The way the upper and lower teeth meet when the mouth closes is known as dental occlusion, or simply the “bite.” This relationship involves a complex interplay between the teeth, the jaw joints (temporomandibular joints or TMJs), and the surrounding muscles. A proper, balanced bite is essential for maintaining oral health, ensuring efficient chewing, and supporting clear speech. When biting forces are distributed evenly, it prevents undue stress on individual teeth, gum tissues, or the jaw joint. Adjusting the bite corrects disharmony in this system, preventing discomfort or long-term damage.
Identifying Symptoms and Diagnosis
Patients typically seek professional help for bite adjustment due to uncomfortable symptoms. Common signs include chronic tension headaches, pain or stiffness in the jaw or neck, and a clicking or locking sensation in the jaw joint, known as temporomandibular joint disorder (TMD). Other physical signs are excessively worn teeth, chipped restorations, increased tooth sensitivity, or frequently biting the inner cheeks or tongue. These issues suggest that biting forces are unevenly distributed, causing trauma to the oral structures.
Before any adjustment begins, the dentist must accurately diagnose the cause of the uneven bite. A thorough physical examination evaluates the alignment of the dental arches when the mouth is closed and during dynamic movements like speaking or chewing. Diagnostic tools are then employed to pinpoint the exact areas of premature or excessive contact between teeth. The most common tool is articulating paper, a thin, colored ribbon that leaves marks on the teeth where they touch, revealing the high spots.
In more complex cases, the dentist may utilize specialized digital technology, such as the T-Scan system, which provides a computer-analyzed map of the bite forces in real-time. Dental models or impressions of the teeth are often taken, allowing the dentist to study the static and dynamic relationships of the teeth. X-rays and scans of the jaw and head provide further information on the underlying bone and joint structures. This diagnostic phase determines the precise treatment plan and the extent of the required adjustment.
The Direct Adjustment Procedure
The most direct and conservative method for correcting minor bite discrepancies is known as occlusal equilibration or selective grinding. This procedure involves the careful and precise reshaping of the enamel surfaces of the teeth to achieve a harmonious bite. The process is highly controlled and is typically performed without local anesthesia, as only microscopic amounts of the outermost enamel layer are removed.
The procedure begins by using articulating paper to identify specific points of premature contact, where one tooth hits its opposing tooth harder or sooner than others. The dentist uses a fine, high-speed dental drill or bur to gently shave or reshape the identified high spots, usually located on the cusps or grooves of the back teeth. This reshaping is meticulously performed in small steps, checking the bite with the colored paper after each adjustment. The goal is to ensure all teeth meet simultaneously and distribute the biting load evenly across the dental arch.
The dentist also eliminates interferences that occur when the jaw moves side-to-side or forward. These interferences can cause the jaw joint and muscles to strain as the patient chews or grinds their teeth. By subtly reshaping the inclines of the cusps, the dentist guides the jaw into a more stable and relaxed position. The final step involves polishing the newly reshaped enamel surfaces, ensuring they are smooth and comfortable.
Restorative Methods for Bite Correction
When an uneven bite involves significant tooth wear, missing tooth structure, or a need to permanently change the vertical dimension of the bite, simple selective grinding is often insufficient. The dentist may use restorative or additive methods to correct the occlusion. A common initial step is the use of a removable appliance, such as a nightguard or occlusal splint, which temporarily stabilizes the jaw joint and muscles. These devices, often worn at night, protect the teeth from grinding forces and help determine the ideal, relaxed jaw position before permanent restorations are placed.
For permanent correction, the dentist may use crowns, onlays, or specialized fillings to rebuild the surfaces of specific teeth. A crown is a custom-made cap that covers the entire visible portion of a tooth, allowing the dentist to precisely restore the tooth’s height and shape. By carefully designing the new restoration, the dentist can effectively raise or lower the surface of the tooth to achieve proper alignment with its opposing tooth.
In cases of severe wear or when multiple teeth require height adjustment, the dentist may place several crowns or onlays to increase the overall occlusal vertical dimension. Onlays are partial crowns that cover only the chewing surface and cusps of the tooth, offering a less invasive option for height and contour correction. In rare and severe situations, especially those involving significant skeletal misalignment, the final treatment plan may require a multidisciplinary approach incorporating orthodontic treatment or orthognathic surgery.