Taking a Fresh Look at Occlusion Issues in Dentistry

Jim McKee, DDS, is a dentist in private practice. He’s also a Visiting Faculty member with Piper Education and Research Center, where he teaches on subjects such as occlusion and the clinical referral process. In this video clip, he discusses how to take a fresh look at occlusion issues in dental patients.

Interview Transcript (slightly modified for readability)

“When you look at the average patient who comes into your practice, typically, the patients will come in with problems caused by one of two things. Typically, it’s either bacteria, which causes decay, or periodontal disease, or some type of bite issue, some type of an occlusion or TMD issue that may cause some type of tooth wear, some type of tooth fracture. It may be linked to sleep-disordered breathing. We have to look at all of those issues.

We’ve done a great job in dentistry treating bacterial problems. We’ve done a great job treating decay and periodontal disease. The difficult issues that we still have, though, are the occlusion, TMD issues. Many times, it’s because we define occlusion as how the teeth fit together, when in reality, occlusion needs to be defined as, not only how the teeth fit together, but how the lower and upper jaws fit together.

While we have to look at the teeth, we also have to look at the right joint fitting against the right-joint socket, and the left joint fitting against the left-joint socket. In order to do that, sometimes it’s necessary to get three-dimensional imaging using MRI and CBCT. If we can obtain that information, then we have an entirely new set of information that we can use to help solve occlusal problems and TMD problems that are so pervasive in all of our practices.

The number of Class 2 patients that we see typically in an average orthodontic practice is going to be somewhere between a third and a half. Most of those patients are going to have some type of TMD problem. So it starts early. The changes in the joint are reflected through changes in the bite.

Being dentists, we’re trained at the tooth level, so we do a great job trying to change the teeth. The problem is, if the main cause of the issue is at the joint level, and we’re treating at the tooth level, that may lead to inconsistent treatment outcomes. In terms of today, I think the contemporary restorative dentist really looks at the occlusion from the tooth level as well as the joint level to understand the risk profiling that’s present in our cases. It’s the same way as probing periodontal pockets in our practice today. We’re going to be able to evaluate risk factors for soft and hard tissue from a periodontal aspect, we can do the same from an occlusion and TMJ aspect as well.”