‘sound’ bites - salt spring dentist · ‘sound’ bites quick, ... and the mandible’s active...

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Dr. Wm. E. Lea, DMD

Copyright 2016. All rights reserved.

‘SOUND’ BITES

QUICK, SIMPLE SOLUTIONS FOR ACHIEVING HEALTHY, FUNCTIONAL OCCLUSIONS

-A simple and easily-understood, quick and easily-applied way to incorporate occlusal diagnosis and treatment into everyday dental practise.

-An explanation of all anyone needs to know about the diagnosis and treatment of most TMD and ‘BITE’ issues and a clear criteria for recognising healthy, functional occlusion.

Dr. Wm. E. Lea, DMD


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OCCLUSION?!

Was I the only one in dental school who was confused about occlusion?

Dr. Wm. E. Lea, DMD


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TWO IMPORTANT QUESTIONS…

1. What is functional occlusion?

2. What is dysfunctional occlusion?

Dr. Wm. E. Lea, DMD


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MY WORKING DEFINITIONS…

1. Healthy, functional occlusion allows an individual to swallow and chew without creating any uncomfortable, harmful or damaging consequences to the teeth, the gums or the joints.

2. Unhealthy, dysfunctional occlusion causes conscious or unconscious discomfort and potentially harmful and damaging consequences to the teeth, the gums or the joints when an individual swallows or chews.

Dr. Wm. E. Lea, DMD


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ANOTHER QUESTION…

If healthy swallowing and chewing are the two normal functions, what are the ‘outside of normal’ functions?

...What is ‘para’ functional?

Dr. Wm. E. Lea, DMD


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ANOTHER OFMY WORKING DEFINITIONS...

Besides the healthy swallowing and chewing; the normal, relaxed, healthy at-rest position; and the mandible’s active but transient, short-lived part in other functions such as speaking, yawning, facial expression, etc.;

...parafunction is everything else!

Dr. Wm. E. Lea, DMD


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MY CRITICALLY IMPORTANTWORKING ASSUMPTION...

Individuals, consciously or unconsciously, go to parafunctional positions with their jaw to avoid something that is, consciously or unconsciously, uncomfortable within their occlusion during the normal functions of swallowing or chewing.

Dr. Wm. E. Lea, DMD


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THE CONSEQUENCE OF THE WORKING ASSUMPTION...If occlusal problems exist, symptoms can initially, often but not always, be created from swallowing or chewing...

but, if or when the patient goes to any parafunctional position, numerous and various secondary symptoms will almost always develop.

THEREFORE...

Dr. Wm. E. Lea, DMD


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SYMPTOMS ARE NOT RELIABLE INDICATORS!

of the basic, fundamental problems within the occlusion!

The symptoms just indicate that there is a problem, they don’t tell me what or where the problem is!

Dr. Wm. E. Lea, DMD


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SO, I NEVER, NEVER, EVERTREAT THE SYMPTOMS!!

If I do, I will end up ‘chasing my tail’ to no good purpose and much grief.

I will be playing endless “Whack a Mole” with ever-evolving symptoms.

Dr. Wm. E. Lea, DMD


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IMPLICATIONS FORDIAGNOSIS AND TREATMENT OF

OCCLUSAL PROBLEMS

Clinically speaking, what matters?

Healthy Function matters!-Swallowing: habitual, ‘hinge’ bite, closed jaw position

...balanced, supported, comfortable Centric Occlusion

-Chewing: ideally ‘canine-protected’, bilateral, ‘uninterfered-with’ function...smooth, unimpeded, canine-guided Lateral Excursions

Dr. Wm. E. Lea, DMD


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IMPLICATIONS FORDIAGNOSIS AND TREATMENT OF

OCCLUSAL PROBLEMS

Clinically speaking, what doesn’t matter?

Unhealthy Dysfunction doesn’t matter!-any parafunctional posture or movement-any specific symptoms-any symptomatic joints and/or muscles

Dr. Wm. E. Lea, DMD


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I MUST FIRST DIAGNOSE

all the basic, underlying, fundamental problems within the occlusion that can create any conscious or unconscious discomfort, or cause any harm or damage to the teeth, the gums or the joints.

So, what are these underlying occlusal problems?

Dr. Wm. E. Lea, DMD


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JUST THE 3 FOLLOWING SITUATIONS:

-inadequate vertical support through the 1st molar area-premature contacts anywhere-unwanted lateral forces created on closure/chewing

...comprise all of, the total number, the complete list! of the initial, primary, basic malocclusions that I must concern myself with.

Dr. Wm. E. Lea, DMD


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1ST FUNDAMENTAL MALOCCLUSION:-inadequate vertical support through the 1st molar area

(View of left teeth from lingual.)

The palatal cusp of the upper first molar needs to make contact, to be supported in, the central fossa of the lower first molar.

Dr. Wm. E. Lea, DMD


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2ND FUNDAMENTAL MALOCCLUSION:

-premature contacts anywhere

That is, all teeth should hit at the same time.

Dr. Wm. E. Lea, DMD


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3RD FUNDAMENTAL MALOCCLUSION:

-unwanted lateral forces created on closure/chewing

The cusps of teeth should only hit against the flatter surfaces--the marginal ridges and fossas--of their opposing tooth or teeth this generates healthy, vertical forces.

Dr. Wm. E. Lea, DMD


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-I’m not saying that the above three situations will always, directly, automatIcally, immediately or even inevitably lead to problems.

-And I’m definitely not saying that individuals can’t be reasonably healthy, comfortable and functional if one or more of the three situations are present.

I’m saying that when I have patients with symptoms of occlusal dysfuntion or mandibular parafunction--and only after I have confirmed that the source of these symptoms is definitely occlusal--if I correctly address and resolve those 3 things, they will find relief of their symptoms.

Dr. Wm. E. Lea, DMD


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THE QUICK, EASY, 8-STEP DIAGNOSTIC PROTOCOL:

-a lot of questions need to be asked-the joints need to be palpated-the jaw’s paths of opening, closing and side shifts are observed-all oral hard and soft tissues need to be examined and charted-upper front teeth need to be palpated-assessment with special base-plate wax-assessment with special marking paper and regular silk-further assessment, using special diagnostic splint, is often needed

Dr. Wm. E. Lea, DMD


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1. A LOT OF QUESTIONS NEED TO BE ASKED.

As the questions are asked, I need to...

LISTEN to, and acknowledge the answers, if there is...

(There are about thirty questions. Here are some, but not all, of the symptoms that can be associated with, that can be an indication of, occlusal dysfuntion or mandibular parafunction...)

-sensitive or painful teeth to cold? or to brushing? headaches? a ‘ringing’ in either ear? a preference for chewing on, or limited to, only one side of the mouth? gum disease? no ‘home’ bite? lip or cheek biting? sore, painful or noisy joints?

(Or I get the patient to fill out a questionnaire in the waiting room before they are seated in the operatory.)

Dr. Wm. E. Lea, DMD


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2. PALPATE THE PATIENT’S JOINTS.

As the jaw is slowly opened and closed, I need to...

LISTEN for any joint noises

FEEL for any crepitis, clicking or popping

LOOK for any limited opening, or deviation of the jaw to the left or right

Dr. Wm. E. Lea, DMD


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3. CHECK RIGHT AND LEFT LATERAL EXCURSIONS.

As the patient attempts to slide their jaw sideways, I need to...

LOOK for any restricted movement or inability of the patient to go to either or both sides without opening

Dr. Wm. E. Lea, DMD


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4. THE MOUTH NEEDS TO BE EXAMINED.

While all of the hard and soft tissues are being examined andcharted, I need to...

LOOK for...

wear facets? periodontal disease? hairline fracture lines? lots of previous endo?

(This is not a complete list.)

Dr. Wm. E. Lea, DMD


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5. PALPATE PATIENT’S UPPER FRONT TEETH.While the patient opens and closes rapidly and firmly on their back teeth, over and over, I need to...

FEEL for any impact or bounce

LOOK for any anterior movement of the teeth

Dr. Wm. E. Lea, DMD


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6. ASSESSMENT WITH SPECIAL BASE-PLATE WAX.

With patient in proper posture and after the wax is heated up to the exact, critically correct temperature, it is placed over all of the lower teeth.

Then the jaw is closed, once, quickly and firmly, until the back teeth contact fully; after which the wax is carefully removed.

I should then...

LOOK for any perforations, tears, or holes through the wax

Dr. Wm. E. Lea, DMD


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Totally balanced occlusion: no perforations--therefore no prematurities or slides.

Dr. Wm. E. Lea, DMD


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angled arrows: distal-driving contacts on distal slopes of upper right first premolar and upper canines

vertical arrows: prematurities on upper centrals

Dr. Wm. E. Lea, DMD


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both yellow arrows: prematurities or slides on left molars

Dr. Wm. E. Lea, DMD


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7. ASSESSMENT WITH MARKING PAPER/SILK.

(Always bilaterally--never just one side at a time.)

I must use a special, stiff, thick, heavy, blue paper first, to reduce the proprioception of any inadequate support, prematurities, or lateral interferences.

Then the thin, red silk right after, to take advantage of calmer muscles.

Dr. Wm. E. Lea, DMD


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AFTER THE TEETH HAVE BEEN MARKED UP, I NEED TO LOOK for... -solid, centric occlusal stops in the central fossas of the lower first molars to contact the palatal cusps of the upper first molars--very important!--as this stabilizes the vertical dimension of mandible

-cusp/fossa, cusp/marginal ridge, ‘point’ contacts--this indicates that the occlusal load is vertical (very desirable)

-any smears on cusp slopes which can create lateral forces

-any ‘distal-driving’ contacts or marked-up wear facets or smears on distal slopes of upper cusps and mesial slopes of lower cusps which are always very undesirable as these forces tend to direct the mandible back toward the joint space which can then trigger the protective but destructive muscle activity

Dr. Wm. E. Lea, DMD


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Occlusal chaos! This is typical of what I might see.

-lower yellow arrows: point to centric stops in central fossas, buccal cusp tips and marginal ridges.

-upper yellow arrows: point to a lot of smears on slopes.

Dr. Wm. E. Lea, DMD


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all arrows: point to distal-driving contacts...

...on distal slopes in maxilla ...on mesial slopes in mandible

Dr. Wm. E. Lea, DMD


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8. THE NEED FOR FURTHER ASSESSMENT, AFTER USINGA SPECIFIC ‘DIAGNOSTIC’ SPLINT, IS OFTEN NECESSARY.

This particular splint is a small, easily-made, soft splint made from clear mouthguard material and is worn on the lower arch.

It is not a treatment! and is only worn for 3-5 days to reduce... -painful muscle spasms around joints

-protective, subconscious ‘muscle splinting’

-parafunctional muscle activity

Dr. Wm. E. Lea, DMD


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clear diagnostic splint

correctly adjusted after being marked up with thick, blue paper

Dr. Wm. E. Lea, DMD


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THE DIAGNOSTIC SPLINT

-keeps all the upper and lower teeth apart... it slightly increases the vertical so ‘unloads’ the joints

-eliminates any prematurities, lateral forces... so reduces the need for muscle splinting, muscle ‘protection’ against uncomfortable slides, prematurities and distal-driving

-supports the mandible in a normal, functional position...

provides soft, slightly compressible, vertical support, in very small, specific, limited area of the mandible

Dr. Wm. E. Lea, DMD


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THE 4-STEP TREATMENT SEQUENCE:

-allow for any necessary anterior ‘decompression’ of joints

-provide specific vertical support through the first molars

-establish point contacts and foil-relief contacts where appropriate

-establish proper, healthy chewing function

Dr. Wm. E. Lea, DMD


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first: (starting in normal, habitual, hinge bite, ‘home’ position, in centric occlusion)I provide/allow for any necessary joint decompression.

-On the upper teeth, all anterior prematurities must be corrected and all distal-driving smears must be reduced to point contacts at the most gingival aspect of the smear.

-Centric point contacts must be retained otherwise tooth positions will be unstable, fewer teeth will absorb the occlusal load and the vertical position of the mandible may suffer from reduced support.

-I use two fingers to palpate the upper front teeth while patient bites firmly on their back teeth to confirm ‘decompression’ is complete.

Dr. Wm. E. Lea, DMD


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second: I confirm or provide specific vertical support through the first molars.

-If there is no solid support for the upper palatal cusp of the upper first molar from the central fossa of the lower first molar, support must be created--pot-holing--an unfortunate term for “adding a very small amount of dental filling material to the lower tooth”.

...A small amount, but plenty enough to solidly support the upper first molar’s palatal cusp.

...I must usually add to the fossa of the lower tooth so that I don’t create an upper ‘plunging’ cusp that will interfere with the function of chewing.

Dr. Wm. E. Lea, DMD


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third: I confirm, establish or re-establish point contacts and foil-relief contacts where appropriate.

-After pot-holing any missing vertical support for the upper first molars’ palatal cusps as described previously, the mandible almost always comes forward!!

-So I establish or re-establish anterior and posterior cusp/fossa, cusp/marginal ridge point contacts by removing any smears on slopes.

-I establish foil-relief contacts for the upper second and third molars (when the first molars are present) and always for upper centrals and laterals.

Dr. Wm. E. Lea, DMD


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fourth: and finishing in lateral excursions, in right and left side-shifts but only after a balanced, supported, comfortable, centric occlusion bite is established.

I confirm/create a healthy chewing function for patient.

-I confirm or, if necessary and possible, establish canine guidance for working function.

-I remove non-working interferences, or ‘balancing’ interferences.

-I remove working interferences.

Dr. Wm. E. Lea, DMD


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TO ENSURE THE BEST RESULTS:

All of the 8 diagnostic, and all of the 4 treatment steps, must be followed.

I must never ‘cherry pick’!

Dr. Wm. E. Lea, DMD


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DIAGNOSING AND TREATING OCCLUSAL IMBALANCES AND/OR DEFICIENCIES IN 5 SHORT, EASY APPOINTMENTS

First, as part of a complete dental examination, 8-step protocol for initial diagnosis of dysfunction/parafunction

Second, if it has been determined that a splint is necessary, records for ‘diagnostic’ splint (30 minutes with dental assistant)

Third, the splint needs to be made to load through the lower 1st molars, adjustment of the splint (15 minutes with me)

Fourth, after wearing the splint 3-5 days (or after 1st appointment), definitive diagnosis and 4-step treatment of underlying occlusal imbalances and/or deficiencies (15-30 minutes with me)

Fifth, as necessary (but always at least once), follow up(s?), one week apart (15 minutes with me)

Dr. Wm. E. Lea, DMD


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“I came to Dr. Lea’s dental office after seeing three other dentists-- I was feeling discouraged because after many visits and spending hundreds of dollars, I was still having problems with my mouth and jaw.

“He explained to me in great detail what was wrong and how to fix it without me having any invasive or difficult treatment. To my surprise and relief he was able to fix my problem with only three visits and without the process costing more than I could afford as I don’t have a lot of money or dental coverage.

“I can happily say that I feel more confident and have no headaches. My bite feels normal and I have no more pressure in my head.

“I would recommend this procedure to anyone as the process was easy and the results were outstanding, not to mention that it feels great to know that your dentist truly cares about your health and well-being.”

Promise M. (Salt Spring Island)

“Your dentistry expertise has taken away the ache in my left jaw joint--I’m not using my mouth-guard anymore!! I’m happy!” Carolyn C. (Seattle)

Testimonials

Dr. Wm. E. Lea, DMD


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Please click here if you are interested in acquiring the professional occlusal protocol.

‘SOUND’ BITES

QUICK, SIMPLE SOLUTIONS FOR ACHIEVING HEALTHY, FUNCTIONAL OCCLUSIONS

-A simple and easily-understood, quick and easily-applied way to incorporate occlusal diagnosis and treatment into everyday dental practise.

-An explanation of all anyone needs to know about the diagnosis and treatment of most TMD and ‘BITE’ issues and a clear criteria for recognising healthy, functional occlusion.

https://saltspringdentist.com/book-for-lay-public/#buy-protocol

https://saltspringdentist.com/book-for-lay-public/#buy-protocol

‘sound’ bites - salt spring dentist · ‘sound’ bites quick, ... and the mandible’s active...

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