Occlusal Disease may be one of the most overlooked and detrimental conditions in dentistry today. It also can be one of the simplest issues to correct. Accessing the occlusion isn’t just confirming the crown or restoration you just placed is occluding properly. An issue may arise a week or a month later when your patient returns and announces that the filling or crown you finished last month is sensitive or chipped. On the other hand, it can materialize when you’re performing a hygiene exam. Just as you’re leaving the room, the patient says, “Oh, by the way, I’ve been having pain on the left side, but I can’t tell which tooth it is.” Also, it may be discovered during an exam when you notice significant wear in one or more areas.
Obtaining ideal occlusion can be very intricate. However, the slightest adjustment can be the difference between occlusal disease and proper form and function. Why is taking the time to evaluate the patient’s bite carefully so critical? What happens if you don’t slow down and do some investigating? Having even one area of interference with full closure can contribute to multiple undesirable conditions such as tooth sensitivity, pulp damage, abfraction, significant incisal and occlusal wear, tooth or restoration fracture, headaches, TMD, and periodontal trauma including tooth movement, mobility, or loss.
Conceivably, the most important part of the evaluation is to slow down. While some adjustments will take minutes others, being more involved, may require a separate appointment. Taking your time and studying the marks left by the articulation film will deliver the best outcome. Ensure the teeth are dry before marking and carefully advise the patient on how you want them to bite. Instruct with your hands as well so that the patient understands fully the movements you desire for an accurate registration. At the end of the adjustment, bring the patient to an upright sitting position and check the bite once more. Analyzing while sitting upright is many times overlooked, but paramount. Furthermore, consider referring the patient to an occlusal specialist if the case is more involved than you’re comfortable treating.
In the end, occlusal evaluation and equilibration are going to always be an important part of your day to day treatment. Carefully interpreting the markings and subsequently adjusting will safeguard the patient's dentition thus preventing unnecessary discomfort and the possibility of occlusal disease.