Occlusion and TMJ
Recently a patient came to us, complaining of long-term tooth sensitivity. His teeth were sensitive to the point of severely limiting cold or hot of liquids he could drink, not to mention an absolute restriction on skiing and snow activities. He also complained of clenching his teeth, mostly at night, but that he had caught himself occasionally doing it during the day. His Tempro-Mandibular Joint, the TMJ, had mild soreness upon opening, but was not his primary concern.
Looking at the Bite FirstWe always look to the bite first, because all of his symptoms most likely arose from the teeth not hitting together solidly. When he tapped his teeth together, there was an almost imperceptible sound, very muffled; normally, we want to hear a sharp snap, almost like clapping your hands together. This silence tells us that the muscles are closing very cautiously, because they do not want to place the full impact on any one or two teeth.
When asked to bite on carbon paper, which tells us where he hits, the patient complied, but when we asked him to shift his jaw from right to left, and vice versa, he could only do so after opening his mouth. This told us that he was getting significant blockage by the teeth to this movement. This was confirmed by the marks on the teeth left by the carbon paper, which showed he was hitting in areas that could only restrict his movement. Additionally, the patient has little grooves forming at the necks of the teeth, something we call “abfractures“, and these were limited to only those teeth which hit inappropriately.
Diagnosis and TreatmentOur diagnosis? The patient had a bite that was being “locked in” to one position, and some teeth were restricting the movement of the other teeth side to side. This in turn caused the grinding of the teeth, which in turn created the abfractures, and the chronic soreness in his muscles. Everything led to this same conclusion, and we were able to say with confidence that we could address his issues comprehensively, and quickly. In his case, the solution would be to selectively polish the high contact points from the poorly-positioned teeth, something that we sometimes do in conjunction with the cleaning appointment. Because his teeth looked quite nice, esthetically there was no reason to consider orthodontics, or Invisalign®, to correct the relatively minor position problems, and we recommended against this.
Bite adjustments are often little more than smoothing out chips already in the teeth, or polishing down rough edges, but care must be taken only to address the problem areas. Done correctly, bite adjustments are incredibly helpful, with nearly instantaneous improvements in comfort, sensitivity, and muscle relaxation. Done improperly, though, they can create far more problems than they solve.
We Have Studied Bite Issues for DecadesDr. Teasdale has studied bite issues and their diagnosis and treatment for decades, and we know what can and can not be successfully treated. We are ultra-conservative in our treatment, preserving whenever possible tooth structure, and explaining in detail every step we take with the patient. If all the patient needs is an adjustment, we don’t tell them they need intensive or extensive (or expensive) treatment. Likewise, if the patient does require a more involved solution, we do not mince the words, and promise what we cannot deliver. That is not us.
But enough of that. What happened with our patient?Well, the patient did not have the time for the adjustment that day, and, confidentially, we think he needed more time to absorb what we had presented. It all makes sense, and we are not pushy, confident that he will return. But for his immediate problem of sensitivity, and of soreness in his TMJ, we offered to treat the muscles with Botox.
What Botox does, of course, is to decrease the activation of the muscle for three months, which in turn will diminish the pressures on the teeth due to grinding, and will thereby limit the grinding and the micro-fracturing of the tooth enamels. His TMJ will relax, because the muscles are no longer tugging quite so strongly at the jaw and joints throughout the day and night. His symptoms will go away, and he will be a happy person for the next three months.
So we were able to resolve his problems doing nothing permanent. The patient understands that this is not the final answer, as would more likely be the case with an adjustment, but he is happy, and appreciates the immediate result, and the time to consider fully the advantages of a minor bite adjustment.
So, If you are looking for the best, most conservative, TMJ Treatment Portland has to offer, we hope you’ll contact us today!