Occlusion & Occlusal Trauma
Occlusion and Occlusal Trauma...
The term "occlusion" means "to close." In dentistry we use the term "Occlusal Balance" to describe how your teeth close against each other in general and more specifically how they touch while the jaw is in "Centric Relation." We will get to defining Centric Relation in a moment.
First of all, have you ever wondered why teeth are so darn sensitive? Sensitive to temperature changes, to metal, sweets, or even worse when your dentist touches them and you aren't sufficiently numb yet? In studying evolution we learn and believe that nothing develops in the body without a reason. So there must be a reason why such highly sensitive nerves exist in our teeth. And it wasn't so that the cavemen knew they had to visit their cave dentists!
Well, as it happens, the tissue around your teeth include very sensitive nerves that tell the brain when your teeth begin to contact something. These nerves are so finely tuned that if you touch a tooth with a feather, the brain will register it. These "proprioceptors" also include highly sensitive nerves inside your teeth that further transmit the existence of additional forces pressing on the tooth as you chew.
In the diagram below there are many structures of the tooth which are labeled. They are all important and they are all described in the "Learning Center" of this website. But for now lets focus on the nerves which are drawn in blue. They not only surround the tooth but also dive deep inside the pulp chamber of the tooth as well.
This "bio-feedback" is important because during occlusion the brain must direct your opening and closing muscles depending on what you are eating and where the food is in your mouth.
Without getting too technical, as soon as your lower teeth contact something, the muscles are programmed to let go, and the jaw opens slightly. If we didn't have this reflex then we could easily break our teeth when we chew.
Occlusal Harmony and Imbalance...
When the occlusion is balanced and in harmony with the TMJ, these muscles are able to work very effectively without undue trauma to themselves, to the joint, or to the teeth. The jaw is in its proper position (centric relation) as dictated by the joint's anatomy, the teeth come together, everything touches in harmony, and we release.
So what would an imbalance be? Lets slow the process down a bit so we can see what happens when it isn't right.
First, the jaw begins to close, the joint assumes this skeletally braced centric relation position and the teeth come together. But where the brain is expecting all the teeth to touch at the same time, and the joint to remain in centric relation, only one tooth touches prematurely.
Part of the brain says "let go" but another part says "keep closing, you haven't touched them all yet." So the muscles don't know what to do. Should they continue to close? Should they start to open? Not knowing what to do, they do both - the true definition of clenching. As it turns out, the brain will not release the closing muscles until all the teeth touch at the same time, in centric relation. Once they do, then you let go.
And what if the first contact is on a slope of the tooth, and when you continue to close, the jaw gets deflected to one side or the other as the teeth come into greater contact. The joint would actually be forced out of its normal position due to the interfering tooth. This can also yield clenching, pain in the joint, and many other symptoms and clinical signs that have been associated with TMJ.
In the midst of uncontrolled clenching and grinding, it is the powerful force generated by these muscles that yield all the signs and symptoms of occlusal trauma including:
- frequent headaches and/or facial pain
- popping,clicking, or locking of the TMJ itself during function
- isolated recession of the gum line with groove-like "ditches" on the tooth itself.
- teeth that are very sensitive to cold, sweets, or metal in the absence of any other diseases, such as "tooth decay."
- teeth that may get loose and wiggly, worn, chipped or broken
- restorations (crowns, fillings, bridgework) that fail
If you have any of these symptoms, I can absolutely guarantee that I will find a tooth that is interfering with the harmony between your occlusion and your TMJ - something we call a "Centric Interference."
Because this section of the website mainly deals with problems in the joint itself, I will focus on the first two signs of occlusal trauma as they relate to facial pain and the TMJ. But trust me, the term occlusal trauma will appear many more times as we discuss all these other signs and symptoms throughout this website. It is one of the most common and damaging conditions which we treat in dentistry and the cause of many a misdiagnosis if it is not recognized properly.
But please trust me when I say that this condition is very easy to diagnose and can usually be treated inexpensively in one or two visits without the need to take medications, wear night time appliances, or require multiple office treatments.
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