Occlusion "malfunction"

March 25, 2005
Remember the "wardrobe malfunction?" As dental professionals, we need routinely analyze the "occlusion malfunction."

By Kristine A. Hodsdon RDH, BS
Director, RDH eVillage

How many times since the 2004 Super Bowl have we heard the jokes and seen the pictures surrounding "wardrobe malfunction?" What's not a joke are the intraoral pictures and/or patients' symptoms surrounding "occlusion malfunction." Our patients daily exhibit clinical signs and symptoms that call out to us to assess occlusion discrepancies so we can educate and enroll our patients into restorative care.

To facilitate comprehensive care, which comprises the elimination of infections, restoration of proper function, and an aesthetically pleasing smile, consider incorporating the following five sequences into your hygiene examination:

1. Begin each hygiene session appointment with a review and re-connecting with medical and dental histories. Ask questions such as:

Do you have, or have you ever had problems with your jaw, or had any injury to your jaw or face area?

Are you aware of, or ever had any pain/discomfort when you chew talk, open to wide, or close?

Do you hear or have you ever heard grating, clicks, or pops?

Does your jaw ever stick, lock, or has it ever gone out?

Do you or have you ever had difficulty chewing or eating?

Are you aware of any grinding or clenching of your teeth?

Have you noticed your teeth getting shorter, longer, or chipped easily?
These questions may offer indications or open up a conversation into occlusal para-function through identification of tension headaches, sinus pain, or other medical conditions that may begin in the oral cavity.

2. Incorporate a thorough intraoral and extraoral examination, head and neck manipulation/massage, oral cancer evaluation, and adjunctive technologies with each patient. Signs and symptoms of TMD, muscle tension, and/or sinus pressure can all easily be identified during a relaxing head and neck process.

3. Learn how to expand the extra-oral exam to include lateral excursion (mandible moves from left to right across the maxillary arch), and anterior excursion (mandible moves forward), evaluate canine rise, group function tendencies, premature occlusal contacts, and/or the possibility of uncoordinated muscle function.

Begin to ask, "What needs to happen to restore proper function? Could this be a clinical reason to restore teeth?"

4. Train yourself to assess Class V non-carious lesions, tooth mobility, open contacts, tilting or drifting, extreme wear, to localize soft tissue changes.

Begin to ask, "Is this pathology normal?" "Can I identify the cause, or do these conditions need further investigation?" Or, "Is this condition stable?"

5. Review current radiographs or digital images and current full-mouth charting begin to notice changes in lamina dura (site by site), thickening of periodontal ligament, radiolucencies in the furcation or apex, root fractures, root resorption, or pulpal calcifications that could be increasing due to traumatic occlusion.

Understanding the essentials of occlusal and functional concepts supports true comprehensive care and a total oral wellness plan, - plus it can prevent your patients from falling victim to "occlusion malfunction."