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Malocclusion Of The Mouth

The term malocclusion literally means "bad bite." It is a generalized 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. 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 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

+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.

TMJ - All About Temporomandibular Joint Disorder

TM disorder describes a variety of conditions affecting the temporomandibular joint - TMJ (the point where the jaw opens and closes) and nerves related to chronic facial pain. These problems are now more easily diagnosed and treated than in the past. Women are twice as likely to be affected than men.

How Is It Caused?

The exact cause of the disorder is unknown. Some factors are related to an improper bite or malocclusion, injury, arthritis, severe stress, or a combination of factors. Clenching or grinding teeth, a condition called bruxism, may develop from stress or as part of a sleep disorder. This can tire muscles and create painful spasms, causing even more pain. Repeated muscle problems may affect the joints, resulting in tissue damage, muscle tenderness, and more spasms, perpetuating a cycle of pain.

What Are Some of the Symptoms?

• Jaw pain or soreness, more noticeable in the morning or afternoon
• Jaw pain while chewing, biting, or yawning
• Earache without an infection, sometimes spreading into the face
• A clicking or grinding noise while opening and closing your mouth
• Difficulty opening and closing your mouth
• A stiff jaw when eating, talking, or yawning
• Sensitive teeth without any signs of dental problems
• Aching on the side of the head and neck pain
• "Locking" of jaw in an open or closed position

How Can This Condition Be Treated?

Proper diagnosis is critical to make sure you receive treatment for your particular condition. Your dentist will recommend treatment after conducting a thorough health history, clinical exam, taking appropriate X-rays, and perhaps confirming the condition through other diagnostic tests.

Your dentist may prescribe a multiple-phase treatment plan. Only minor corrective treatment may be needed. Treatment may be simple or require more steps for alleviating the condition, depending on the degree of severity. Some of these treatments include:

• Taking a non-aspirin pain reliever or prescription medications such as muscle relaxants, analgesics, or anti-inflammatory drugs
• Eating soft foods
• Avoiding chewing gum
• Applying moist heat or ice
• Physical therapy
• Teaching relaxation techniques to control muscle tension
• Stress management training techniques
• Posture training
• Wearing bite plates to eliminate the harmful effects of clenching or grinding the teeth, and a better positioning of the jaws
• Adjusting the bite, known as "occlusal equilibration" involving removing interferences when the teeth touch
• Replacement of defective restorations that prevent the jaws from meeting properly
• Orthodontics, to put the teeth in proper position
• Surgery

In most cases, the symptoms related to TM disorders can be successfully treated to reduce or eliminate your discomfort. Postponement of treatment usually results in more damage to the joint, muscles, or teeth. Be sure to discuss any questions you may have about TM symptoms and treatment plans with your dentist.

By Brian J. Gray, DDS, MAGD, FICO

+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.