Step-by-Step Instructions for Preparing Your Staff to Assist With Occlusal Equilibration
by Peter E. Dawson, DDS
At The Dawson Academy, our number one goal is to educate dentists about the importance of occlusion, allowing them to provide their patients with a lifetime of optimal oral health care. We accomplish this goal by giving our students invaluable classroom lectures, hands-on coursework, and support. However, we also remind dentists that optimal oral health care cannot be achieved without the support of a knowledgeable staff who understands and practices the time-tested principles of occlusion, particularly equilibration. The following will provide you with detailed instructions for preparing your staff to understand and assist you with occlusal equilibration.
As mentioned above, our primary goal is for patients of complete dentistry to keep their natural teeth for a lifetime. While this statement is certainly easier said than done, we do know this: almost every breakdown of the teeth is caused by either bacteria or occlusal stress. Because of this, most patients know what happens if you don't brush your teeth or floss properly. What's more, they are also familiar with how to correct these problems—and most patients fear them without question! What most patients are not familiar with, however, is the damage—and subsequent treatment required by—from occlusal disease. It is a fact that excessive forces on the teeth can cause significant damage that requires even more extensive treatment to correct. That's why it's imperative for every member of your staff to have a thorough understand of occlusion. From the causes of occlusal disease to the need for treatment, a knowledgable staff will be able to answer patients' questions, affirm their decisions to proceed with their required treatment, and, perhaps most important, anticipate next steps during an occlusal procedure. With that being said, let's begin by reviewing some of the structures of the masticatory system to see how they function.
The Components of the Masticatory System
For the average patient, dentistry is all about teeth, so they spend an inordinate amount of time brushing, flossing, and rinsing—which is obviously a terrific first step toward maintaining healthy teeth. However, what the average patient is not aware of is that brushing, flossing, and rinsing are just a part of the process for maintaining healthy teeth. In reality, each and every component of the masticatory system, which consists of the anterior teeth, posterior teeth, muscles, and temporomandibular joints (TMJs), must also be maintained in good health. That's because each component of the masticatory system must function together. If any part of the system does not function properly, it will have a profound ripple effect on the remaining parts of the system, including muscle pain, worn teeth, headaches, and countless other problems. In order for your staff members to be aware of the importance of the masticatory system to complete dentistry, please review the following synopsis of both the masticatory system and its role in your patients' overall oral health with each of them.
Teeth: The teeth are attached to the bone, and the bone of upper arch is fixed in the skill, meaning that all jaw movement is the result of movement of the lower arch or mandible.
Muscles: The muscles that move the mandible are called, as a group, the muscles of mastication.
Jaw joints: The jaw joint is where a hinge in the mandible called the condyle fits into the socket. The jaw joint plays an extremely important role in the health of the masticatory system. The illustration to the right shows a cross section of the TMJ or jaw joint.
The condyle fits into the fossa or the socket as shown. In between the condyle and the fossa is the disk, which is attached to the back of the condyle by a ligament called the posterior ligament. The front of the disk is then attached to the lateral pterygoid muscle. The joints fit when they are at their most superior position against the emenentia with the disk properly interposed. The reason we perform occlusal equilibration is to achieve a bite relationship where all biting force is equally distributed on the teeth without any interference to complete closure. In other words, we want to make sure the jaw joints don't have to displace when the teeth come together.
Let's take a moment to examine this relationship. By now, you've learned that the most important lesson you can share with your staff is that the relationship of the teeth, joints, and muscles is crucial to complete dentistry. In fact, if we are only concerned with how the teeth fit together and ignore the position of the joints, a patient's mouth may look like the illustration on the left. Notice how the teeth appear to be lined up at the midlines. What's more, notice how they fit together nicely along the entire arch. While this is certainly important, don't be fooled by its appearance. If you look at the position of the left condyle, you'll notice it has to displace when the teeth come together. When one or both TMJs must displace in order for the teeth to fit, there is a profound impact on the muscles that move the jaw.
For example, notice how the lateral pterygoid muscle has to actively pull the left condyle down and out of its socket every time the teeth come together. This process overworks all the muscles on that side, causing muscle fatigue, potential spasm, and pain in the masticatory muscles. When the doctor manipulates this patient's jaw to make the TMJ fit properly, the front view of the patient would look like the image on the right.
Notice that the teeth no longer fit together. In fact, the back teeth only close on one side now. This type of interference is called a posterior interference to centric relation. See how the midline has shifted when the joint is properly seated? When patients have occlusal interferences, the muscles constantly have to move the jaw to pull the jaw joint out of position in order to get the teeth together. As a result, the interfering teeth take a pounding, simply because they're in the way of where the muscles want the teeth to go. The ensuing damage on the teeth can include worn enamel, loose teeth, and possibly even misalignment. If the jaw has to slide around interfering teeth, it will often slide into other teeth, causing worn enamel and/or sore or loose teeth.
When patients do not have harmony between the teeth, muscles, and joints, the bite forces will then be unequal. The effects of an unequal bite can include loose, sensitive, and/or worn teeth, abfractions, cracked and broken teeth, recession, and bone loss. In addition, the constant pull of the muscle on the condyle pulling it out of its socket can lead to TMJ problems, including headaches and facial pain.
Let's look again at the illustration of the TMJ. When the lateral pterygod muscle has to constantly pull the condyle down and out of position to geth the teeth together, the upper belly of the pterygoid muscle that controls the alignment of the disk can also become spastic, contributing to disk displacement. Some popping and clicking joints are the result of the ligaments being stretched so far that the lateral pole of the disk pops on and off of the condyle when the jaw opens and closes.
Although the concepts discussed above may seem complicated, their importance cannot be emphasized enough—especially to your staff. The more your staff understands about occlusion, the harmony between the teeth, muscles, and the joints, the better prepared they will be to help you accomplish your goal of a lifetime of healthy teeth for each of your patients.
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