Occlusal disease - the modern day dental problem

By Dr Marike Lourens (BChD) and Dr Arno Weber (BChD, Oral Pathology)

Intercare Glenfair Medical and Dental Centre

Occlusal disease is caused by an imbalance between the teeth, the chewing muscles and the jaw.The consequences, if left untreated, are many, progressive and widespread. The disease is not limited to the older generation.

Signs and symptoms are the following:
  • Loss of hard tooth tissue

*Attrition: teeth repeatedly rubbing against each other.

*Erosion: acid eating away at the teeth.

*Abrasion: extraneous objects repeatedly rubbing against the teeth. Most often this is seen on the neck area of the teeth close to the gum-line and is due to traumatic ‘scrubbing’ toothbrushing technique, but it can also be due to things like opposing tooth crowns, pens, needles etc.

*Abfraction: When a tooth is occlusally overloaded, the flexion around the neck can cause stress fractures of the outer layer (enamel) of the tooth.

It’s important to realize that the outer layer of the tooth (the enamel) is much harder than the inner dentin and root surface. Once the outer layer is rubbed or eroded off, the damage to the tooth will progress much quicker.

  • Splayed/Flared front teeth with spaces between the teeth

*Loss of posterior tooth height will lead to the forward positioning of the lower jaw in order to try and establish posterior contact. This will push the upper anterior teeth forward and create the flared appearance.

  • Cracking of the teeth
  • Mobility of the teeth
  • Pain in the tooth when biting

*Overloaded teeth can cause compression of the ligament around the tooth and even the blood- and nerve supply to the tooth.

  • Oversensitivity to cold and warm foods
  • Pain in the muscles of mastication and even migraines

Treatment is aimed at correcting the centric occlusion, allowing the condyle to assume the correct position in the joint and for the masticatory muscles to relax. In the beginning stages of the disease, only minimal invasive treatment is needed but once the disease progresses, a multidisciplinary approach is often needed, involving not only your general dentist and laboratory technition, but also an orthodontist, periodontist and/or maxilla-facial surgeon. Total rehabilitation of the occlusion often involves many months of treatment. Proper planning is essential and requires aids such as articulated study models, a wax-up of the proposed outcome and multiple X-rays.

Regular dental check-ups will allow early detection of the problem and proper treatment thereof. Occlusal guards for patients who grind at night might also be helpful.

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