Occlusal evaluation and treatment has long been a source of confusion for many individuals. In a normal, healthy occlusion (bite relationship), the teeth fit together in the ideal position where the jaw joints are most comfortable and work best. The points (cusp tips) of the back teeth should fit nicely between each other and mesh smoothly, much like gear teeth do, when the bite is in centric relation, i.e. the jaw joint is fully seated. When the teeth do not fit together ideally where your joints are most comfortable, your brain must constantly choose between stretching the joint to make your teeth fit together or wearing down the teeth to fit best with the jaw.
Additionally, when you move your jaw from side to side, the canine (eye) teeth should guide the bite to open sufficiently so that the cusps of back teeth clear the teeth on the opposite arch. If the back teeth do touch during these horizontal motions, we call these “balancing interferences”. As a consequence, your brain sends subliminal messages to your jaw muscles to alter your chewing patterns using your canines as feelers to guide the movement. These are called “avoidance patterns”.
If your jaw must move front, back or sideways in order for the teeth to close together completely or to avoid bumping into each other during normal functional movements, this is often the basis for a number of problems including the following:
By far the most common symptom we see is unusual wear patterns on the teeth. The canines are commonly the first teeth to show signs of wear. As they become shorter, the rest of the front teeth begin to rub against each other causing them in turn to begin to wear and chip. For some patients, the wear will eventually progress to the back teeth as well. This process, especially in the beginning, can happen slowly, over a period of years or even decades, at first wearing away the hard protective layer of enamel until finally it reaches the softer, underlying dentin. Once through the enamel, the wear typically accelerates.
Often the wear is so gradual that it goes unnoticed by a patient until it is severe. The bite collapses as the patient looses tooth height and the patient may notice that their smile looks less youthful. They may assume that this is a natural and inevitable process of aging but this is not the case. It is possible to stop this process, and the earlier the cause for the wear is diagnosed and treated, the easier the remedy can be.
The diagnostic process is accomplished by obtaining gnathological records, called diagnostic models (also called facebows). These records involve taking impressions of both upper and lower teeth, which are poured up in a plaster-type stone. These stone models of the upper and lower teeth are then positioned on an instrument called an articulator using the facebow and bite registration measurements. The articulator allows the simulation of the teeth, jaws and both joints in all positions and chewing movements as they occur in your body.
After we have assessed your bite we may recommend:
When dealing with human health care, there are standard treatments that will, in most cases, cure certain symptoms and disease. But there is never one absolute cure-all that works in every case. The sicker the tooth to begin with or the more “unique” it's physiology, the more advanced treatment it will require to get un-sick.
There is no way to predict in the beginning exactly how each tooth will respond to root canal treatment. We can't tell in advance if this will remove all of the infection permanently.
This tooth was just so sick that standard, normal treatment was not enough to cure it. It's the same as if a patient has cancer - how much chemo will cure the patient? If the cancer is not completely eliminated, most people don't think that the doctor that he did the first chemo wrong. They realize that the cancer was just too strong or prevalent to be permanently eradicated. The same can happen with teeth. You begin with the most logical, conservative treatment, and see if that alone is enough to cure the disease. If not, you move on to the next available treatment options with specialists who are trained to treat “exceptional” cases.
We are looking forward to meeting you and are grateful to for recommending you to our practice. As promised, I have enclosed some information and patient forms for you. We want you to know that when patients chose to come to our office, we are committed to offering them the best dental service available. In our practice, our focus is on approaching oral health comprehensively with an eye toward prevention.
As we discussed, at your first visit we will plan on doing a thorough evaluation. That is why we devote an hour and a half to every adult new patient visit (a cleaning will be done at a subsequent appointment on a different day.) We will focus as much on your personal dental goals and how you would like us to help you with them, as it will on your teeth, gums and jaws. We will devote time to letting you tell us about your expectations and concerns. Since so many of our patients tell us that they have never really thought much about their dental care in this way, we have enclosed a worksheet that might help stimulate ideas about your expectations or help you to recall events and details that you'd like to share with us. Please feel free to work with it in any way it is useful to you.
We want you to know that in our office you can expect to be treated with respect at all times and to receive the best diagnosis and treatment that dentistry has to offer. However, we can't do it without your help. We believe that mutual exploration and communication are the basis for a healthy relationship and encourage you to involve yourself in your treatment and to ask questions. In our opinion, patients who are involved in choices about their dental care end up happier with their teeth, achieve the highest level of health and are less likely to experience unexpected dental urgencies.
It is quite reasonable for patients to want to understand the financial implications when planning their dentistry and so we will spend a few minutes discussing how we typically handle the fees and reviewing any insurance benefits that you might have available to you. Although we are not involved contractually with any insurance company, our goal is to help patients better understand what to expect and what not to expect from insurance so that “surprises” surrounding the benefits do not become a barrier to receiving high quality dental care. Our patients, who are informed, involved and pro-active with their insurance carrier are most often not disappointed. You will have our support in these efforts. At all times, however, you can be confident that we will always provide you with our best services based on the needs of your health, not your insurance coverage. To do otherwise would violate our contract with you - the one contract we feel morally obliged to honor.
Above all, you are the client. Your priorities, values and expectations will guide us. We believe that our care, skill and judgement provide us with the ability to help and treat, but we will only provide that which you specify and which you completely understand. We look forward to inviting you into our practice as a patient and a friend.
Dr James A Miller, Aesthetic Dentist - Providing cosmetic, bioaesthetic and neuromuscular dentistry to the areas of Hillsboro and Portland, Oregon.
Hillsboro aesthetic dentistry
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