Bite (occlusion) = cusp on one arch working with fossa on the other arch when chewing. The mountains and valleys of tops of teeth & how they work together.
GUIDELINE: 1) A bad bite is not the cause TMD 2) Cause of TMD is grind/clench
History: 1) 1st research on jaw joint damage (TMD) was done by dentist 2. A hammer see nails, plumber sees pipes, and dentist sees teeth 3) it was assumed that bite caused TMD 4) After 30 years research, bite is not cause TMD 5) Bite is a contributor to damage 6) Occlusion accuracy does reduce damage TMD
GUIDELINE: Jaw joint stability comes before bite stability. 1) If the disc/joint TM J is not stable, the bite is changing 2) If bite is changing, where do you put mountains and valleys of teeth 3) Therefore, you stabilize joint before perfecting occlusion 4) NO braces or crowns before jaw joint stability
DID YOU KNOW: The jaw joint (disc/condyle) plays a greater role on bite, than bite plays on joint stability. You cannot fix bite if you have jaw joint instability.
DIFFICULT BITES: 1) Dual bite 2) Disc displacement 3) Osteoarthritis 4) Hypermobile joint 5) High anxiety
Dentist recommending equilibration or bite reconstruction needs to look for: 1) Joint instability 2) Dual bite 3) Destructive grind
Joint Instability: 1) Bone loss in TMD 2) Displaced disc TMD
Dual Bite: 1) Jaw jt vs tooth bite 2) Teeth dictate bite most time , control muscles 3) that is why accurate orthotic necessary 4) Discover difficult dual bites is during chewing system orthopedics 5) majority patients have no dual bite, 10 % have small, 5% have dual bite 6) Difficult concept, spent 40 years searching for understanding dual bite
Destructive grind: 1) destructive 2) hidden 3) high anxiety 4) destroys 4 structures 5) restorative failures
What names does a bad bite go by?
- Unstable bite 5) Interferences 9) Arch inadequacy
- No home for my bite 6) Crossbites 10) Steep curve Spee & Wilson
- Multiple bites 7) Arch collapse 11) Skeletal differences
- Dual bites 8) Poor alignment
When a bite is off and moderate jaw joint damage present, what is treated first ? 1. Jaw joint stability is a required before any dental treatment 2. Dentist & patient runs risk of increasing pain in chewing system 3. Patient runs risk when desperate for quick fix, pressures doctor into treating bite when he feels jaw joint stability or the high anxiety patient may increase pain in chewing system
Why Jaw joint orthopedics first?
The accuracy of where to place the mountains and valleys, the cusp &fossas, cannot be determined if the jaw joint is changing or unstable.
Can equilibration-occlusal adjustment be successful on mild jaw joint damage? Yes:
- Jaw joint instability affects where mountains and valleys are placed
- Dual bites are determined before orthodontics
- When orthodontics aggravates jaw pain, there will be more pain not less
- Term for “multiple bites”
- One bite is "Jaw joint bite" and other bite is "Tooth bite"
- Bite are different, measurable
- Bites statistics: a) Jaw Bite equals Tooth bite = 85% b. Jaw bite slight different tooth bite = 10 % c.Jaw bite is measurably different tooth bite = 5%
- Dual bite are suspected to be hypermobility in TMD
When are equilibrations not successful? 1) Jaw Jt bite does not equal tooth bite 2) Destructive grind-clench 3) Jaw joint instability
OCCLUSION: 1) how cusps and fossa fit & work together 2) one who studies accuracy of occlusion 3) Occlusionist: a) prosthodontist b) dentist graduate Pankey-Dawson
Guidelines for Occlusionist:
- Must have jaw joint stability
- Must study occlusion
- Must understand geometry of mouth
- Must be perfectionist
- Must refer orofacial pain for jaw joint stability
- Jaw Instability before reconstruction requires accuracy of bite
- Preventing relapse is as important as accuracy
- can't fix a bad bite when there is jaw joint instability, dual bites
- Refer to orofacial specialist for jaw joint stability before you equilibrate