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Bad Teeth: Occlusal Plane Abnormalities

Bad Bite and Occlusion

Overbites, underbites and crossbites are familiar terms to a great many dental patients, young and old.

Treatments during childhood developmental stages for bite abnormalities are usually provided by orthodontic dentists and orthodontists (specialists) on a routine basis.

Influencing the eruption and growth of teeth and modification of the physical relationships between the upper and lower jaws, for many young patients, are achieved in a relatively short amount of time (1-4 years).

Providing orthodontic treatment on a timely basis, as recommended by a general dentist or the family dentist can be uneventful and successful for most.

Orthodontic problems can arise and become quite serious for many more reasons, however. The most common serious occlusal problem arises from not obtaining orthodontic treatment when it is needed or recommended the most. Although family resources may be a delaying factor, the ensuing problems can be quite dramatic and may require more complex treatment, depending on the length of delay.

Poor eating habits, oral health habits, severe decay / untreated caries, delay in routine dental treatments, severe periodontitis and even nocturnal bruxing can also influence the development of occlusal plane disturbances.

Once established, a significant disturbance in occlusion has a tendency to compound itself, leading to tmj - tmd problems, tooth breakage, angulation of upper or lower tooth structures and can easily destoy previous restorations.

This gallery contains examples of occlusal disturbances, the causes or factors of the occlusion disorder and possible treatments used to normalize the bite or provide better management of the overall occlusal problem.

ZERO anterior occlusion: By far, one of the worst cases of adult overbite we have seen in a long long time. How this person manages to eat a variety of foods comfortably is a mystery. Anterior occlusion is literally non existent.

While the cosmetic impact of this degree of abnormality can be significant, the effects upon self confidence and social functioning, in some settings, are probably unimagineable for many adult patients.

Treatment will be complex and likely include reconstructive dentistry, possible dental implants and a variety of choices for completing the final restorations.

Bad Adult Overbite
Anterior Occlusal Defect
Kristin Petulla, DDS

Twenty three (23) year old female patient refered by an ENT with complaints of one year history of bilateral chronic facial pain, nasal congestion and pressure in her ears. Symptoms included: daily headaches, TMJ noise popping and clicking, both joints, ear congestion, non specific facial pain, nervousness, TMJ pain severe upon palpation, limited opening, reduced range of motion, posture problems and facial asymmetry. Treating dentist provided treatment for two missing teeth ONLY, consisting of dental implants. No thorough examination provided, no routine occusal study performed. Multiple orthodontic issues require treatment for correcting occlusal plane BEFORE implant treatments.

Bone Loss - Super Eruption - Crown Decay
Dr. Ira Koeppel, DDS

So... the academic question of the day is how does stuff get this bad and how do we treat it. There is evidence of cross bite, over bite and even no bite with associated bone loss, tooth flaring and feeble attempts to do a quick fix that leads to even more destruction.

A man in his fifties, his request for treatment was ONLY to repair a loose tooth that had been temporarily fixed with a home style "stucco job" (dentist's words). With the current state of affairs... the patient has no "real" servicable teeth. Most of the mandibular teeth bite into the roof of the mouth. Denture prosthetics will have to be specialized to correct and reposition the jawbones back into a normalized occlusal plane.

Bad Home Repair Do It Yourself Dentistry
Dangers of Do It Yourself Dentistry
Overbite - Crossbite - No Bite Bone Loss
Dr. Ara Nazarian, DDS

Bizarre Occlusion: This photo is a very real exaggerated situation where a seemingly unnoticable adult overbite can cause wholesale ruin of opposing teeth. Notice how neatly the upper teeth have shaved away, at a precise angle, the enamel and dentin structures of the lower teeth.

Patients with angulated teeth (not all that uncommon) are at risk for this type of damage if wear is not monitored and treated on a timely basis. Reconstruction, if initiated early enough, can consist of crown treatments and, in some cases, custom veneer products that can be used to reshape the biting surfaces, incisal edges. In this case, tooth replacement may be required, consisting of individual implants, fixed bridgework or partial.

Destructive Overbite
Destructive Overbite
Dr. Corinne Scalzitti, DMD, MAGD

Pure negligence: This is another one of those "bad everything" pictures showing how avoidance of basic dentistry treatments can lead to a horrendous situation where bone loss is significant and eventually affects the entire occlusal plane.

The failure to treat basic cavity issues and the failure to replace an "important" missing tooth causes tooth breakage problems that eventually affects all dentition. As time progresses, unwanted lateral forces cause changes in adjacent teeth further accentuating overall degradation. In this case, significant tooth replacement may be required, consisting of individual implants, fixed bridgework or partial.

Severe rot extractions bone loss
Dr. Ira Koeppel, DDS

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