Occlusal Disease, Part II
As life expectancy increases, older generations are wrestling with how to address tooth loss while maintaining the aesthetic of their younger smiles. In our first installment of occlusal disease information, we focused on what you can do when a single tooth is lost. Now we examine the loss of teeth in quarters of the mouth or even entire arches.
What happens when you lose all the teeth along one side of the mouth?
- The teeth will move until they bite on the opposing gum. This will cause pain and ulceration of the gum tissues.
- Since people can’t chew easily where teeth have been removed, the patient will tend to do all of their chewing on the other side of their mouth. This can cause pain, fracture and increased mobility of the teeth because they are being over worked.
- Teeth can shift so that smiles look crooked. This is called a canted smile and occurs due to the growing or super-eruption of the teeth on one side but not on the other. This can be very embarrassing and must be corrected prior to replacing the missing teeth for optimal esthetics.
- The entire bite can collapse. When people lose enough teeth, the remaining teeth can shift. If you think of the front teeth as a “door stop,” the loss of back teeth can cause the front teeth to loosen or shift so that the nose and chin get closer together.
When people have a normal complement of teeth, their nose-to-chin distance is a fixed measurement called the vertical dimension of occlusion. Loss of back teeth and shifting can lead to a movement of teeth, and the nose-to-chin measurement can get closer together. That is called a loss of vertical dimension.
What happens when my bite collapses?
You can get more wrinkles or deeper crevices by the corners of your mouth, nose and chin. These wrinkles represent the loss of muscle tone by having the bite close down. Some people refer to this as a “bulldog” smile.
What is occlusal disease?
Occlusal disease is the multi-factorial problem set that develops as teeth are lost or have erupted into non-ideal positions and the trauma that develops as a result of this mismatched situation.
This disease can refer to teeth that are all in the mouth where they are not hitting in the correct spots or it can refer to the trauma that results from loss of one or more teeth.
My bite is off and my jaws hurt when I chew. Is this occlusal disease?
There are many opinions as to whether jaw problems are a result of biting problems or whether biting problems cause jaw problems. The truth is probably a combination of both. Teeth with fillings that are poorly adjusted can cause occlusal disease, as can people with normal teeth but abnormal TMJ joints.
Does occlusal disease break teeth?
When teeth are not hitting in proper way, they can be overloaded. This can lead to a fracture. When teeth have larger fillings in the tooth, they are more susceptible to breaking as the hard bite can weaken already compromised teeth. Fillings always compromise a tooth due to the drilling forces, expansion and contraction of the filling material on the remaining tooth structure.
My bridge is sunken down in the middle and is lower than the sides. Do I need to get this fixed?
It needs to be evaluated. The type of bite someone has can sometimes adapt to certain bite schemes. It may be adequate the way it is or it may require replacement if your dentist finds other trauma that is occurring due to this bridge design.
Conformative versus rehabilitative dentistry:
When a dentist doesn’t look at super-eruption carefully or doesn’t perform bite adjustment to address uneven teeth, then this is conformative dentistry. They are just replacing what has been lost or broken with something that fills the hole.
When a dentist does a proper evaluation of bite problems and they make changes to improve someone’s bite before performing fillings, crowns or implants, then they are trying to restore someone’s bite to a more ideal position. This is something called rehabilitative dentistry, as the dentist is trying to rehabilitate what is breaking down.
Based upon someone’s financial situation and personal desires, it is okay to simply “fix” a tooth without doing all this other stuff?
Yes, conformative dentistry is an acceptable option in some situations. It is always good for a dentist to look at leaving your mouth better than how they found it. So when ever possible, it is better to fix occlusal disharmonies before putting new dentistry in your mouth.
An analogy would be if you have new carpeting installed, it is always better to make sure the floor underneath is solid and supportive prior to investing this new money.
How do you treat occlusal disease?
Rehabilitation for occlusal disease can be done with:
- Simple or complex adjustment (equilibration).
- Orthodontics to realign the teeth.
- Crowns to change the plane of occlusion or way teeth touch.
- Splint therapy to help align the teeth or change how they contact.
- Segmental rehabilitation – crowns on a tooth or teeth as needed to correct bite problems or occlusal disharmonies.
- Full mouth reconstruction or rehabilitation to take full control over the shapes, sizes of teeth and how they contact each other in three dimensions.
What happens if I have a denture in one arch and teeth that are crooked down below?
Occlusal disease or bite problems can be carried over from teeth to dentures!
When teeth are lost in one part of the mouth and not replaced, the super-eruption can affect how the partial is made. This partial denture can look like a rocking chair and can lead to problems when biting against a full denture.
My lower partial smacks into my denture, and when I bite, my denture tips. Is this fixable?
The short story is yes. You can sometimes do orthodontics even when many teeth are missing by using small implants called TADs or temporary anchorage devices. These work to change the position of the teeth prior to making a new partial or implant over denture to correct this “rocking” problem.