Thursday, March 25, 2010

10 Occlusal Factors that are often Overlooked in Every Day Dentistry

10 Occlusal Factors that are often Overlooked in Every Day Dentistry

by Clayton A. Chan, DDS
Founder/Director Occlusion Connections - Center of Neuromuscular Dentistry & Orthopedic Advancement

1. Ignoring the status of both left and right temporomandibular joints – condyle/disc relationship within the glenoid fossa. Most within our dental profession do not have a complete grasp of proper condyle/disc relationship, let alone how to optimized the disc if it was in the wrong position (e.g. anteriorly or medially displaced). Clinicians must recognize that occlusion doesn’t start with the status of the TMJ condition, but rather with what is the status of the masticatory muscle system that contributes to the ills of joint degeneration.

2. The status of the masticatory musculature is often overlooked and rarely considered a significant factor when it comes to evaluating the existing occlusal condition of the mouth. Worn dentition, facets, chipping, broken or missing teeth, are indicators that have direct correlation to muscle imbalance problems. How to recognize muscle problems is often ignored and not understood by most clinicians. The fact that even the most astute clinicians do not understand how to resolve cervical neck imbalances, masseter facial pain complaints as well as occipital pain problems at the base of the back of the head is a clear indicator that most may talk about muscle problems, and may even use TENS, etc, but don’t know how to clinically address these problems effectively, shows a significant lack and necessity to learn the proper principles of occlusion.

3. Vertical Dimension of occlusion is often ignored during routine clinical examinations and or overly emphasized when recognized. Most clinicians do not realize how to optimally find the proper vertical position, even if they were faced with a severely overclosed bite. On the flip side, many don’t know how to find the proper vertical dimension of occlusion if they were faced with an anterior open bite case problem. The Physiologic Rest Position CAN be effectively used to establish a reproducible VDO. The challenge is that our dental profession doesn’t understand how to establish physiologic rest as it relates to condyle/disc relationships and correlate it to proper muscle posture in 6 dimensions, thus they don’t believe it is possible to use Physiologic Rest as a determined in establishing a proper vertical dimension.

4. Proper transpalatal width dimension is another misunderstood and or highly unrecognized problem within the dental profession. Without a clear understanding of muscle health as it relates to proper mouth breathing and tongue postural dynamics the so called neutral zone cannot be established. If muscles are not measured, neither are they properly relaxed prior a diagnosis (establishing a proper maxillary to mandibular cast relationship), how can proper clinical treatment begin for either orthodontic or restorative therapy? How can any clinician proceed to a finalizing phase without proving the final end game and expect a stable neuromuscular result?

5. Establishing Myocentric is one of the most challenging of all. Where is it? What vertical should be used to establish a proper myocentric? And what jaw closure pattern (NM trajectory) should be used to establish a proper myocentric? If a trajectory closure path is not properly identified while at the same time the hidden joint dysfunction is present, then it makes it more difficult for the clinician to remedy the occlusal/muscle/joint problems. Myocentric can be achieved without manual manipulation techniques of the jaw and or having to lay the patient back in a supine position. Gravity, condyle/disc, occlusal and muscle dynamics all play a role in establishing a proper terminal contact position (the bite) even if one is using the K7 or whatever method or bite technique. The bite must be placed in neutral.

6. In the neuromuscular community we shouldn’t have to worry about long myocentric problems. If ones experience has been to observe the patients jaw to shift down and forward during occlusal adjustments after a TENS bite or K7 bite was taken, perhaps a re-evaluation of the techniques learned will help move one forward to appreciate what it means to “optimize” the NM trajectory or optimize the TENS bite. The use of the term Optimized is now being used to give the impression that the bite is being taken correctly, but the fact of the matter is if the clinician has to verbally coach the patient to a particular position (move up….let the jaw float back….more to the left or more to the right, etc. etc. etc.) even if using the K7 Scan 4/5 is a clear indication that the bite is in actuality being forced and may not really be optimized. The clinical application, methods and or techniques presented must be questioned and re-evaluated. At OC the clinicians are discovering that when the bite condyles, disc and muscles are truly optimized on a proper trajectory very little verbal coach needs to be used and one finds that finding the isotonic optimal trajectory takes on a different meaning.

7. Anterior contact and disclusion is a gnathologic concept that must be acknowledged, when you have established an optimal trajectory/closure pattern. To ignore and or dismiss the need to have anterior contact (especially in restorative dentistry) is an admittance of a lack of neuromuscular occlusal understanding, especially if one is seeking optimal occlusal posture and dynamics. Determining the angle of disclusion during protrusive, retrusive as well as the various lateral movements is crucial and significant to any student of occlusion, thus a need to learn GNEUROMUSCLUAR OCCLUSION.

8. The envelop of physiologic function cannot be achieved if the basics to proper VDO, muscles rest, condyle/disc optimization, head and mandibular postural balance is not acknowledged clinically.

9. The angle of the Occlusal Plane is significant and does make a difference as to long term maxillary to mandibular occlusal stability as well as skeletal/structural balance. To ignore what nature has designed as a template and insist that the occlusal plane is to be leveled (flat) relative to horizontal level is a masking of how the stomatognathic system really works. How to determine a proper occlusal plane must be learned and or re-learned in certain cases. Why the occlusal plane is angled is important, because it relates to the anterior teeth and posterior disclusion and functional occlusal dynamics as well as head, neck and shoulder posture.

10. Lastly, occlusal contact management is often under estimated among clinicians today. The power of micro occlusion and its relationship to proprioceptive response as it relates to the central nervous system is tremendous. It does take time, skill and a clear understanding of how the body works. Thank goodness for patient adaptive capacities, but one the adaptive capacity of patients are sick and dysfunctional it now is in the hands of the treating clinicians abilities to try to meet those demands placed on him or her to meet those occlusal challenges in a time, efficient manner. Taking the Psychosomatic route is another means to mask and ignore the real issues of being a physician of the mouth. Taking the route of treating the Somatopsychic takes knowledge, understanding, patience and skill. It can be learned and properly implemented.

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