Bio Mechanically Induced Dental Disease

Biomechanical induced dental disease A Scientific Article by Assistant. Professor Dr. Muneer Gohar Babar Jinnah College of Dentistry Abstract Biomechanically induced dental disease affects at least 75% of the adult population. It is likely that more teeth are lost due to biomechanically induced dental disease than to the effects of caries. Nonetheless, caries has been the main focus of the preventive dentistry movement since Arnum and Bass' theory of bacteria and philosophy of preventive dentist
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  Biomechanical induced dental disease A Scientific Articleby Assistant. Professor Dr. Muneer Gohar BabarJinnah College of Dentistry Abstract Biomechanically induced dental disease affects at least 75% of the adult population.It is likely that more teeth are lost due to biomechanically induced dental diseasethan to the effects of caries. Nonetheless, caries has been the main focus of thepreventive dentistry movement since Arnum and Bass' theory of bacteria andphilosophy of preventive dentistry was popularized by Barkley in the early 1970s.The controversy of occlusal imbalance as a biomechanical etiological agent in dentaldisease is due primarily to the fact that it is difficult for many practitioners toclinically define and then establish a condylar position in which the condyles canoperate in harmony with the biting surfaces of the teeth.' As a result, apples arecompared to oranges and much of the dialogue in the scientific literature cannotwithstand the scrutiny of logical analysis. In order to move forward, first it isnecessary to define rigidly the terms we use every day and then utilize a method toachieve the biomechanical relationship we have defined easily, predictably, andconsistently.An examination of the literature reveals that most of the controversy aboutocclusion is not the result of scientifically defined and rigorously applied methodsbut actually is due to sloppy logic and inconsistently applied biomechanics.Many people have defined centric relation as the position of the condyles in theglenoid fossa where they are in a stable nonmuscle braced position. Dawson hasdefined this position as the rearmost, uppermost, midmost (RUM) position of thecondyle in the fossa at which the medial pole of the condyle disc assembly is bracedagainst the bony wall of the emenentia. In this position the condyles are supportedby the bony structures and muscle activity is balanced and minimized (Fig.1) Theteeth, in order to intercuspate fully when swallowing or biting together all the way,can fit together in only one position, just like a key can fit into a lock in only oneposition.When the teeth can fit together in a position of maximum intercuspation at thesame time the condyles are in the RUM position, they are said to be in anonconflicted occlusal condylar relationship. If the cusps cannot fit together whenthe condyles are in the RUM position, the occluding cusps of the teeth act likemechanically inclined planes and actually can force the condyle to deviate from thisRUM position to allow for maximum interdigitation. This occlusally determinedcondylar position requires all of the muscles to contract in an unbalanced anduncoordinated fashion.  It is a testimony to the remarkable adaptability of the temporomandibular joint(TMJ) that it can attempt to accommodate to this conflict. No other joint in the bodyhas the capacity to function in a condition of continuous dislocation.Figure 1 shows that the teeth can intercuspate completely without forcing thecondyles to assume an occlusally determined eccentric condylar position. Figure 2demonstrates that when the condyles are in the centered RUM position, only oneoccluding surface can contact.Figure 3 shows the effect of the contacting surfaces of the teeth forcing thecondyles into an eccentric, occlusally guided position.Fig. 1. Teeth fully intercuspated with he condyles in the RUM position. Fig. 2. Thecondyle in the RUM position. Due to a conflict between the teeth and the TMJ, onlyone tooth can touch its opposing contact. Fig. 3. The teeth in conflict with theoptimal condylar position. Full intercuspation of the teeth results in an eccentric,occlusally determined condylar position.Realizing that two condyles must coordinate together, one easily can imagine that avery complicated series of muscular accommodation are required for the mandibleto move into a position at allows full dental interdigitation Figures 1-3 show onlyone condyle in two dimensions. In actuality, the two condyles operate threedimensions, which requires geometrically more comlpex accommodations.It is I rare for a patient to have a condylar relationship that is not in conflict withthe occluding surfaces of the teeth. A thorough examination of adult patientsreveals at it is equally rare to find one who does not have any signs of biomechanically-induced dental . disease that can be proven to result from toothclenching and grinding. Materials and methods One hundred consecutive patients entering the author's practice for routine oremergency dental care ere examined clinically and by bitewing and panoramicradiographs and screened by routine medical and dental histories. In addition tobacteria-caused decay and periodontal disease, patients were screened for the 12biomechanically-induced dental problems that follow. A photograph of each of thesedental problems or conditions is provided with a description to illustrate the  condition (Fig. 4-15). Although these problems can and usually do occur incombination, they are listed separately. Sensitive teeth When you clench or grind your teeth, the nerve inside the tooth may becomeinflamed. This inflammation of the nerve, or hyperemia, causes tooth pain. Thetooth may hurt spontaneously but it is more common for the pain to occur duringtooth grinding, normal chewing, and especially when eating or drinking cold foodsor beverages. Some people experience so much cold sensitivity in their teeth thatthey avoid very icy beverages entirely or have to drink through a straw. Thisinflammation doesn't cause any structural damage to the tooth and generally isreversible when the clenching or grinding stops. This is similar to what is observedwhen a dentist places a restoration that has an occlusal interference. Thesymptoms of sensitivity are relieved when the occlusal interference is reduced. Fractured teeth Clenching or grinding forces can break a tooth. Breakage is especially common inteeth with large fillings because decay and fillings can weaken the tooth and makeit more fragile. Usually these teeth can be saved by crowning them but unless thegrinding and clenching forces are controlled it is only a matter of time beforeanother tooth will break. Worn teeth As teeth are ground back and forth in a subconscious attempt to wear down the protruding points, they can become extensively worn. Ironically, though,grinding won't correct the unevenness that first stimulated it.  Tooth grinding follows a back and forth or side to side pattern. Because of theshape of the teeth and the bones of the jaw, every tooth along the path of thegrinding experiences some wear.The 12 dental signs and symptoms caused by excessive occlusal forces. Dental condition Percentage of patients exhibitingsymptomsAbfracturesBroken teethChipped teethCracked teethGum recessionInternal cracksLoose teethLost teethRoot exposureSensitive teethShifting teethWorn teeth56307320605316656531696 The teeth that wear the most are often the front teeth, even though the offendinguneven points almost always are located on back teeth. The amount of wear variesfrom slight to extreme depending on the intensity of the grinding. In extremecases, more than half of the tooth structure can be worn away and the patient mayrequire extensive reconstruction to rebuild the worn tooth structures.
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