I apologize for the lengthy post, but my situation is complex, and I badly need your advice, so please read to the end.
I had a lot of dental work done over the years (all my molars are crowned and I have two implants as well), but my mouth was stable and functional until about two years ago. This is when I was subjected to a bite adjustment (unnecessary in my opinion) that caused an initial imbalance. Since then I’ve seen several dentists who did new adjustments trying to get my mouth back in balance, but each time things got a little worse.
Currently, when I bite straight down I have good contact only on the last molars on the left side, and slight contact on the first molar on the right side. Besides not being able to chew normally, this has caused gum irritation in the teeth that now take more pressure than they should, and also bad breath. Also, it seems to me that after the last adjustment, there is slight contact between the back of the upper front teeth and the front of the lower front teeth when I close my mouth sometimes, which I believe I never had before. However, my bite is not stable enough to know for sure whether this happens in the normal biting position or when my lower jaw makes some movements to try to compensate for the uneven bite.
A couple of weeks ago I went to a new dentist who says he has treated such cases before. He is not a prosthodontist, but a general dentist.
He took impressions of the upper and lower teeth and mounted the diagnostic casts on an articulator to simulate my bite and determine what the problem is and how to fix it. His conclusion is that there is interference from a couple of molars that happens in the neutral, relaxed position of the lower jaw. According to him, this neutral state is when the lower jaw is as far back as possible compared to the upper jaw – in that position the TM joint is in the right position and the jaw muscles are relaxed. However, he said, this interference is causing my jaw to look for better contact between molars, which causes the jaw to slide forward in a less than ideal position. Also, he said the front teeth are not providing guidance to the jaw, which is also a problem (not entirely sure what that means).
His solution is to do a new bite adjustment to eliminate the interference and make all molars touch evenly when the jaw is in its neutral position. He also wants to add composite to the back of the upper front teeth to provide a “stop” for the lower front teeth, and stabilize the bite. It’s this stop I don’t understand – is this going to make my lower teeth touch my upper teeth every time I bite down? Are the front teeth even supposed to touch (not the edges but the back of the upper and front of the lower teeth) when I bite down? Also, each successive adjustment was done by slightly reducing the height of some of the teeth. Isn’t it time to start adding height instead, by replacing some of the crowns for example, when trying to re-equilibrate the bite?
After all I’ve been through, I am very nervous when I hear about yet another bite adjustment, so I would like to hear if anybody on this board has gone through a similar situation, how they solved it, and if this dentist’s plan sounds right.
I have been through this myself and it is very scary. Its unbelievable to me that dentists are "adjusting" bites when there is no need, and are doing far more permanent harm than good by doing so. Apparently there are a few dentists on the seminar circuit or dental schools that are drumming up sales by teaching this procedure called an equilibration or occlusal adjustment.
It was pretty much determined that its useless and potentially dangerous 30 years ago, but some dentists believe that grinding natural healthy enamel from their patients in a futile effort to "optimize" their bite and make a few hundred dollars doing this easy work is worth the risk they are taking. In some cases a small adjustment is needed when a new crown in installed but its sounds like you are going through what I went through.
A new dentist I saw said he had to remove a couple of wear marks he noticed on my molars, and then went ahead and did a lot of adjusting while I was in the chair, thinking he was doing me some big favor. I had never had any bite problems, but my jaw postures slightly forward of what is called "centric relation" which is farther back.
It sounds to me like your dentist thinks your jaw needs to be in this position when it likely never was and you can't tolerate. There is a minority of dentists who think that unless your jaw is in this position you have disease, and need an adjustment to fix this. My bite was ruined, and I have been through 3 years of trying to get my bite back by building the molars back up with composite. It was long, tedious, and since the dentist who did this took no records, a trial and error procedure.
Fortunately the dentist I have has been very patient and helpful and assisted me putting humtpy dumpty back together again. I have talked to a number of dentist who have themselves been suckered into having this procedure done to them and were horrified when their bite collapsed causing TMD, speaking problems and all sorts of other dysfunction.
My opinion is that this "ideal" jaw position called centric relation is wrong, and is only used because its a repeatable position, not a correct one. So if you have a patient with no teeth and need to position the jaw, pushing it all the way back and up so its against the skull is a repeatable position. For whatever reason, some dentists believe that its the only correct position, which I believe is completely wrong, and studies back this up. Its often used to try and cure TMD but studies show it doesn't work in most cases, and is irreversible.
What I found has worked for me is having composite material added to my upper mesio lingual cusps, which is where they typically remove the material to force the jaw back into the skull. Once this was put down my jaw could come forward again, and many of my symptoms have gone away although I still have a ways to go. I am still in treatment 3 years later, but I think I should be able to get a bite that will work back eventually, but its been a total nightmare. The jaw and bite will figure itself out without any need for grinding of any teeth, and dentists are ruining people's bite by trying to make everyone have the same jaw position. I think its malpractice myself, and simply can't understand why a dentist would do this to a patient with no bite problems. It weakens the teeth making them more sensitive, creates interferences and collisions that damage teeth and can wreck the jaw joint. I would find someone who can restore your bite in a reversible way, and then get permanent restorations to give you your vertical dimension and bite back. I am very sorry you are going through this and know exactly the horror that it is. Don't let them grind your teeth down any further. Its like leveling a table with uneven legs. Before you know it your table is inches off the ground. Apparently dentists don't know this, and naively starting grinding using a "dentistry by numbers" methodology and create a huge problem where non existed before. Occlusion is very complicated, but some general dentists think they know what they are doing after attending a half day seminar where they are taught to do this procedure in a rote way to all their patients because its so profitable. Be very careful and good luck.
Last edited by Administrator; 05-06-2012 at 06:14 PM.
The Following User Says Thank You to ariot For This Useful Post: adr (05-05-2012)
Your situation confirms what I've been thinking all along - that most adjustments were just a way for the dentist to make a quick buck, without providing a real benefit, or even worse, with catastrophic consequences.
You also provided me with a good attempt to fix things: add instead of removing. Once a comfortable bite is re-established, I can then go ahead and fix individual crowns if necessary.
No problem, I am not a dentist, but have learned a lot from my current dentist. Fortunately, the jaw is a very forgiving joint, and will self adjust to your current occlusion scheme as long as it stays within some boundaries.
One thing to note, that I didn't realize in my dental ignorance, is that the jaw joint is so adaptable that the jaw position is pretty much determined by the teeth when you shut your mouth as far as you can into what is called maximum intercuspation position (used to be called centric occlusion).
What a dentist did to me was grind down the cusps that kept my jaw positioned forward in a relaxed position to achieve this bogus centric relation position. What they are trying to do is get centric relation equal to centric occlusion or CR=CO. This means that when you bite down into maximum intercuspation, the condyles of the jaw are in this retruded position in the skull called centric relation. If, when you bite down, your condyles are forward of CR, then you are labeled as having a malocclusion and by grinding down the enamel that keeps your jaw forward, the jaw will fall back into the skull into centric relation, deemed the ideal position by dental zealots trying to sell a dental religion.
I am not sure if that is what happened to you, but in my case, it wasn't that I lost all this vertical dimension or height, but that once those supporting cusps were sanded down, my jaw retruded back into my skull, thereby changing the interface of every tooth in my mouth so that no tooth lined up correctly with its opposing tooth, my tongue was now in the wrong place, and many, many other problems occurred immediately following this procedure.
So if you get material added, remember that it might not be that you need added height, but that you might need the occlusal "ramps" or slide back that allows you to position your jaw forward, and once there, you will "find" your old occlusion, still there, but you have been unable to reach it now that your jaw has retruded back, if that is indeed what happened to you.
You have to be careful though, since the jaw will try and adapt to the new material, and you end up going around in circles as the jaw continually adapts. If too much vertical dimension is added it can push the condyles out of position and cause all sorts of problems you don't want. I experimented with balled up paper and positioned it to force my jaw forward again, and this helped a lot and made me realize that this was a much more comfortable and natural position than having my jaw forced as far back as it will go, and was the position I had my entire life with no problems.
How a dentist can think that having your jaw shoved as far back as it will go is an ideal position is beyond my comprehension. None of this is taught in dental school, so finding a dentist who knows anything about it is very difficult, and many have some very bizarre ideas about occlusion and gnathology so you don't want to become a victim of some crackpot's theories like I did. After a lifetime of low maintenance teeth and no jaw pain, I am now dealing with TMD and many other problems, so be very careful, and try to avoid anything permanent until you can live with it comfortably for a few months.
Last edited by Administrator; 05-08-2012 at 10:19 PM.
Thanks again for your detailed reply. I also feel for you - I hope you get your problem solved soon. I know the stress and anxiety this kind of issue can cause - the sense that things are out of control, the helplessness and hopelessness.
I just emailed my dentist asking if he could add composite instead of removing, I'll see what he says.
Last edited by Administrator; 05-06-2012 at 06:15 PM.
You mention your anteriors hitting, and this is what I have noticed too. The back of the upper front teeth get smacked by the lowers. It has made my upper front teeth very sore and made speaking for more than a few minutes impossible. What I think is going on there, is that normally my jaw was kept more forward by the back molars and the lower teeth sat right behind the uppers and guided off of them when my jaw opened and closed. After the equilibration and my jaw moved rearward, instead of guiding along the front teeth, there is this fore-aft room that allows the lower teeth to smack into the uppers and higher up on the tooth causing pain. As my jaw gets positioned more forward, the lower teeth end up right up against the back of the upper teeth, so there is no room to hit them from a distance. Instead my mandible gets guided down as I open my mouth. This is what is referred to as anterior guidance. As you open your mouth the lower teeth slide down the backs of the upper teeth and as this happens the molars disclude.
However, if a dentist removes the guidance on the back molars that keeps your jaw forward, like what was done to me, then the jaw can fall backward, the anterior guidance is lost, and now there is a lot of play in the jaw and the lower teeth can now forcefully hit the backs of the upper teeth from this more rearward position. What I think is happening is that general dentists who have little to no training in occlusion, are mistaking guidance for interferences, not knowing the difference, and grind the guidance away that then leaves the jaw with nothing to guide its movements other than muscles, which can't guide the jaw properly to avoid collisions.
Last edited by Administrator; 05-06-2012 at 06:17 PM.
How do you go about finding a real expert in occlusion? Can you please give me the name of the dentist who's fixing your bite? Even if I couldn't be his patient, maybe I can ask for advice and a referral in my area.