WHAT IF THE BITE IS NOT RIGHT?
Let’s take an example of how an imperfect bite can affect you in ways that you would normally think of as non-dental reLated. The American Council for Headache Education states that “tension-type headaches are the common headaches of everyday life” and that they are associated with muscle tension. Many of these headaches are temporal headaches — focused in the temple area of the head. And what did we just learn is in the temple area oIthe head? The posturing (temporalis) muscles of the jaw! These postural muscles should be relaxed and barely working when you are not eating, speaking or otherwise using your jaw. However, if they must work overtime to posture the jaw because the teeth don’t naturally fit together right, they can go into spasm (constant tension) and produce pain in the forehead area. Some temporal headaches may result from other sources, but neuromuscular dentists have learned that a high percentage of them are a result of an improper bite or subconscious bite habits.
Neuromuscular dentists evaluate the muscles and joints to establish a neuromuscular occlusion that they believe is crucial to achieving optimal results in every type of major dental procedure and in treating many types of pain and dysfunction. We will explore the scientific methods the neuromuscular dentist uses to plan an idealized bite and see how the bite affects the most common major dental procedures. No matter what type of treatment you are considering, it will help you understand the importance of getting your bite right.
HOW DO WE GET THE BITE RIGHT?
Before we explore how important the bite (and neuromuscular occlusion) is in virtually every type of major dental procedure, let’s see how the neuromuscular dentist goes about evaluating your bite and establishing your neuromuscular occlusion. They may use a combination of the following aids to help with their diagnosis.
Using computerized instrumentation, the neuromuscular dentist can precisely measure jaw opening and study the pattern of opening and closing through its full range of motion and in three dimensions. The computer can also document the precise point at which your jaw is being held in relation to the upper teeth. This is accomplished by putting a tiny magnet on your lower gingiva and having you wear a light weight spectacle-like sensing device. The sensors can determine the location of the magnet on your jaw with pinpoint accuracy and in all three dimensions.
Observing action of the jaw on a computer screen, the neuromuscular dentist can follow the path of the jaw as you open and close and detect abnormal movements that may otherwise be so subtle that they are not detectable.
When muscles are functioning, they generate tiny electrical signals. These signals can be detected through electrodes adhered to the skin, using much the same technology as that used to evaluate heart function using an electrocardiogram (EKG). The more forceful the muscle action, the greater the strength of the signal produced. This procedure, called surface electromyography (SEMG), uses the same computerized system as used in jaw tracking studies. it requires placing small adhesive electrodes on the skin over various muscle groups. The electrical signal generated by the muscle is displayed on the computer and recorded. Data is then studied by the doctor who observes the patterns on the computer screen.
For example, seeing a high degree of muscle activity when the jaw is at its neutral or resting state shows the doctor that there is muscle activity or spasm present when there should be practically none. Status of the muscle will be recorded both before and after relaxation allowing the doctor to determine the degree of muscle spasm that was present. Only by this means can quantified, objective data be obtained concerning the state of the muscles.
If the dentist is concerned about the condition of the temporomandibular joints this test maybe conducted. This is another computer-based evaluation procedure. By means of two small detectors worn over the joints much like small headphones, tissue vibrations resulting from underlying joint sounds are detected and captured. Analysis of the resulting data provides the dentist with additional information with respect to the condition and function of these joints.
All three of the above procedures are painless and non-invasive — they simply capture data from the body. The data is stored on the computer and can be stopped, started, or replayed as often as desired, permitting the dentist to study the information in detail. Just as with x-rays and many other forms of medical tests, these procedures do not diagnose — that requires the doctor’s knowledge and skill in interpreting the collected data. Most often data is collected on an early visit to record your baseline information, and then data may be taken again after muscle relaxation or treatment. In this way the dentist can compare the “before and after” data to aid in diagnosis or to assess treatment progress.
The dentist may want to view the structure of the occlusion and the temporomandibular joints as part of the diagnostic process. This may be done by means of trans-cranial dental X-rays or a more sophisticated form of X-ray called Tomography. These are the only tests that would be considered invasive, although the amount of radiation you are exposed to is minimal.
These are the plaster casts of the teeth familiar to most dental patients. They are made from impressions obtained by having you bite into a putty-like material. Plaster is later poured into the impressions, replicating your teeth with a high degree of accuracy. Since they duplicate tooth anatomy, they offer a convenient way for the dentist to study the tooth structure and arrangement of the teeth other than by direct examination. These “models” as they are also called, are integral to many different laboratory procedures involving fabrication of crowns, reconstruction components, and orthotics (splints), to mention just a few. These will also be used when doing a bite registration, physically recording the optimal jaw position.
Once the dentist succeeds in relaxing your muscles and determining the jaw position that corresponds to neuromuscular occlusion, they will want to record that position physically as well as on the computer. The physical recording is done through a process called bite registration. This is done by placing a fast setting putty-like material between your teeth, then bringing the jaw to the desired neuromuscular position. As the putty begins to harden, it is removed from the mouth and placed on the plaster models
of your teeth where it fully hardens. This creates a spacer” between the upper and ]ower models that causes the upper and lower jaw relationship to be in the correct neuromuscular position. it is subsequently used in the dentist’s studies of your bite and, if indicated, is used by the laboratory to create an orthotic that can then be worn to reposition the bite temporarily.