Mysterious Sudden Change in the Bite? A Place to Look

Dr. Halligan
Dr. Halligan

I’d like to share an email I received last week and then comment. The article referred to is ‘Rethinking Equilibration,’ and is available on my web site. This email is similar to at least three others I have received this month, in other words, his is not a particularly unusual request for help, but it does point out an area of dentistry that needs greater attention.

Hello Dr. Halligan,

I read your excellent article and it sounds like my situation.

Three years ago, I was 44 years old with a history of fillings, crown work and periodontal disease. I received quarterly cleanings from my dentist and periodontist. I wore a bite splint at night that covered my top teeth. I had tested negative for TMJ in 2011, but my jaw and joints were often sore and uncomfortable.

Rather suddenly in 2017, my bite shifted to where I was hitting only on my left side. And I also developed a dull pain in number 14, a long before root-canaled and crowned tooth.

My regular dentist examined me twice and couldn’t determine the source of the pain. He referred me to an oral surgeon who felt it was a gum issue and that I should see my periodontist.

My periodontist said it wasn’t a gum issue and the pain I was feeling in 14 was related to my occlusion. He said he would perform an equilibration to even it out. He just used the occlusal contact paper and started drilling. He finished in probably 10 minutes.

The result was similar to what the patient in your article experienced. Contact points on the molars were removed and my jaw felt like it was floating. The bite was totally off and uncomfortable. I went back to the periodontist and he tried to correct it.

No shock absorption is the perfect way to describe it. The bite is still not correct and my jaw is constantly sore and uncomfortable. My bite splint no longer fits correctly and I think that is impacting my sleep.

Second opinions have varied from orthodontics for two years followed by veneers and gum grafting, a total reconstruction, basically, to three different dentists who said they would like to perform a proper equilibration. However, I really don’t trust anymore grinding of my now-sensitive teeth and would prefer a restorative approach, but don’t know how that would work.

Any advice or directions would be greatly appreciated. I live in Northeast Ohio. 

I have an appointment in February with a different oral surgeon to reevaluate me for TMJ, but I’ve also noticed a general decline in my aesthetic appearance since my teeth were ground down and my speech has been affected as well.

Thank you and best regards,

(Name omitted)

Ok, Doctor, what do you think?

If you’ve been reading my site for a while, or if you know me personally, you know what to do next: obtain CT scans or MRI, do not reach for the donut diamond, and do not start restorative dentistry without knowing what’s going on with the foundation of occlusion, the joints—the condylar-disc assembly and how they relate to the cranial base. And then fix that problem before proceeding with any other treatment.

MRI of a left TMJ with anterior disc displacement and posterior displacement of the condyle.

And yet this man has seen a periodontist, an oral surgeon, an orthodontist, and three general dentists, and so far nobody has looked at the joints. Perhaps the next oral surgeon he sees will do that. Fingers crossed.

If your car suddenly listed to one side, you’d immediately think broken springs or blown shock absorber. You probably wouldn’t let the air out of the tires on the opposite side to make the car level. You’d get to your favorite mechanic and let him determine the cause and then fix it.

Do I know for certain that the man who wrote the email has a displaced disc on the left side with subsequent posterior displacement of the mandibular condyle on that side? Without MRI or CT scans, no I don’t. But it would be a pretty safe bet, and I’d be happy to put a twenty on it in Las Vegas.

There are plenty of other possibilities such as muscular contraction pain, occlusal problems including lateral interferences, even sleep issues. But my twenty is still on anterior disc displacement on the left side.

Bottom line? Always remember that the condyle-disc assembly, so often ignored and overlooked, is the foundation of occlusion. Sudden change in the bite? It’s not about the teeth.