Dentists, what is an Occlusal Adjustment

I went to the dentist last week, for the first time in a couple of years. I think he maybe trying to pull a fast one on me.

A bit of background. I’ve been told I grind my teeth at night, though how much I really don’t know. For the most part my teeth to me seem to be in good health. I’ve had a couple, 3 maybe 4 cavities in my life. As a matter of fact I’ve had one that was just filled for two years or so. I also have one crown up front and one plaster top on my upper front teeth. I had a bike accident and broke both of them. I have been told before, the last time I went to a dentist, that crown could be replaced as well as fixing the second tooth to make them look better, but there was no problem with the crown or other tooth.

Now, however, I have been told that the crown needs to go, and the other tooth needs to be fixed. I’ve also been told I will need a mouth guard, which I was told before I even opend my mouth, and I will need to have a Occlusal Adjustment. I have no idea what an Occlusal adjustment really is and googling gave me a number of paper abstracts. It seems that it is to fix lockjaw, which I also do not know what it means, but can not find any evidence that it will do anything. I’m the type that does not want to fix things if they are not broken. I’ve also never been told I would have to have this done before. I was also feeling pressured into getting it done and told them I would have to wait a few months and was then told it really needed to be done now. I’m getting the impression that I don’t really need it done but they are trying to scare me into it.

So what do the SDMB dentists say, or anyone with experience? I’m thinking on getting another look at my teeth, but my insurance does not cover much so it would be out of pocket.

Your dentist is probably recommending an occlusal adjustment because he feels that your bite is not coming together properly, which may lead to problems.

It sounds like he is not explaining exactly what the situation is, and exactly why he thinks you need these treatments now. Some dentists and doctors are like that - they get annoyed when patients don’t just automatically submit to recommended procedures.

You must see another dentist and get another opinion regarding all of this. You need to know exactly what the problems are, what options are available, and which procedures are the most urgent.

I recently was in a similar situation in which I went to a dentist who recommended that I get quite a few fillings. He was annoyed with my questions and talked to me in a very condescending manner. Furthermore, my teeth still hurt two weeks after getting fillings. So I went to another dentist to get a second opinion. This new dentist said that those four teeth in question had some pitting and should be looked at during the next visit, but they didn’t need drilling and filling at this time. I had a good discussion with him about dentistry, and he had no problems with my questions. He also worked on a malocclusion caused by the first dentist who built up a couple of fillings too high, which caused a great deal of pain with my bite.

I’ll try to speak to your comments and questions, and add a few comments of my own. I’ll try to keep it short.

It can be very difficult knowing how to choose a dentist. There is no sure way. Probably the best way is to talk to people you trust about their dentist. It is difficult for a person to know the actual quality of the dental treatment they receive. Problems can occur even after the best available treatment. Sometimes a technically superior dentist can have lousy chairside manners.

Get a second opinion; get a third opinion if you feel you need it. Find a dentist that seems to fit your concept of what a dentist should be. This is your mouth. It is a BIG mistake to base your decisions on your insurance.

**The mandible (lower jaw) fits into sockets in the skull: The Temple/Mandible Joint. Temporomandibular Joint. The TMJ. It is a very delicate and complicated joint. When you stick your chin forward or the side, the mandible slides out of socket. When your chin is centered to your midline and pulled straight back, the mandible is seated in the sockets. The joint is designed to work in this position (centric relation). If the teeth (occlusal relation) are not aligned to this position, closing your teeth causes a shift in the joint that stresses on the joint. Your subconscious knows that the bite is incorrect and tries to correct it when.

** If joint damage occurs it is too late. Short of surgery or artificial joint placement, you will have to live with it broken.

Occlusal Adjustment: The dentist will put carbon paper between your teeth and have you bite in centric relation, as your teeth hit and slide into occlusal relation, the paper will leave marks. The dentist will remove these interferences. This is like trimming your hair of fingernails, the enamel is not living, the adjusted amounts are minimal and should cause no sensitivity. The goal is to have all teeth touch evenly in centric relation. At this point your night grinding might stop and you may not need the occlusal guard.

There is no way of knowing whether your grinding is going to lead to problems. Problems only occur in a small minority of cases. On the other hand the occlusal adjustment is minimally invasive, and people with TMD (dysfunction) can be in severe pain the rest of their life. (Kind of like whether you should wear a seatbelt.)

**A lot can happen in six months. Another possibility is that one dentist thinks similar to you: “It’s only a minor problem, I’ll watch it for now.” Another dentist could be more prevention oriented: “If I fix it now while it’s only a minor problem, it will not have a chance to become a major problem.” Either philosophy could be right for a given situation.

AV8R: If your dentist uses composite resin (tooth colored) fillings, you might want to have him follow one of the pits to see how deep it really goes. If it breaks into the dentin, it has been stopped as small as possible and if it does not break into the dentin, he can seal the pit to prevent a future cavity. The smallest pinhole cavity can reach the dentin and do considerable damage before it is detectable. This one tooth will help you decide about the others.

Sorry I wasn’t basing my decision on my insurance, I’m not worried about money, but about doing things that may not need to be done.

Thanks for the info.

See I was not told this part, I was told I would have to have one, at the cost of $400 or so. No, you might need this but you will need this.

I have been looking a bit on the web and have seen conflicting info, some have said that it does nothing while others have said it will work wonders. I really wanted to know why after 30 years this is the first time it’s ever been brought up, and without really looking at my teeth. I will find another dentist today. Thanks for the information that I was looking for.

Ronbo hits it on the head…but in a very detailed way.

Basically, the occlusal surface is the scientific way of saying “the biting surface”. So anytime they do anything to the biting surface, it’s an occlusal adjustment. On the low end, it might mean polishing them down to a different shape, or adjusting the the thickness of a sealant. On the complicated side it might be a larger treatment for TMJ. Then of course there are lots of stuff between. Say you get a filling and it’s too high. Well the reshaping is an occlusal adjustment.

Either way, any Dentists who talks to you in “occlusal surface” terms and not plain ol’ english needs to learn a lesson in chairside manner.

**You’re certainly welcome, I’m glad I could help.

It may depend on how “broke” the joint was before the adjustment. There are many compleltely different factors in TMD, its partly a matter of luck whether your problem can be resolved with just an adjustment. The successes can be dramatic.

**1) TMD is progressive. 2) Some dentists may or may not be as familiar with occlusal adjustment or feel it is not necessary until a problem occurs. 3) The diagnosis of TMD can be made on the basis of night grinding, but yes, the dentist could have been more thorough.

Good Luck.