In simplistic terms, “occlusion” refers to your “bite.” But this oft-neglected or outright ignored aspect of dentistry plays as large a role in long term oral as periodontal disease. Periodontal disease is the leading cause of tooth loss among adults. Our understanding of the connection with chronic gingival (gum) inflammation with systemic diseases like heart disease, Alzheimer’s disease, and Parkinson’s Disease is growing every year. We also now understand the critical importance of obstructive sleep apnea and many dentists are taking the responsibility to screen for it at our routine visits with patients. Many people see their dentist far more often then they see a physician.

Dental school taught me to be a gum-disease and cavity sleuth. They also introduced us to a nebulous idea called “occlusion” and some basic concepts we never confronted in totality beyond conceptualization and terminology. We learned to deal with a person‘s bite one tooth at a time as we performed fillings and crowns. Denture occlusion is a different concept that we explored rudimentarily and with limited exposure. Then we were released from the harbor to set sail with sails full and no idea how to navigate anything but favorable winds and waves around rocky shoals.

In my last blog, I mentioned that relationship-based dentistry is the first pillar of my practice philosophy. Some readers have asked me what the second pillar is. The answer: occlusion.

The simplistic idea of a person’s “bite” doesn’t capture the complexity of what ”occlusion” entails. One component is the way teeth contact each other. But that is related to several elevating (biting) muscles and several opening/positioning muscles. These are also connected to one of the most complex joints in the human body and the only one that can move in three dimensions. It can rotate to a little more than 1 inch of opening and then it must translate forward to open fully. No other joint in the body is evolved to do this and when it does move this way, trauma is often involved and we refer to the injury as a dislocation.

What determines where the jaw is positioned? Many people say, “I have TMJ.” TMJ simply means “Temporomandibular Joint”. What they mean to say is they have “TMD” or “Temporomandibular Joint Disorder” and, often they mean “OMD” or “Occlusal Muscle Disorder.” This condition can lead to various symptoms ranging from limited motion and pain in the muscles to ringing in the ears and headaches. Because of our body’s remarkable ability to adapt, some of the most common symptoms are rarely painful: broken teeth, loose teeth, heavily worn teeth, gum inflammation, and bone loss. 

When a patient breaks a tooth, 9 in 10 will tell me something along these lines: “I wasn't evening eating something hard!” I’ve come to expect to hear that from them and would be surprised if they told me otherwise. Why? Because the primary cause of tooth fracture Is the patient’s bite or occlusion. Ninety percent of people DO NOT have a “bite” that is balanced when the joints are positioned in their most stable position. But they’ve adapted to not feel discomfort. They may have a little “clicking” in the joint but they are comfortable. 

When grinding our food, our teeth don’t actually touch since food is crushed between the “mortar-and-pestle“ anatomy of our molar and premolar teeth. Thus, we understand that “para-function” or the activity of teeth outside of chewing, speaking, and swallowing is a greater threat since teeth are working against each other. The jaw functions as a Class 3 lever. When we can move this parafunctional contact of the teeth more forward, we can mechanically decrease the amount of force placed on the teeth. In addition, elevator muscle activity is inhibited by the contact of front teeth (the 6 teeth from canine to canine) in the absence of contact of teeth behind this. So your front teeth actually can play a protective role for the back teeth if their relationship is harmonized by orthodontics or equilibration. 

This phenomena can explain the wear and fracture of many people‘s teeth, particularly as we age and our teeth have more time to accumulate micro-traumas from years of use. Neglecting this complex component of our oral health often results in painful outcomes and expensive solutions later in life. For a problem that takes years to manifest to a patient, it can take months to years to rehabilitate. For the majority, solutions are simple both for prevention and correction.

When I joined my first practice out of dental school, occlusion remained a mystery I hoped I wouldn’t have to deal with. My first employer and mentor didn’t communicate the ideas any better than my college professors. When I started seeing my work come back with broken fillings, crowns, and simple tooth pain, I felt at a loss. Not only that, but the PPO driven, insurance reimbursement model of practice rarely compensates for even the exam portion let alone treatments necessary to diagnose and manage occlusal disease. So, my boss and his practice didn’t do it. We referred most jaw pain to an oral surgeon.

During this time, I remembered a couple of dentists in Oklahoma City, where I attended dental school, who spoke simply and confidently about occlusion. They made the complex concept simple and expressed that it was comprehendible to any of us. (My dental school professors repeatedly told us how difficult it was and showed us the concepts like a magician performing a parlor trick. We could see the set-up and the result but not the magic that got them there.) I recalled that these dentists—Jeff Baggett and Michael Fling—shared a post dental school commitment to a small institute of dentistry in Florida. So, I attended The Pankey Institute during the summer of 2012 and I am profoundly grateful I did. Over the years with the help of faculty at the institute, the “magic” of occlusal treatment has been made accessible to me and thus, to my patients who deserve the highest standard of care, skill, and judgment a recovering cavity sleuth can offer.

We encourage every new patient in our practice to receive a thorough examination in which we take photos, models of their teeth, and specific measurements and exam of their occlusion in addition to routine x-rays, oral cancer screening, cavity and periodontal exams. We can offer a risk assessment based on those findings and have a baseline of findings with which to compare in the event something does change. We’ve experienced the profound increases in comfort for people who have experienced chronic jaw pain and even for those who accepted treatment and didn’t realize they were in pain until they were relieved of it. Treatments range from occlusal-orthotic therapy to equilibration to orthodontia to a combination of two or more.

The most prevalent rewards for us and our patients is the promotion of well-being. Chronic pain relief does a great deal for mental and emotional health. And we experience the satisfaction of knowing we delivered the highest standard of care for a grateful patient.