This is the second of a two-part series discussing the philosophy of occlusion. Read part I, Is The Bite Right?.
The crucial question of occlusion is not which philosophy to follow, it's to understand when will different approaches not be successful. And if it's not going to work, what is it about the approach that's going to make it not work.
What really determines whether a patient's occlusal relationships are successful is the ability of a patient's masticatory system to tolerate their level of muscle activity.
The concept of a threshold of adaptability is the point at which patients develop symptoms, and it's different among patients. Also, the same patients' thresholds can change at different times and in response to events in their lives.
It's important to know when the occlusion is not within the adaptability threshold and how to alter it. Occlusal therapy needs to be individualized for different patients. What are the goals for the occlusion?
- For the patients to close into their intercuspal position without inducing excess muscle activity, joint loading, or stress on the teeth.
- For the patient to function during chewing, swallowing and speaking without inducing excess muscle activity, joint loading or stress.
- For the occlusion to not initiate any non-functional mandibular movements or muscle activity.
How does all of this affect clinical practice?
Step 1: Examine the joints, muscles and teeth to determine if the existing occlusion is physiologic or pathologic. Is the patient's existing occlusion within an acceptable range of adaptability?
Step 2: Following the examination make a diagnosis of the current occlusion. Is it physiologic (acceptable range) or is it pathologic (tooth wear, joint problems, etc.).
If patients have a physiologic occlusion you have to ask if you are going to change it. The most common reason is the patient has to restore a single tooth, or several. In some cases, if you alter a patient's occlusion, you will destabilize it. If it's determined that change is necessary, where are you going to change it? Are you restoring a posterior tooth or an anterior tooth?
If a patient's current occlusion is pathological how are you going to change it? What is that you do differently?
If patients don't have any occlusal issues, we are still at risk because whatever is altered may potentially change what they have that's working for them. If patients do have occlusal issues, dentists have to determine what to change.
To view a preview of a video series on occlusion presented by Dr. Frank Spear from Spear Digital Learning. To learn more about the upcoming seminar, “Demystifying Occlusion”.