Talking with Patients

Occlusion (Part 2 of 2)Lee W. Boushell, DMD, MS*

André V. Ritter, DDS, MS†

In the previous Journal of Esthetic and Restorative Dentistry’s Talking with Patients, wedefined occlusion and malocclusion and discussed when and why malocclusion is a concern.In this issue we will discuss the diagnosis and treatment of malocclusions.

HOW IS A PARTICULARMALOCCLUSION IDENTIFIEDAND TREATED?

Malocclusions can be diagnosedduring careful, routine dentalexaminations. The tendency todevelop an abnormal occlusion canbe detected early in life. Childrenshould be examined by theirdentist on a regular basis. Earlydiagnosis and preventive therapymay result in the need for lesstreatment later in life. The dentalexamination may include makingreplicas of the teeth that are usedfor more in-depth study of theocclusion. Patients that developexcessive muscle tension, jaw jointproblems, destruction of toothbiting surfaces, loose teeth, orcombinations of these requirecareful analysis of their occlusion.Dentists will often use a devicegenerally called a “bite guard” toassist in this analysis. The biteguard may also be used to helpslow ongoing damage of the occlu-sion. The general dentist, upondiagnosis of a malocclusion, will

assess the potential level of treat-ment required and recommendtreatment or may refer to a pediat-ric dentist, orthodontist, or anoral/maxillofacial surgeon forevaluation and treatment.

Treatment of malocclusion will bedictated by the particular problemthe patient is experiencing. Treat-ments range from relatively simpleadjustment of the bite (by selectiveand precise grinding of prematureor improper tooth-to-tooth con-tacts) to moving the teeth withbraces to more ideal positions.Malocclusion may also requirereplacement of missing teeth ortooth extractions to adjust forbetter alignment of the teeth intothe dental arch, and, in moresevere cases, orthognatic surgery tocorrect jaw abnormalities.

We will expand on commonmalocclusion treatments:

1. When dentists observe areasthat have a greatly increased

tendency for plaque accumula-tion that may result in decay orinflamed gums, moving teethinto normal occlusion may helpreduce the potential for tooth orgum problems. Creation of astable occlusion will distributethe biting pressures more evenlyon the teeth and that may helpprevent gum problems

2. Correcting arch width mis-matches (cross bites) may fostera return to normal jaw growthand proper alignment of theupper and lower teeth. Dentistsare able to expand a narrowupper arch in a growingchild. Adults that requirearch expansion mayrequire surgery

3. Frequently the crowding ofteeth is due to a mismatchbetween the top and bottomteeth, not enough arch room forthe teeth, or a combination ofboth. At times the dentist maybe able to realign the teeth toeliminate crowding. In somecases it is necessary to remove

*Assistant Professor, Department of Operative Dentistry,University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA

†Associate Professor, Department of Operative Dentistry,University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA

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some teeth to allow for properarch alignment and correctionof the occlusion

4. During examination the dentistmay find that the overall posi-tion of one or both jaws willnot allow for healthy occlusionand facial balance to occur.Repositioning of the upperand/or lower jaw(s) usuallyrequires surgical interventionand is accomplished in concertwith elimination of any crowd-ing and establishment ofcorrect occlusion

5. Tooth deterioration and lossmay result in a need for recon-struction of the proper shapeand size of teeth. The dentist

will choose filling or prostheticmaterials based on the causeand amount of destruction aswell as the relative loss ofproper occlusion. The ultimategoal of this type of correctivetreatment is to reestablishnormal occlusion

SUMMARY AND CONCLUSIONS

Occlusion refers to the fit of theupper and lower teeth and arches.The jaw joint position is influencedby the occlusion. Malocclusionmay negatively impact the smileand the ability to chew. The long-term health and stability of theteeth, gums, and jaws may require

correction of some malocclusions.Regular dental examinations mayallow early recognition, initiationof corrective steps, and preventionof more severe malocclusions andassociated dental problems. Thecomplex fit of the upper and lowerteeth and jaws requires carefulattention to detail during bothexamination and, when necessaryto correct malocclusion,dental treatment.

DISCLOSURE

The authors do not have anyfinancial interest in the manufac-turers whose materials arediscussed in this article.

TA L K I N G W I T H PAT I E N T S

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