Every one of the structures in the masticatory system is interrelated to each other. If we don’t know how that relationship works, then we’re not going to know what to do with these. Let me say it in another way. You cannot be a good tooth dentist if you don’t understand the temporomandibular joints. You can’t be a good TMJ doctor if you don’t understand occlusion. You can’t understand occlusion if you don’t understand how the endo guidance works. You can’t be any better than a mediocre dentist if you don’t understand how all these parts fit together and relate to the neuromuscular system.
So, if we look at it from the standpoint of typical, usual, and customary dentistry, this is what most dentists look at. They see the teeth as being separate from the rest of the masticatory system and that just doesn’t cut it.
To be a complete dentist you’ve got to be a physician of the total masticatory system. And don’t let that overwhelm you because when we start to take the parts of the masticatory system, and look at them individually and see what they do and why they relate to each other, the understanding of these factors makes dentistry simpler, not more complicated.
Dentistry is complicated when we don’t know how the system works, so we’re guessing at everything.
By understanding how all these parts interrelate, we start to make sense out of diagnosis and treatment planning, and all the things that go into being a complete dentist.
So, what does that mean?
It means that you must understand the TMJs, and you must understand the anterior guidance. I think of that as the back end and the front end of the mandible with the teeth attached. And you must understand how the anterior guidance relates to the TMJs. You see, they’re connected, the lower anterior teeth are part of the mandible which is part of the condyle, and you can’t move the condyles without moving the lower arch of teeth. So, the position of the condyles has a profound effect on how the teeth come together. And, so, we can’t separate the teeth from the temporomandibular joints. We can’t separate the front and the back from what’s in the middle, or what’s in between.
You see, the ideal understanding of occlusion is to understand the back end of the mandible and the front end of the mandible and how they relate to whatever is in between. That’s the back teeth. If we put it together like that, we’ll then understand how this combination affects the total neuromuscular system – the elevator muscles, the temporal muscles. When we cause somebody to have a tension temporal headache and don’t know that we were even responsible, that’s not knowing what we don’t know because, the fact is – and I can tell you this with absolute assurance – that far more than 90% of tension headaches in the temporal region are result of occlusal interferences, and you correct the occlusal interference and those muscles quiet right down. The strap muscles, the depressor muscles, they all relate to this total picture of masticatory system harmony.
Disharmony Cause & Effect
What is disharmony within this occlusal muscle relationship do?
Disharmony of any of these parts with each other has a potential for occlusal wear problems. When you see wear on posterior teeth, that is not because the patient bruxes. It is because the patient bruxes with occlusal interferences to the front and the back of the occlusion there. That is a disharmony situation. It is the result of sore teeth. When you have sore teeth, if you can bite down a mega tooth hurt, you have an occlusal problem. That is correctable.
Loose teeth are an absolute sign that the occlusion is an interference with how the jaw works. And how the jaw works is related to what happens at the front and the back, you see. So, when we see any unstable dentitions, that is a very good indication that something is out of harmony with something else in the system. The result almost inevitably is muscle pain and dysfunction.
The number one cause of pain in the system is what we entitled occlusal muscle pain. Because it is muscle pain, that’s the direct result of occlusal interferences or occlusal disharmony. So, we cannot know how to diagnose it and we cannot know how to treat it if we do not understand how the total picture of the masticatory system comes together. Because you see, the various orofacial pain problems are in most instances going to be related in some way to occlusal muscle pain.
However, we have to understand it so we will know when orofacial pain is not an occlusal problem, when it is not a masticatory system problem. That is going to be the great responsibility of dentistry is when patients are referred to us with head or neck pain and say, “Is this a masticatory system problem?” We have to be able to say it is either all the problem, part of the problem, another problem in the masticatory system. It has got to be something else. So then, we can get that patient into proper specialist hands. So, it is very critical that we understand the system so we will know when it is a problem that is related and when it is not related and we can do that. We can do that very accurately.
What about fractured teeth or fractured restorations or those laminates that you put in and then they break? If you think that is just because the patient has stress, you are missing a point. They break because they are in the way – there is disharmony of the system.