As a dentist, you need to check for cavities, tooth infections, and gum disease. You are taught to listen to your patients’ complaints, but when you investigate the problem, are you looking in the right direction?
When you notice a worn tooth, your first thought may be to treat it with a bite protector. When you have sensitive teeth, your first thought may be gum recession, exposed dentin, or cavities. In these and other situations, your first reaction may quickly prompt you to fix the initial problem, but is that really what is best for the patient in the long run? You may be overlooking the most important aspect of their complaint—the bite!
Bite problems are a risk factor for many potential problems. I will share two clinical examples that demonstrate to these patients (and others like them) that bite is critical.
A 40-year-old woman came to my office for a temporomandibular joint (TMJ) consultation with complaints of right jaw pain. She was experiencing severe migraines several times a week. She had a wisdom tooth extraction and a root canal on tooth #2, which was followed by two new crowns. The patient also received monthly steroid TMJ injections. She could only open up to 26mm.
Checking her bite was the first step. The exam showed that the patient had a mild class 2 bite with an end-to-end bite on the right side. The patient initially had a bite that was only in contact with the right side, but then she would slide her teeth forward and to the left to make contact with the left side.
The previous dentist had overlooked the underlying problem. They recommended removing the wisdom teeth and performing a root canal. Her previous dentist told her that the problem was with the PFM, so she opted for an all-ceramic crown.
We completed a CBCT scan of her condyle. The patient completed a comprehensive treatment with Invisalign to correct the class 2 bite on the left side. After six months of Invisalign treatment, the patient can now open up to 46mm. She no longer has migraines and no longer needs steroid injections. The patient is very happy and healthy again. It’s all down to the bite!
A 40-year-old female came to my office with no complaints. She flossed daily and had excellent oral hygiene. She casually mentioned that she had two sensitive teeth in her front teeth (maxillary canines) and that they had always been so. All the dentists she had seen had told her that she brushed too hard and that nothing could be done about her sensitivity.
My first thought was to check her bite. The patient had no orthodontic history. Her teeth were nice and straight, aligned, with good interproximal contact and a Class 1 occlusion. Upon checking her bite, it was discovered that she was only biting on her canines, which were the teeth causing the sensitivity.
I discussed my findings with the patient and explained the treatment options of comprehensive orthodontics or bite balancing. I explained to the patient that it was impossible for her to brush two teeth harder than the others to cause the sensitivity.
This patient had her bite balanced and it was a complete success. A follow-up visit ensured that the bite was correct. The patient no longer had tooth sensitivity and she told me how happy she was and how it had changed her life. It’s all in the bite!
Changing the way you think about your patients and their teeth will make you a better clinician, not just a dentist. Examining your patients’ bite and addressing potential issues will ensure that your patients will continue to receive your care for the rest of their lives.
The next time a patient comes in with sensitive, broken, or worn teeth, don’t do them a disservice by not allowing them to get treatment for a Class V complex or wear a night guard. Examine your patients thoroughly and observe their bite.
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