Bite registration decides the fate of the patient. If done correctly, he’s going to be the happiest patient. But the smallest occlusal discrepancy could see him visiting the ENT specialist, the neurosurgeon, the orthopedician and finally the psychiatrist. Almost 80% of patients come to me with TMD (Tempero-mandibular joint disorder) as a result of that discrepancy. They are there as a last resort and that, too, after being advised to meet a psychiatrist to get their aches treated which according to them (the ENT, orthopedics, et al) are mental illusions!
Centric occlusion (CO) is defined as….well, we all know what it is defined as, don’t we? But for a TMD patient, isn’t it that very same CO that has led to the problem? What all we do, to try and coerce that patient into CO….the Dawson’s technique, the forced Dawson’s technique, the hand in mouth technique! Have you ever given it a thought that while forcing the patient to bite into that CO, you may be actually pushing the mandible and hence the condyles backward and upward into the retrodiscal pad of the glenoid fossa? That CO may only be his habitual occlusion which his body may have self repaired to compensate for that small occlusal discrepancy which we always tend to overlook. The muscles that act upon the mandible have been trained by our CNS to keep the condyles in that position to avoid that high point! AND THAT’S HOW WE CREATE TMD! And help our ENT and orthopedic friends!
We need to deprogram those muscles of mastication by relaxing them with a TENS. Then with a highly sophisticated mandibular tracking device (K7), we create the actual occlusion by finding the myocentric occlusion. The difference is that, since the muscles are relaxed, the mandible, more often than not, drops. This exposes the Freeway Space, which has been the real culprit all the while trapping the oral tissues and the condyle. The TENS helps free the mandible from this grip. When the mandible gets free, it has the freedom to move forward. How much forward, is decided by the tracking device. That position is then maintained with a splint or jigs or even crown build-ups and orthodontic treatments.
Forget the sophistication….lets keep it simple…TMD is common in deep bites, midline discrepancies, narrow arches, tongue thrusts, etc. These patients invariably suffer from headaches, neck aches, shoulder aches, tinnitus, pain around eyes, migraines, facial asymmetry, etc. Just think of it – 80% of all those uncured headache patients queueing up at the ENT’s clinic are your patients. Identify these problems and solve it even without the equipments. For example: clear deep bites by giving crown build ups on either side of the posterior arches after bringing the mandible downward and forward to an inter incisal position with an overbite of 1.5mm and overjet of 1mm. Another case would be clearing the midline discrepancy by manually shifting the mandible laterally so that the lower labial frenulum is aligned with the upper labial frenulum. Although, I’d always suggest using the K7.
The problem in India is that, Occlusion is only defined in our curriculum; it is not taught as a subject. Articulated with its opposing tooth, each tooth can be considered a separate occluding skeletal joint. This relates to the position of the condyle in the glenoid fossa which in turn affects the occiput and the cervical spine. Therefore occlusal dysfunctions are orthopedic in nature, representing the terminal end point of the postural chain. Hence, when the TMD disappears, you can see a marked improvement in his posture. So, think neuromuscular…broaden the horizon of your thinking…STOP CONSIDERING YOURSELF AS JUST A TOOTH DOCTOR!