The areas of occlusion (dental bite) in dentistry hasn’t had much emphasis until recent years, meaning dentists haven’t been involved in treating patients with disorders relating to their bite and the related joints and muscles. As a rule of thumb, the specialty most involved in this area is orthodontics. Areas of dentistry that have been involved in treating temporomandibular dysfunction include prosthodontics, periodontics, oral surgery, and general dentistry. Currently, temporomandibular dysfunction (TMD) refers to the syndrome, and temporomandibular joints (TMJ) is used to describe the anatomy of the location.
Before your teeth erupt (come through your gums as they grow), your skeletal size is already partially formed. Because your primary (baby) teeth and permanent teeth erupt into the mouth one by one, your upper and lower teeth will occlude (come together) in an irregular manner in direct relation to:
- Tooth size
- Size of the upper and lower jaws
- Relation of the jaw joints in the head
- Relation of jaws to one another
- Your health and oral habits
And many other factors. If each factor occurs in relation to the way as intended by nature, the teeth occlude correctly. However, if one or more of the related factors is not correct, malocclusion (incorrect bite) may occur, teeth may develop in a crooked manner, and the bite may be abnormal. Other factors that can cause a poor bite include:
- Genetics
- Improper jawbone development
- Accidental trauma to the mouth
- Dental fillings
- Bridges and dentures
- Conditions such as arthritis and many others
Although poor bite doesn’t automatically contribute to jaw dysfunction, pain, and joint disintegration, one of the conditions associated with temporomandibular disorder is a bite that is misaligned. This condition causes significant pain and distress among patients, and confusion among both patients and health practitioners. Not all dentists treat malocclusion, so you are always advised to initially discuss any issues you may have with your general dentist. If they do not treat this condition themselves, they will refer you to a specialist.
What You Feel or See: Conditions, Signs and Symptoms Related to Occlusion or Temporomandibular Dysfunction
- Pain in the Head, Neck and Shoulders
Very often, pain with no obvious cause is the result of muscle dysfunction related to misaligned occlusion, which is described as temporomandibular dysfunction, or simply TMD. There are many causes of head, neck and shoulder pain, and it is advisable to speak to your dentist before concluding or dismissing TMD as the cause. Pain caused by TMD is usually located in:
- The sides of the head (temples)
- The sides of the jaws (cheeks)
- Either side of the neck, back of the head, top of the shoulders, and upper back
Pain in each of these areas may be felt at the same time. However, head pain is not usually related to the jaw if it felt in the forehead, eyes, nose, or the top of the head, and pain experienced in these areas do you usually indicate a problem with the jaws. There are many ways to diagnose occlusion issues, along with many treatment options. The most simple and commonly used treatments include:
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Muscle relaxants
- Physical therapy
- Hot or cold packs
- Transcutaneous Electrical Neurostimulation (TENS)
- Do nothing
- Popping or Clicking Jaw Joints
You may hear or feel a ‘pop’ or ‘click’ when you open and close your jaw, and the noise may be loud enough for others to hear, or so slight that only you can hear it. You may or may not feel pain when this sound happens, and you may be able to stimulate the sound by moving your jaw in a certain way, or by placing stress on the jaw when chewing. A pop or click without pain may not indicate a problem, but pain may suggest an issue is present. The most used therapies for treating jaw joint popping or clicking include:
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Muscle relaxants
- Physical therapy
- Hot or cold packs
- Transcutaneous Electrical Neurostimulation (TENS)
- Orthodontic therapy
- Do nothing
- Grating or Grinding Sounds in Jaw Joints (Crepitus)
A ‘gravelly’ grinding sound may occur in the jaw joints after many months or years of jaw dysfunction, or other conditions such as arthritis or an accident. This condition often indicates the jaw joints have been worn, but may not necessarily be associated with poor occlusion (bite). Unfortunately, when this noise occurs, the possibility of implementing a simple and successful treatment is greatly reduced. The available treatment methods for grating or grinding jaw joints vary from fairly simple to incredibly complex, and may include one or more of the following:
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Muscle relaxants
- Physical therapy – muscle exercises
- Transcutaneous Electrical Neurostimulation (TENS)
- Surgery on the temporomandibular joints
- Oral rehabilitation – rebuilding the teeth to improve occlusion (bite) with fillings, crowns, bridges, etc
- Orthodontic therapy – removing teeth to improve occlusion (bite)
- Do nothing
- Can’t Open or Close Jaw
Occasionally the muscles, ligaments, and bones associated with jaw movement can become misaligned, resulting in an inability to open or close the jaw. This can be both frustrating and very painful. Your dentist may be able to manipulate your jaw in their office to remedy this, but in many cases further treatment is required. One or more of the following treatments will usually be needed:
- Physical therapy – muscle exercises
- Transcutaneous Electrical Neurostimulation (TENS)
- Muscle relaxants
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Do nothing
- Teeth Are Visibly Worn From Bruxism or Jaw Clenching
Around a quarter of the world’s population grind their teeth excessively, which wears the teeth down well beyond what would normally be expected. This condition is known as bruxism or clenching, and often goes undetected during the early years of life. It is often the case, that this condition is only noticed, diagnosed, and treated after much damage to the tooth structure has taken place, and death of the teeth can occur. Patients that brux or excessively clench their teeth often have the following treatment options:
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Oral rehabilitation – rebuilding the teeth to improve occlusion (bite) with fillings, crowns, bridges, etc
- Removable partial denture to cover the chewing surfaces of the teeth
- Hypnosis to help slow or stop the bruxism
- Do nothing
- Loose Teeth (Primary or Secondary Occlusal Trauma)
The occlusion (bite) can cause teeth to loosen through becoming overstressed (primary occlusal trauma), or conditions such as periodontal disease and excessively forceful chewing can also lead to loosening of the teeth (secondary occlusal trauma). If the teeth have become loose but the gums and bone are in good condition, the following options may be available:
- Occlusal splint (bite splint)
- Occlusal equilibration (bite readjustment)
- Do nothing
In situations where the teeth are loose and the gums and bone have weakened, available treatments include:
- Periodontal therapy
- Occlusal equilibration (bite readjustment)
- Occlusal splint (bite splint)
- Splinting teeth
- Do nothing
- Teeth Do Not Occlude (Meet) Correctly
Your chewing may be affected because your occlusion (bite) is not correct. This condition is often caused by mispositioned teeth in the dental arch, or a difference in the size of your teeth relative to the size of your jaw (teeth are too small or too large for the jaw). The following treatment alternatives are available:
- Orthodontics (move teeth)
- Oral rehabilitation – rebuilding the teeth to improve occlusion (bite) with fillings, crowns, bridges, etc
- Orthognathic surgery
- Occlusal equilibration (bite readjustment)
- Do nothing
What Your Dentist Can Do to Treat Occlusal (Bite) Problems
Hot or Cold Packs
Advantages
Placing hot or cold packs onto the affected area is a fast, simple, inexpensive, and moderately effective treatment.
Disadvantages
Rather than cure the disease, hot or cold packs only alleviate any pain you may experience. However, this reduction in pain allows additional therapy to continue at the same time. Placing hot or cold packs can become habitual, and should be used sparingly.
Risks
Unless this treatment is used excessively, there are no risks involved. Overuse of hot packs can lead to damage of soft tissues.
Alternatives
Muscle relaxants, physical therapy, pain medication, and application of Transcutaneous
Electrical Neurostimulation (TENS) are all possible alternative therapies.
Cost
The cost is very low if hot, moist towels or ice in a plastic bag are used. Moderately priced cold or hot packs are also commercially available.
Result of Nontreatment
Pain will continue and function may remain limited, but the condition may ease without treatment after a short period of rest.
Hypnosis for Occlusal (Bite) Issues
Advantages
Hypnosis can be successful in the reduction or elimination of clenching or grinding teeth, headaches, and other related issues. The cost is relatively low, and this treatment is simple and painless to apply, and can be used to manage many physical conditions.
Disadvantages
While hypnosis can be an effective treatment for many people, it does not work for everyone. It can be a time consuming process, and requires complete acceptance and cooperation of the personing undergoing treatment. Only a very low percentage of healthcare practitioners offer hypnosis as a therapy, and finding a practitioner that does will often require a high level of effort.
Risks
Contrary to many popular beliefs of hypnosis, patients are in complete controls at all times during treatment. Professionally managed hypnosis presents no risk to the patient.
Cost
Although significantly less expensive that alternative options such as surgery and oral rehabilitation, the cost of hypnosis is moderate, and often requires a significant time investment.
Result of Nontreatment
The condition would continue unless alternative therapies were applied.
Muscle-Relaxant Medications
Advantages
Discomfort and pain caused by muscle tension will usually reduce quickly, often allowing normal function of the affected area.
Disadvantages
Because the muscles to be relaxed cannot be targeted, muscle relaxant drugs will usually relax other muscles in the body. This can cause tiredness and limit both physical and mental activity.
Risks
All medications have possible side effects and potential to trigger allergies. If used to treat occlusal problems, use and dosage should be limited.
Alternatives
Other possible treatments include hot or cold packs, physical therapy, pain reducing medication, and Transcutaneous Electrical Neurostimulation (TENS) application.
Costs
Short-term use of muscle relaxants usually incur a moderate cost.
Result of Nontreatment
Pain will continue and ability to move the affected area will remain reduced unless alternative treatments are applied.
Occlusal Equilibration (Bite Readjustment)
Advantages
To aid correct contact of all teeth at once, the bite can be adjusted by removing small amounts of previously placed crowns, bridges, or unworn sections of enamel on the chewing surfaces of the teeth. When the teeth of the upper and lower jaws meet correctly, the pain and discomfort of the jaw soon disappears. Under normal conditions, this technique is simple to implement, logical, and painless, while immediately correcting the imbalance of the bite.
Disadvantages
The removal of small pieces of the tooth structure, or dental filling or prosthesis material may be considered a disadvantage by some. However, without doing so, the condition will continue as it cannot heal itself. This procedure can be compared to car tires being unbalanced – they will remain unbalance and affect the performance of the car until they are altered.
Risks
In situations where fillings, crowns, or tooth structure require alteration to balance the bite, an experienced dentist will have no problem making these changes. The risks of this option are very low.
Alternatives
There are very few alternatives available if the jaws are truly misaligned because of incorrect tooth contact. Possible alternative options include continuously wearing a bite-correcting splint, or rebuilding the fillings, crowns, and bridges to help correct the relationship.
Cost
Bite adjustment therapy is moderately priced, often costing more or less the same as one crown.
Result of Nontreatment
The condition and related pain and discomfort will continue or worsen.
Occlusal Splint (Bite Splint)
Advantages
As it can be removed from the mouth, wearing any type of bite splint is reversible, and the effects of this therapy are very effective. Splints work by directing the teeth to meet correctly or opening the bite, which places biting force on the front teeth to relieve stress. Splints also prevent excessive grinding from harming the remaining tooth structure, as the they are worn on the opposing teeth.
Disadvantages
The pain relief provided by an occlusal splint is only effective while the splint s being worn. The associated pain often returns if the splint is not worn for a significant amount of time. Occlusal equilibration (bite adjustment) is often required after the splint has reduced pain to ensure the teeth occlude in the saw way provided by the splint. Because they’re softer than the opposing tooth structure used for chewing, splints often wear out after a few years of use.
Risks
If splints are used correctly, there are usually no risks involved. However, dental caries (decay) may develop if the teeth are not thoroughly cleaned each day.
Alternatives
An occlusal splint is one of the most effective and inexpensive methods of repositioning the jaw and protecting the teeth. If your dentist recommends a splint as the best option for your condition, you should take it.
Cost
Occlusal splints are a moderately costing therapy, and depending on the particular needs, usually costs no more than double the cost of one crown.
Result of Nontreatment
Unless another form of therapy is applied, the condition will remain and worsen over time. Although not unheard of, it is very rare for this condition to get better without treatment.
- Oral Rehabilitation
Placing crowns and bridges on most or all of the teeth is known as oral rehabilitation.
Advantages
The correct relationship of the upper and lower jaws can usually be established and stabilized through oral rehabilitation. Additionally, the appearance of the teeth and smile can be improved.
Disadvantages
This procedure can be expensive, and due to normal wear and possible breakage, will often require replacement after several years of use. A significant time investment is also required for this form of therapy.
Risks
Oral rehabilitation can sometimes cause endodontic (root canal) therapy to be required in some teeth, and there is no guarantee that the treatment will completely resolve the jaw problem.
Alternatives
As an alternative to oral rehabilitation, an occlusal splint may be worn indefinitely for developing and maintaining an acceptable relationship between upper and lower jaws, and correct alignment of the jaws.
Cost
Most methods that fall under the oral rehabilitation category tend to be among the most expensive of available dental therapies.
Result of Nontreatment
The condition that requires treatment will remain and continue to worsen.
Orthodontic Therapy (Moving Teeth)
Orthodontic treatment is sometimes required for treating occlusal dysfunction.
Advantages
When treatment is required, orthodontic therapy is used to reposition misaligned teeth back into their correct natural position, and to stabilize the relationship of the upper and lower jaws.
Disadvantages
A large time investment of between several months and several years is required for orthodontic therapy. In addition, the teeth often have many visible wires, brackets, or bands throughout the duration of the treatment.
Risks
Any therapy involving the movement of the teeth carries a risk of developing irreversible conditions such as endodontics (root canal therapy), tooth roots becoming shorter through root resorption (degeneration), along with many others. There is also no assurance that the orthodontic therapy will fully solve the occlusal problem until the teeth have been moved successfully and treatment has been completed.
Alternatives
Some of the available alternatives to orthodontic therapy include occlusal equilibration (bite adjustment), oral rehabilitation (altering the tooth structure), and wearing occlusal splints (bite splints) indefinitely.
Cost
This moderately priced therapy is placed between the high cost of oral rehabilitation and the lower cost of an occlusal splint.
Result of Nontreatment
Unless an alternative treatment is sought, the condition will remain and likely worsen.
Physical Therapy
Advantages
This type of therapy is simple to implement, inexpensive, relatively pain-free, and usually very effective. It is also reversible and non-damaging if used correctly.
Disadvantages
The physical exercises are typically time consuming, and some may induce a certain amount of pain. They initially require some sort of supervision to ensure correct application of the exercises, and a level of self-discipline is required of the patient.
Risks
When applied correctly, there are very few risks involved with physical therapy.
Alternatives
Some other effective alternatives include muscle relaxation and/or pain-reduction medication, and Transcutaneous Electrical Neurostimulation (TENS) therapy.
Cost
The cost of physical therapy is relatively low when compared to some other alternatives.
Result of Nontreatment
Doing nothing will result in the condition remaining and potentially worsening.
Surgery of the Temporomandibular Joints
Advantages
In situations where surgery is required, the likelihood for success is very good, although very few patients require surgery. Only a small number of patients – around 1-5% – have jaw problems severe enough to need surgery.
Disadvantages
Some surgical procedures can be painful, often require several weeks for healing, and can be expensive. Some conditions require the jaws to be wired closed to allow healing for up to 6 weeks.
Risks
As with all surgical procedures, there are many possible risks involved. These include risk from anesthesia, unexpected outcomes, and accidental damage to other anatomical areas.
Alternatives
There are usually no alternative options available when an occlusal problem is severe enough to require surgery.
Costs
Surgery is one of the most expensive options for treating occlusal problems.
Result of Nontreatment
The condition will continue and worsen without some form of treatment.
Transcutaneous Electrical Neurostimulation (TENS)
This form of therapy involves applying a small electrical current to the affected muscles to relax them quickly and easily to reduce pain.
Advantages
TENS offers excellent and fast-acting muscle relaxation therapy and pain relief.
Disadvantages
A large time commitment is needed, and requires cooperation from and understanding of the patient for treatment to be effective. Further, ongoing treatment may also be necessary.
Risks
There are no risks involved when TENS is properly applied. However, certain patients such as those that are pregnant or have pacemakers are not suitable for receiving this type of therapy.
Alternatives
Other acceptable alternatives to TENS include physical therapy, muscle relaxation medication, occlusal (bite) splints, and pain-relief medication.
Costs
TENS is a relatively low-cost treatment.
Result of Nontreatment
Doing nothing will result in the condition continuing and becoming worse.
Problems with occlusion (bite) can be highly complex, sometimes confusing, and in many cases, very difficult to treat. Because opinions can vary widely among practitioners, it is recommended to obtain a second, or even third opinion before undergoing treatment. Occlusal issues require highly competent and experienced practitioners who will cooperate with others on the health team, and full patient cooperation and acceptance is required.