accommodate any improperly aligned teeth. Patient symptoms may include clenching, grinding, premature tooth wear, and muscle and tendon stress.
2. Anterior teeth: The anterior teeth are critical to the long-term stability of the entire dentition, so they cannot be determined separately from the rest of the teeth. In fact, anterior guidance determines how the front end of the mandible moves. In an ideal occlusal relationship, all contact by posterior teeth is determined by the combined border paths at the both the front and back ends of the mandible. Therefore, the anterior teeth play a dominant role in establishing the functional path that the mandible can travel.
3. Posterior teeth: The third circle of complete dentistry represents the posterior teeth, which should always be non-interfering. As mentioned earlier, the posterior teeth are determined by both the condylar path and the anterior guidance of the front teeth. Therefore, the posterior teeth should have equal intensity contacts that do not interfere with either the TMJs in the back or the anterior guidance in the front. The ideal occlusal scheme is complete separation of all posterior teeth by the anterior guidance the moment the condyles leave centric relation.
4. Muscles: If the patient’s occlusal relationship is in harmony, muscles will react in a coordinated pattern. However, when the teeth get in the way of how the jaw should function, muscle will interfere to try and straighten things out, leading to a world of problems. For example, if temporal muscles get hot from over-adjusting, they will trigger tension headaches. Therefore, your staff must be aware of how the muscles interact with the overall function, harmony, and form of the entire masticatory system.
How to Become a Go-To Dentist
While the above represents the primary tenets of complete dentistry, it’s important for a dentist to properly apply these tenets to their practice. More often than not, dentists treat the problem, but ignore the symptom. For example, if a patient has a cracked tooth, the dentist may be quick to crown it. But in reality, the dentist must first determine why the tooth has cracked. Is it a malocclusion? If so, the dentist can treat the problem and leave his patient satisfied with both the short- and long-term outcomes. In turn, the patient will gladly refer additional patients to a dentist who is now seen as a trusted advisor. This level of trust will allow a dentist to grow his practice exponentially—and this level of trust is never as abundantly displayed as when the initial patient exam is conducted.
Complete Exam
Dr. Michael Schuster once said that the new patient exam is “the most significant, most important process you complete in your practice.” And since you never get a second chance to make a first impression, this is the time for you to shine—a fact that your staff must never forget, since they part of the first impression.
In order to garner a patient’s trust, both you and your staff must be willing to overlook their clothing, insurance limitations, and financial background. The mere fact that a patient is sitting in your chair is all the reason you need to provide them with complete service. Ignore the cosmetic revolution and focus on their true needs. The last person a patient should trust is someone who focuses only on the front teeth. In fact, looking at the teeth is not even enough to competently treat a patient. The teeth are but a part of the entire masticatory system. Therefore, you should focus on the TMJs, teeth, muscles and tendons, and overall smile to provide a patient with a complete examination. Examine the position of the condyle in the socket, then the front teeth and whatever is in between. Are the front teeth interfering with either the condyle or the back teeth? Once those are adjusted, the muscles need to be examined to determine if they are functioning in a peaceful neuromuscular structure. If teeth are in the way, muscles will be hyperactive. All of the four circles are co-dependent on each other in order to properly treat a patient. For example, conduct a clench test on your patients to determine if the occlusion is causing any muscle hypertension, often leading to tension headaches. If a dentist is just a tooth dentist, opportunities to get a patient out of pain will often be overlooked. However, if the dentist can identify these problems, that builds trust in the doctor and the staff. Therefore, always be willing to focus on the needs of the patient.
The number one factor that dentists must consider when examining patients is knowing how to solve their problems.
More often than not, patients’ problems are caused by a malocclusion. In fact, occlusal disease is the number one destructive dental disorder. What’s more, it is the number one cause of tooth loss and the number one cause for needing major restorative dentistry. Therefore, the first step you must complete to perform a complete exam is to examine the patient’s occlusion. Are there any signs of occlusal wear, particularly cracked teeth, splayed teeth, fremitus, etc? If so, then the patient has occlusal problems that must be addressed.
First, you must examine the temporomandibular joints. All occlusal analysis starts at the TMJs. The movement of the lower jaw is determined by where the jaw is located and moves in relation to the upper jaw. If the joint is out of position or displaces to get the teeth together, there is a problem. If the condyles are completely seated, there should be no problems. Unfortunately, many problems persist after a dentist places a crown or restores the smile. Therefore, the dentist must find maximum intercuspation, which is the location when the teeth will completely close as tightly as they can be contacted. However, if patient reaches maximum intercuspation by requiring displacement of joints from centric relation, problems will ensure. That’s why dentist must take bite records to study casts so dentist can study relation between teeth and joint to find harmony. If patient must displace the joints to find maximum intercuspation, problems will ensue. If a dentist takes bite records, a dentist is willing to bring the teeth into harmony with the joints. In fact, it’s the only proven way we have to study the jaw-to-jaw relationship. If there is a problem, patients are likely to beat their teeth to make the jaws fit, causing muscle incoordination, or a malocclusion. Therefore, you should check every tooth for mobility. The intial patient exam should include the following:
Welcome to our office: Make your patients feel as is they are part of the entire experience. In other words, make your patients feel at home. Examine their entire mouth and consider the consequences of any problems. Is there a problem with the occlusion? Do the posterior teeth interfere with the proper closing of the jaws? One of the most easy ways you can check is through the clench test. Can the patient bite on their teeth and make the bite sore? If so, then a maloccuslion exists and the bite must be adjusted. Even if the bite has an absess, the bite must be making the teeth hurt.
Develop a special doctor-patient relationship: Dentists must be empathetic to the problems a patient experiences. Therefore, a dentist must be considerate of the fact that a patient may be a member of the practice for many years, so a patient must be a friend, as well as just a patient, which Is an attitude that must be reflected in the entire practice. Therefore, both the dentist and the staff must take the time to become better acquainted with the patient and their needs. Ask the patient “what would you like me to know about you? What would you like to know about me? What main concerns do you have about your teeth, jaws, or the appearance of your smile?” These types of questions will open up a dialogue with the patient that will allow you to discover any overall problems.
