Orthodontic Tips July 22, 2014
Doctor, I’m hitting my teeth harder on the right. Something is wrong with my bite.
Watch the dental midlines for habit related occlusal problems.
This morning one of my TMJ cases came in with the complaint that he was hitting too hard on the right side when he was wearing the splints.
I put some articulating paper between the upper and lower splints to mark the occlusal contacts. Occlusal markings were present on both sides. However, to let the patient know that I acknowledged his complaint, I removed a slight amount of contact on the right side.
When I asked him how his bite felt now, he said it was still hitting too hard on the right.
I gave the patient a hand mirror to inspect his bite and I pointed out that the dental midlines were not lined up. He was positioning his mandible very slightly to the right. I did this by comparing the upper and lower dental midlines. When he lined up the dental midlines, there was equal contact on both sides of the bite.
On occasion, patients will position their jaw off centre if there is an active TMJ habit. This asymmetrical muscle tension is from grinding the teeth more on one side than the other. If we accommodate to the patients request to reduce the high contact, sometimes the patient will shift their mandible further to that side with the result that it will still be “high” on that one side.
Teeth will naturally adjust to equal contact on both sides. If there is a discrepancy, then there is a habit that is causing it, unless, of course there is a high restoration.