Whenever I do an assessment on a new patient, I always breakdown the treatment plan into three important factors: 1 – Health, 2 – Function and 3 – Aesthetics. I also explain that the priority, for any patient, should be to have all three of these factors corrected, but most importantly, to have them done in the same order as stated above. There is no use in having your dental aesthetics corrected, if you still have gum disease present or if you can’t chew your food correctly!
Each factor is important in its own way, and each needs to be corrected before we can move on to the next one. The first factor health has been covered in a previous article of mine, and in this issue I will speak about function and in the next issue aesthetics will be covered.
So what is functional dentistry?
Simply put, it’s the way in which the jaw and teeth come together to allow one the ability to comfortably and correctly bite and chew food. Food is an integral part of our lives. Some of us ‘live to eat’, but many ‘eat to live’, either way if you cannot perform the simple function of chewing food, your quality of life will be severely impacted.
For people living with diabetes, I certainly don’t need to stress the importance of having a balanced diet. Therefore, it is imperative to ensure that your teeth function correctly and that there are no limitations to what you can eat.
The way in which the teeth come together – when the upper and lower jaws close – is called occlusion. Occlusion is a rather complex topic which involves the harmonious relationship of the teeth, the muscles that control the jaw and the temporalmandibular joint (TMJ) that connects the jaw.
Most of us take it for granted that there is a harmonious relationship between our teeth when we close our mouth. However, all it takes is as little as a millimeter discrepancy to throw the entire occlusion off. If you’ve ever had a filling, you’ll know that feeling when your dentist asks you to bite down and the one side of your mouth isn’t contacting because the new filling is too high. When the occlusion is not in harmony, we call this a malocclusion. This is mainly caused by: missing teeth, orthodontic issues, defective fillings and tooth wear or grinding.
When the occlusion is balanced, both sides of the mouth – left and right – contact at the same time and the TMJ slides into its socket without clicking or shift. This balanced relationship is the key to functional dentistry. If you begin to favour one side of your mouth when chewing, you can land up overworking the teeth, the muscles and the TMJ on that side, which can lead to long-term issues that can be costly and complicated to repair.
Having missing teeth, especially missing posterior teeth (molars), is a major cause of malocclusion. Molars are specifically designed for chewing food; their broad surfaces and multiple sharp cusps enable us to chew and breakdown the food we eat. This not only assists greatly with digestion; it also allows us to eat a wide variety of food. Without this function, a balanced diet is simply not possible and many people who lack molars will suffer from poor diet, weight loss, malocclusion and a collapsed bite.
I have seen many patients who lack the correct balance of occlusion due to missing molars and they land up using their anterior (front) teeth to chew with. The anterior teeth are designed for biting and tearing food, so this discrepancy not only limits one’s diet as previously mentioned, but it will also greatly impact the longevity of the anterior teeth as they’re simply not strong enough for chewing food.
When we speak of orthodontic issues, many people think of straight teeth, arguably, this falls into the aesthetic dentistry category. However, the relationship of the back teeth and how they come together in a balanced way, is very much an orthodontic issue. Skew molars, open contacts and overlapping teeth are major causes of malocclusions. Most times, the correct functional relationship of the teeth needs to be corrected by an orthodontist to ensure a balanced occlusion.
Defective fillings can be a major nuisance and cause a host of issues in the mouth. If a filling has not been done correctly, or has broken, chipped or leaked, it can lead to toothache, food trapping, bad breath and of course malocclusion. It is imperative to have these defective fillings repaired as soon as they become apparent. Leaving a defective filling for a long period will severely impact the functional aspects of one’s mouth and can also create bigger issues that will ultimately be costlier and time consuming to repair.
Tooth wear is mainly caused from grinding or clenching one’s teeth. It’s an incredibly common occurrence in this day and age; this is mainly because it’s a stress-related habit that is powered by the central nervous system. Many of my patients are not aware that they grind their teeth as the habit occurs while they are asleep.
It’s important to identify the habit of grinding and to wear an appliance, such as a bite plate, which will prevent further tooth wear. The long-term effects of grinding one’s teeth will lead to the destruction of tooth form, a collapsed bite, malocclusion and damage to the TMJ. This severely impacts in maintaining a stable, functional mouth. Discuss this with your dentist if you believe you could be grinding your teeth.
Functional dentistry is an integral part of maintaining a high quality of life. Your dentist should understand the dynamics and the relationship of your teeth and jaw to correctly guide you into maintaining correct function. At the end of the day, when you’re craving that delicious meal, all you truly want is the ability to enjoy it and by having a mouth that is in full working order, you will be able to do so.