Page 28 - SPRING 2016

aids for sleep time, but what about chewing forces and daytime Upper and lower teeth that fit together better will help patients
grinding? keep their teeth at least twenty years longer, if not a lifetime. This
is due to the fact that form dictates function and teeth that fit
Furthermore, teeth that are under heavy occlusal forces due to together with proper jaw alignment, function better under less
mechanical stress will be weakened at the microscopic level. The stress, hence teeth last much longer. As I explain to all our
enamel is strong but under tensile pressure will create vertical patients, the teeth are the hardest substance in the body. As such,
fractures near the occlusal surface and will create horizontal chip- why should they be the first part of the body which most patients
ping and fractures near the gingival area, termed abfractions. have problems with since we see many patients lose teeth early in
Abfraction is caused by forces of opposing teeth biting together at life?
a wrong angle and incorrect contact areas creating poor occlusal
forces. Abfraction is a mechanical loss of tooth structure that is Poor occlusion is the main reason for many dental and periodon-
not caused by tooth decay. This leads to a concentration of stress tal issues no matter how good hygiene care is. Teeth that do not fit
and flexion at the cement-enamel junction (CEJ). The tension- together correctly are under constant stress and repeated trauma
compression theory explains why abfractions occur more on the which also lead to failed root canals due to repeated trauma.
buccal vs lingual areas due to the fact that the majority of times, Furthermore, stress in certain contact areas leads to grinding of
teeth are tilted lingually leaving buccal areas under flexural stress. natural teeth or restorations. Crowns, fillings, and veneers easily
Bruxers grind to the point that the occlusal surfaces are flattened, fracture or fail no matter how good the clinical work or the lab
hence a flat surface of a maxillary tooth over flat surface of a work is. Gingival margins recede after crown or veneer place-
mandibular tooth does not give the same flexing action, which ment due to repeated occlusal trauma. Many dentists wonder how
mechanically explains why there is less abfraction in such cases. failed restorations are possible despite their great clinical work
and paying so much for top quality lab and materials. We have
Many patients suffer from chronic long term migraines, jaw pop- seen great veneers fail that were treated by highly experienced
ping, clicking, headaches, earache, and many other medical issues cosmetic dentists. Patients get frustrated and dentists also lose
for which most providers do not offer any long-term solutions time, money, and reputation having to redo the same treatment.
except for pain medications and steroids. What if we could help Many patients end up switching dentists due to this mysterious
the majority of these patients without any long-term drugs and failure only to find out the same or worse occur elsewhere. We are
with a simple non-invasive treatment without surgery? According neither helping ourselves nor our patients.
to Robert Nicholson, PhD, “More than 38 million Americans suf-
fer from migraines, affecting a wide variety of people of all ages Imagine performing veneers on upper incisors to treat fractured
and every walk of life, giving researchers 38 million reasons to incisal edges and craze lines on a patient with an anterior edge to
find a cure.” 4 edge bite. While many dentists may perform veneers right away,
not only do they not get the ideal esthetic results, the veneers also
Orthodontics can help sleep disorders by expanding the arches, by tend to fracture or come off easily. We have seen this too often
advancing mandibles in children and also by creating more tongue when patients come to us stating my previous dentist did a poor
space to advance the tongue in adults in such cases as crowding job because the veneers keep coming off and state they lost con-
and retracted lower anteriors. According to Dr. Ronald Perkins, fidence in their dentist. This could be easily prevented by per-
“If orthodontists can prevent a few more children from develop- forming a few months of Invisalign to simply correct the edge to
®
ing ADD, ADHD, and other cognitive problems by getting more edge occlusion which is damaging to veneers, teeth and the TMJ.
oxygen to their developing brains,” 5,6,7,8,9 we can really make a dif- As we explain to our patients, teeth are like scissors. Our front
ference and improve the quality of life for many people. teeth are made to cut just like scissors and as such they cannot
function if they are hitting edge to edge and will not cut anything.
We are currently using simple Invisalign® orthodontics without Therefore, we must move teeth into proper function to ensure that
any invasive procedures to treat many patients with migraine, the uppers slide over the lowers by about 1mm. If you are plan-
headaches, jaw popping, clicking, sinus issues, head and neck ning to do veneers, imagine how much easier and more pre-
issues, back pain, breathing issues, which lead to ADD, facial dictable results will be by taking these simple steps.
asymmetry, facial deformity, etc. We are not claiming 100% of
the patients will get 100% better, but simple orthodontics can cer- The example above is just the tip of the iceberg when it comes to
tainly correct and prevent many issues to a high degree. Many the importance of setting up perfect occlusion before ideal restora-
times, patients may have jaw surgery, but if the occlusion is not tion and cosmetic dentistry. Going back to the building analogy,
corrected, which was the main cause of wear and tear on the TMJ, engineers first ensure the foundation is perfect and strong and all
the issue may not be 100% corrected and the problem will return. the beams are placed in perfect position and angulation before
We often notice early signs of grinding and clenching in patients they add walls, windows, and esthetic features. In other words, in
with poor occlusion. I explain to patients that grinding and clench- every dental case, we must visualize and ensure a strong peri-
ing is the response of their jaws and neuromuscular structures to odontal foundation, ideal orthodontics by making sure the teeth
not being comfortable with how their teeth are fitting together, (beams) are in correct position and angulation, and only then can
which affects poor jaw position. They are grinding and clenching we achieve or work on further cosmetics. Of course, all sources
to find a more comfortable jaw position, but since teeth do not fit of decay and infection must be removed and at least temporarily
together well, they will end up wearing and tearing the teeth until corrected before orthodontics. Once orthodontics is completed,
they are so flat they can easily accommodate where the TMJ the final crowns or veneers are easily placed. Many times, we
wants to be. However, by then, both teeth and the TMJ are both want to restore missing teeth with implants or even a bridge only
worn out and will need lots of restoration/reconstruction in addi- to find out there is not enough room for missing teeth due to
tion to orthodontic treatment. Therefore, it is best for patients and mesial drift and supra-eruption. Bridges made on teeth that are not
doctors to diagnose and recognize this problem and agree to an in ideal occlusion will also cause immediate and long term peri-
early preventive solution through orthodontics alone. odontal issues and less than ideal occlusal forces which lead to

www.nysagd.org | Spring 2017 | GP 28