Here’s a computer scan of Renee closing on her back teeth, C.O. or MIP in dental talk. Plain to see things aren’t exactly perfect if perfect means every tooth touching at the same time with about the same amount of force. In fact, this looks like a big problem. The questions abound: did her orthodontist leave her like this? Likely yes, but we’ll never know. Does she have a tongue thrust habit causing that anterior open bite? It’s a place to look. It is certainly not normal to have zero front tooth contact.
Next, what happens when Renee chews and moves her lower jaw side to side? Here is a graphic of her tooth contact when she chews on the right. I think any dentist will tell you that this is a huge problem. Research conducted by Dr. Robert Kerstein shows that if there is not an almost instant disclusion of posterior teeth during lateral movement then there will be significant adverse contraction in the muscles of mastication.
Renee’s occlusal problem is worse than that because there is no disclusion at all, just extreme interference on the first molars on the right side. I suppose she’s lucky that she has not fractured the buccal cusp of #3 or lingual cusp of #30-yet.
Left lateral excursion also shows no canine guidance and in this case again she’s contacting on the right side (a non-working side interference).
What to do with a problem like Renee’s? In my opinion she should have orthodontics again. As you might imagine, that wasn’t a welcome suggestion. “What? Can’t you just make a night guard that will fix me?”
I don’t think so. How much good will a night guard do for someone who has excessive right side force every time she closes—and she closes to swallow every two minutes during her waking hours. What good will a night guard do for someone who cannot eat without pain. No, her occlusion needs to be corrected and in a major way. A little equilibration will not suffice for her.
What’s the take home lesson here? Listen to your patient and then look. Really look. Years ago, I heard Dr. Ron Jackson tell a group, “If your patient is breaking back teeth, look at the cuspids.” Meaning, if your patient is fracturing posterior teeth, maybe she doesn’t have canine guidance. Well, I’d expand that to this: If your patient has symptoms of TMJ pain, look at the cuspids and look for lateral interferences. Maybe there is real TMJ pathology, but take a careful look at occlusion. There may not be any simple answers, but Look.
So, should she just do Botox every few months for the next few decades? That’s the approach that some are following. But why not address the cause?
To the dentist: would you be interested in a hands-on workshop on the use of T-scan to carefully analyze your patients’ occlusion, the results of your restorative dentistry, help with equilibration and so on? Other possible topics could include interpretation of CT scans and MRI, orthotic fabrication for TMD and more. Feel free to contact me.