Degenerative occlusal conditions

Now is the time to observe and treat dental occlusion 
Gordon J. Christensen, D.D.S., M.S.D., PH.D.
J Am Dent Assoc, Vol 132, No 1, 100-102.  © 2001
 … (O)cclusal conditions and diseases should not be neglected by either practitioners or patients. 

  • Bruxism: Excessive tooth grinding is the most prevalent and destructive occlusal condition.2 I estimate that about one-third of the population experiences bruxism or clenching. However, others3,4 have reported bruxism in 5 percent to 100 percent of the general population. Patients subject to bruxism or clenching grind their teeth at various times of the day or night, and usually the tooth wear is catastrophic. Excessive tooth grinding can eliminate canine and incisal guidance in the dentition. The result usually is highly worn teeth, with a relatively flat plane of occlusion, and a group function occlusion in the dentition. If bruxism or clenching is not treated, the centric-occlusion contacts become worn. Patients in these situations have mutilated and unsightly dentitions by the age of 40 years. 
    . What can be done for the bruxing patient? One of the most important methods of preventing bruxism is educating the patient about the condition and its expected consequences. Usually, education reduces daytime bruxism. However, tooth-grinding during sleep is still a problem. Occlusal splints—a treatment method I and others have promoted for many years—help the bruxing patient to reduce or eliminate the damage caused by bruxism. Splints are worn primarily at night, and also during times of psychological stress. Occlusal splints should be a routine treatment in every general practice. Occlusal equilibration also is thought to reduce the tendency of bruxing patients to grind their teeth.
  • Clenching: Clenching has been called “centric bruxing.” A patient who clenches his or her teeth does not grind them in lateral excursive movements; rather, he or she places the upper and lower teeth together and places pressure on them in centric occlusion, the most interdigitated position. The result of this abusive tooth contact is excessive wear in the centric-occlusion position. Canine rise and incisal guidance become steeper, rather than less inclined as in bruxism. The teeth of a clenching patient have the same quantity of destruction as those of a bruxing patient, but the wear is in centric occlusion instead of in eccentric positions. 
    . On a routine basis, every dentist inadvertently causes primary occlusal trauma when placing restorations in teeth. 
    . Treatment of clenching is similar to that of bruxism. Education of patients is essential to obtain their assistance in preventing further tooth destruction. Occlusal splints worn at night and at times of psychological stress during the waking hours can reduce or eliminate the tooth destruction caused by excessive tooth grinding. Occlusal equilibration often is indicated to reduce the tendency to clench the teeth. If a dentist merely “watches” patients as they wear their teeth down, he or she is practicing supervised neglect and contributing to continued tooth destruction. (…) 
  • Temporomandibular Dysfunction: Everybody talks about temporo-mandibular joint dysfunction, or TMD, but only a few dentists treat it. The reason for non-treatment is the condition’s multifaceted nature and psychological overlay. Most dentists would agree that most short-term TMD is muscular in nature. These muscular TMD cases are the ones that general practitioners should be treating. I approximate (from my 40 years of treating TMD) that they compose nearly 80 percent of the TMD cases that come into a general practice. Usually, pain is present in the muscles of mastication; there is limitation of mouth opening, and a generalized feeling of worry and helplessness on the part of the patient.  
    . Most dentists use occlusal splints as the first and foremost therapy for TMD. After a period of observation, and reduction of the muscle pain, an occlusal equilibration is accomplished to make the teeth come together in a harmonious interdigitated position. Usually, muscular TMD cases can be treated in this manner in a few weeks. More complicated cases involving bone degeneration or chronic long-term pain are far more difficult to treat. Some require surgery, long-term physical therapy or drug administration. I suggest that general dentists should be actively involved in treatment of simple muscular TMD, and that they should refer more complicated cases to other competent practitioners in their geographic area.

Extracted from Now is the time to observe and treat dental occlusion 
Gordon J. Christensen, D.D.S., M.S.D., PH.D.
J Am Dent Assoc, Vol 132, No 1, 100-102.  © 2001

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