Your bite, or occlusion, is simply the way your upper and lower teeth fit together when you bite down.  Seems like a fairly basic idea, but your occlusion is very important and can affect your health in many ways. If your teeth do not come together properly, it can cause stress to the jaw joints, jaw muscles and teeth. Over time, the stress of a "bad bite" can cause damage and pain. Some examples of damage caused by a bad bite (malocclusion) could be a crown that keeps coming off and continually needs to be re-cemented, a filling that cracks a tooth, grinding and wearing down teeth, crowding of lower front teeth, unexplained pain/sensitivity on a tooth, or unexplained chipping of a tooth or porcelain crown.

Until recently, most dentistry has been based on the assumption that wherever your bite was naturally (habitual occlusion), was the correct position.  Today, most dental treatments are still planned from the patient’s existing or habitual occlusion.  Because the habitual jaw position may be in a reasonably good position, and because our body system is often adaptable to less than ideal circumstances, many of these procedures have acceptable results.  However, there are also many times that treatment procedures carried out with “textbook” accuracy do not produce a result that is fully functional and comfortable. 

The growing field of neuromuscular dentistry goes beyond using your habitual bite as the basis for planning treatment.  Neuromuscular dentistry considers the entire system that controls the positioning and function of your jaw, teeth, muscles and joints.  The neuromuscular dentist seeks to establish a harmonious relationship among these main factors, resulting in a jaw position is called “neuromuscular occlusion”.

TMJ or TMD

TMJ, although it has become almost a household word, is a non-specific, catch-all term for a variety of pain dysfunction conditions of the head and neck. It was originally derived from "Temporomandibular Joint", your jaw joints - once thought to be the source of most of these ailments. Today we know that there are many causes of head and neck problems that may or may not be related to the temporomandibular joint. For this reason, although not as widely familiar, most dentists use TMD (for temporomandibular disorders) to more accurately describe the condition. You may normally think of a number of symptoms of TMD as being medical conditions, not related to dentistry. Here we will explain what they are, why they may involve the dentist, and how the dentist would diagnose and treat them.

Some signs and symptoms of TMD

The symptoms most commonly cited are as follows:

• Facial pain
  
• Jaw joint pain
  
• Back, Neck, cervical pain
  
• Postural problems (forward head posture)
  
• Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
  
• Headaches
  
• Pain in the muscles surrounding the temporomandibular joints
  
• Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
  
• Pain behind the eyes
  
• Swelling on the side of the face and/or mouth
  
• A bite that feels uncomfortable, "off," or as if it is continually changing
  
• Clenching/bruxing
  
• Tender sensitive teeth
  
• A limited opening or inability to open the mouth comfortably
  
• Deviation of the jaw to one side
  
• The jaw locking open or closed
  
• Ringing in the ears, ear pain, diminished hearing, and/ or hyperaccusis
  
• Sinus like symptoms
  
• Dizziness or vertigo
  
• Visual Disturbances
  
• Tingling in fingers and hands
  
• Insomnia - difficulty sleeping
  
  

This list of subjective symptoms is by no means exhaustive, but does provide a good idea of the nature of the complaints that are often made by those suffering from TMD.

Understanding “bite” basics
Usually, we don’t think about moving our jaw or about how it’s done - we just do it.  When most people think of their bite, they think of their teeth.  But, as we mentioned earlier, there is a whole system that controls the positioning of the jaw. Here are a few basics:

Role of the muscles
Different muscles come into play for posturing the jaw, opening and closing the jaw (biting or chewing), and swallowing.  The muscles that open your jaw are in your neck.  The muscles that “posture” your jaw, or keep it from falling open, are rather delicate muscles that extend from the jaw upward through the cheeks and into the forehead area – even around behind the ear to some extent.  The power muscles for chewing are in the cheek area.  Swallowing muscles (like all muscles) must have something firm to brace against to function.  Because the body is efficient, the posturing muscles generally hold the jaw at a position where the teeth are close to occlusion – a millimeter or two apart.  This is an efficient location since we must bring your teeth together to swallow hundreds of times a day.  Control of all of this is done subconsciously without having to think about it – your brain is programmed to do this through a process that doctors call proprioception. If everything is just right and nothing is moving, most of these muscles are said to be at rest, or barely working to maintain posturing.  If your natural teeth don’t fit together properly, your muscles may accommodate, forcing the jaw to close on a path that stresses and fatigues the muscles over time.  This puts the jaw in a position where the teeth are close to occlusion, but at the same time prevents the muscles from being relaxed when they should be.

Role of the joint
The jaw is able to move since it operates on a joint called the temporomandibular joint, its name the basis for the often heard term “TMJ”.  For descriptive purposes, you can think of a joint being something like a ball and socket, the jaw bone portion (ball) of the joint functions within a depression in the skull (socket).  There is also a soft pad called a disc that lies between these two structures.
The position of the jaw end of the joint (the condyle) within the corresponding depression in the skull (the fossa) is largely determined by where the muscles are holding the jaw – a position in turn affected by the bite (occlusion).  If the system is in balance, the condyles will essentially be centered in the fossa and the disc moves freely with the joint.  If the muscles of mastication are accommodating as described above, they may be holding the jaw joint in an abnormal position, negatively affecting its function.  Frequently this results in the disc being “pinched”, causing it to resist the movement of the joint until it finally releases.  As the “pinched” disc releases, it results in the joint popping or clicking.  This sound is often obvious to you and is a sign of abnormal joint function that may in turn be related to your bite.

Role of Posture
Posture can also play a significant role in your occlusion.  The jaw could be considered one end of your interrelated skeleton, with the feet being the other end.  If any part of the skeletal system is affected, it may in turn affect other parts of the system.  You can experience this by lightly touching your teeth together, taking care to note which teeth first touch.  Then, tilt your head back as far as you comfortably can and repeat the process.  Don’t be surprised if the teeth first touch in a different location now.  You have altered the balance of the skeleton (and your bite) by simply changing your head posture. 
Another example is if you have a filling placed when you are in a prone position in the dental chair.  Under anesthesia, it feels as if the filling fits fine.  Then later when the anesthesia wears off and you are sitting or standing upright, you notice that the filling is uncomfortably too big.  It is for this reason that the neuromuscular dentist establishes your occlusion when you are seated in the upright position – the position in which you normally use your jaw.  If it is established when you are in a reclined position the jaw may have moved back, resulting in a position different than that in which you normally function. 
With head posture affecting occlusion, and because of the inter-relationship of the entire musculoskeletal system, the neuromuscular dentist will want to know if there is tension in the muscles of the neck and upper back.  If there is, it may well affect the occlusion and therefore the outcome of the diagnosis or treatment.
Now we are beginning to see that the bite is far more complicated than just the way the teeth fit together!

TMD Diagnosis

To diagnose properly we will consider all of the information gathered by taking your history and doing a physical examination of your teeth, head and neck. When indicated, we may conduct a series of tests using a non-invasive electronic instruments and k7 Evaluation system. Data from these tests will indicate to us whether your bite is a major contributing factor to your problem and will help rule in or rule out your bite as the cause of, or major component of, your condition.

If these tests show that your habitual bite is a probable cause of your condition or pain, we then identify a jaw position while the jaw muscles are in a relaxed state. This jaw position and the corresponding new bite is called neuromuscular occlusion.

Treatment

An orthotic is a custom made appliance fabricated of plastic that can be worn over te teeth to maintain the neuromuscularly derived bite position. At this point, nothing is done to permanently alter your teeth or your bite. You typically wear this plastic appliance for a prescribed period of time to verify that this new position solves or reduces the problem. If it does, it has proven that the imperfect bite was the cause of the problem and you may elect to go on and have your natural teeth treated to permanently maintain that new bite position.

If symptoms are not substantially alleviated, the bite position is most likely not the cause of the problem. Your natural bite has not been altered and other causes may then be further explored. Although this latter circumstance is possible, it is not likely since we will only proceed with an orthotic if there are strong indications that the bite is a major factor in your problem.

 

Call us for a complimentary evaluation today at 202-363-2155