IS THE FORCE WITH YOU?

Dentists are taught the skills in dental school and beyond to diagnose and treat dental decay, gum disease, tooth loss, and other things to help preserve teeth for a lifetime. A more mystical area of dentistry for many dentists is the ability to identify, communicate and treat bite-related problems that occur over long periods of time.

The term in dentistry for how the teeth come together is called occlusion. The masticatory system is composed of the teeth, the joints (TMJs), and muscles. How the teeth occlude and what a person does with their teeth, determines what happens to the teeth, muscles and joints over time. If these three things are not working together in harmony, something has to give; teeth wear down, joints and muscles can become sore, etc.

Would you want to know that there is a potential problem or prefer to have it ignored and deal with the consequences when and if they should arise?

The fact of the matter is – every person is different and does different things with their teeth. How do you compare a 90 year-old with all of their teeth with minimal wear to a 30 year-old with 25% of their tooth structure missing (unknowingly in many cases)? Both individuals eat, sleep and breathe but present very differently. Theories abound; there is no question that some people put greater forces on their teeth when they sneeze, swallow, chew and sleep than others.

Greatly underdiagnosed, these forces help cause things like teeth wearing, teeth breaking, TMJ/muscle soreness, tooth loss, tooth sensitivity, gum recession, and poor sleep patterns. Many dentists (including myself) see the signs but often choose to avoid a challenging conversation with a patient about a disease process that is not fully understood. Unfortunately, ignoring these signs is not in the best interest of the patient. It is the obligation of the dentist to raise the patient’s awareness of these forces and to discuss strategies to combat them. It is only through this awareness that patients will be able to decide if they want to do anything about it or not.

Keep in mind that many of the bodies functions, including the forces put on teeth, occur without any cognitive thought. Patients will often say, “I know I grind my teeth in my sleep when I’m stressed”. Things like stress may have some effect on this, but is it important to look beyond specific instances and evaluate the bigger picture of what is really going on.

For example, breathing is perhaps the most essential of all life functions. If you are not getting the proper oxygenation when you sleep, there are some crazy things your body does as a defense mechanism to get air. Sleep-related breathing disorders are underdiagnosed and undertreated and may just be one of the leading causes of tooth wear and TMJ problems.

I am finishing my “mini-residency” at Tufts this week in dental sleep medicine so I will be bringing this topic up again in future columns with updated information. If you have any questions about this topic, or any other, please send me an email.