Seeing Your Patients With New Eyes

Traditional dental diagnosis focuses on individual teeth, periodontal health, and how the teeth and arches relate to each other when a patient fits their teeth together. But there is more to oral health and functional occlusion than bacterial counts and simple interdigitation. The teeth function within a three-dimensional system along with the tempormandibular joints and masticatory muscles. Neuromuscular dentistry asks us to take all three of these components into account whenever we consider even the most minor changes to the teeth or bite.

Through the years I have seen many patients with technically beautiful Class I occlusions who suffer from a great deal of pain and masticatory dysfunction. I make a point of asking every patient – no matter how perfect his or her occlusion may seem – if their “bite” feels comfortable to them, and the answers I get can be amazing. Many people will say yes, they are comfortable – sometimes even when the occlusion is technically compromised. But a surprising number of people with seemingly perfect occlusion tell me no. These are some of the comments I hear:

“Which bite are you talking about? I bite differently on the right and left side.”

“I have to pull my jaw backward to get my back teeth together.”

“My bite doesn’t feel solid.”

Some of these occlusion problems are developmental, and many are related to mouth breathing and/or a compromised airway in childhood. But far too many of these cases are iatrogenic – we dentists help to cause them by doing “individual tooth” dentistry without first analyzing basic jaw function. Or we cause it by moving the teeth orthodontically to a beautiful, but ultimately dysfunctional, position.

Neuromuscular dentistry requires us to look at our patients with different eyes – to begin our diagnosis by assessing the larger picture of three dimensional jaw function first. This can be as simple as asking the patient to do some gentle stretching and then asking them to tell you which teeth touch first when they close the FIRST time. Or paying attention to the wear facets on the teeth, particularly on the anterior teeth. Or making sure the muscles of mastication are working together. Only then can we begin looking at the individual teeth and the periodontium with a more informed understanding of the dysfunctional conditions that may also be contributing to other forms of pathology in the mouth.