Within dentistry, occlusion can cause confusion, even controversy.[i] Debate surrounding its definition has existed for over a century.[ii] The complications of poorly managing occlusion mean that its mechanical definition is not the only concern for dentists. Occlusion should also be interpreted at a broader level that encompasses patient health and even the central nervous system.[iii]
Some dentists, particularly those providing orthodontics, advocate occlusion as the key to resolving multiple disorders, even some that are far removed from the masticatory system.
Watching jaws
Orthodontic treatment seeks to achieve a functional and aesthetic improvement by moving teeth into the optimum position.[iv] Orthodontists therefore must consider the relationship between the maxillary and mandibular teeth to manage malocclusions such as overbites, underbites and open bites.
Occlusion is unique, and inherited factors, habits like thumb-sucking, and skeletal abnormalities can all be causes of malocclusion. Having extensive knowledge of the patient’s medical history is beneficial for an accurate diagnosis and predictable treatment.
The notable signs of malocclusion include limited masticatory function, speech problems, misaligned teeth, an alteration from nasal to mouth breathing, and changes in facial structure. v If these signs are observed to disrupt the patient’s quality of life, they should be referred to an orthodontist.v
Evaluating occlusal problems can be assisted with extraoral radiographs, such as panoramic radiographs or a cone-beam computed tomography (CBCT) radiograph. These can provide a greater understanding of the teeth position and permit analysis of the patient’s airway and the temporomandibular joint, allowing for a more accurate diagnosis of malocclusion. v
Untreated and unchecked
35-45% of all children and adolescents have a severe malocclusion that needs orthodontic treatment.[v] If left untreated, malocclusion can cause tooth wear and can increase the risk of tooth decay and caries, as crowded mouths trap food and make brushing and flossing harder. Plaque build-up can lead to gingivitis, too.
Untreated malocclusions put limitations on the patient’s ability to masticate. If the mechanical reduction of food is inhibited, digestion becomes suboptimal and can lead to the development of gastritis and ulcers.[vi] Malnutrition may also emerge as a consequence if diet is changed to accommodate the limited masticatory function.
The impact of an impaired chewing function then extends beyond the physical as the overall quality of life will be impacted if food cannot be fully enjoyed.[vii] This is particularly prevalent among adolescents.ix
The TMD Debate
Untreated occlusion can be a factor, though this is still being debated, in the development of temporomandibular disorders (TMD), the second most common musculoskeletal condition after chronic lower back pain.iv During orthodontic treatment, TMD signs and symptoms have been known to appear.[viii] These include pain around the jaw, ear and temple, clicking noises when the jaw is moved, headaches around the temples, and jaw locking when the mouth is open.[ix]
Despite the volume of research on TMD and occlusion, there is still a controversy around their tenuous connection. Much of the discourse concerns the varying definitions of each term.[x] Some believe that the link is as clear now as it will ever be, and that progress can only be made by studying what is available and implementing practitioners’ experiences.xvi
Therefore, by managing occlusion there is a chance that TMD may be prevented or least reduced. Even if occlusion and TMD are more disconnected than some think, enhancing teeth alignment will still boost the physical, social and psychological well-being of a patient.[xi]
Brace yourself
Malocclusion can be treated in several ways. The use of palatal expanders before orthodontic appliances is sometimes useful for adolescent patients as during puberty the maxillary bones become fused.
Clear aligners have grown in popularity as a way to enhance occlusion.iv Computer-aided design technology digitally scans the dental arches so that clear removable trays are created. The patient may then wear one for two weeks, 22 hours a day before changing to the next aligner. This will straighten the teeth and alleviate less severe malocclusion.v
Knowing how to define, diagnose and deal with occlusal problems is an integral part of keeping patients healthy and happy. To learn more about occlusion, the IAS Academy offers The Basics of Occlusion as a two-day training course that promises to give you the confidence and skills to confront and grade occlusal risk. Formerly taught online by respected dentists Dr Jaz Gulati and Dr Mahmoud Ibrahim, the course now takes an in-person, practical approach. It uniquely covers post-orthodontic occlusion principles such as the occlusal adjustments after aligner therapy in adults. Rooted in experience, study and innovation, The Basics of Occlusion course will demystify the confusion of occlusion.
For decades, occlusion has sparked debate and controversy. With numerous complications associated with it, getting to grips with occlusion is essential to helping your patients lead happier, healthier lives.
For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)
Author: Dr Tif Qureshi
Dr Tif Qureshi founder and a clinical director of IAS Academy, qualified from Kings College London in 1992. He is a Past President of the British Academy of Cosmetic Dentistry, an International faculty that provides mentored education for general dentists on a pathway from appropriate simple to comprehensive orthodontics.
Tif has a special interest in simple orthodontics and truly minimally invasive dentistry. He has committed his life’s work to empowering dentists to provide important alternative techniques. He offers a wide variety of treatments to many more patients, while always respecting the fundamental precepts of orthodontics.
Tif also pioneered the concept of Progressive Smile Design through Alignment, Bleaching, Bonding – a course that combines tooth alignment, composite bonding and teeth whitening to produce superior smiles using techniques with the absolute minimum of invasiveness available today.
An experienced teacher in the Dahl concept, Tif shows how this technique is used to plan tooth alignment and minimise invasive dentistry in the development of a beautiful smile.
Tif now lectures and published scientific articles internationally. BACK TO TEAM
[i] Estelle, C., Jean-Philippe, R., Anne, G., Anne, P. and Jean-Daniel, O. (2021). Dental Occlusion: Proposal for a Classification to Guide Occlusal Analysis and Optimize Research Protocols. The Journal of Contemporary Dental Practice, 22(7), pp.840–849. doi:https://doi.org/10.5005/jp-journals-10024-3113.
[ii] TÜRP, J.C., GREENE, C.S. and STRUB, J.R. (2008). Dental occlusion: a critical reflection on past, present and future concepts. Journal of Oral Rehabilitation, 0(0), p.080218050859280-??? doi:https://doi.org/10.1111/j.0305-182x.2007.01820.x.
[iii] Michelotti, A., Rongo, R., D’Antò, V. and Bucci, R. (2020). Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence. Journal of the World Federation of Orthodontists, 9(3), pp.S15–S18. doi:https://doi.org/10.1016/j.ejwf.2020.08.003.
[iv] Ghodasra, R. and Brizuela, M. (2023). Orthodontics, Malocclusion. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK592395/.
[v] Göranson, E., Sonesson, M., Naimi-Akbar, A. and Dimberg, L. (2023). Malocclusions and quality of life among adolescents: a systematic review and meta-analysis. European Journal of Orthodontics. doi:https://doi.org/10.1093/ejo/cjad009.
[vi] Leck, R., Paul, N., Rolland, S. and Birnie, D. (2021). The consequences of living with a severe malocclusion: A review of the literature. Journal of Orthodontics, 49(2), pp.228–239. doi:https://doi.org/10.1177/14653125211042891.
[vii] Alshammari, A., Almotairy, N., Kumar, A. and Grigoriadis, A. (2022). Effect of malocclusion on jaw motor function and chewing in children: a systematic review. Clinical Oral Investigations, 26(3), pp.2335–2351. doi:https://doi.org/10.1007/s00784-021-04356-y.
[viii] CALDAS, W., CONTI, A.C. de C.F., JANSON, G. and Paulo César Rodrigues, C. (2016). Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice. Journal of Applied Oral Science, [online] 24(4), pp.411–419. doi:https://doi.org/10.1590/1678-775720150295.
[ix] NHS Choices (2020). Temporomandibular disorder (TMD). [online] NHS. Available at: https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/.
[x] de Kanter, R.J.A.M., Battistuzzi, P.G.F.C.M. and Truin, G.-J. (2018). Temporomandibular Disorders: ‘Occlusion’ Matters!. Pain Research and Management, 2018, pp.1–13. doi:https://doi.org/10.1155/2018/8746858.
[xi] Jaber, S.T., Hajeer, M.Y. and Sultan, K. (2023). Treatment Effectiveness of Clear Aligners in Correcting Complicated and Severe Malocclusion Cases Compared to Fixed Orthodontic Appliances: A Systematic Review. Cureus. doi:https://doi.org/10.7759/cureus.38311.
