Occlusion Simplified

Occlusion is easy when there is a deep understanding of its fundamental principles. And yet, it is perhaps the most misunderstood aspect of dentistry.

Let’s start at its foundation.

The simplest definition of occlusion is this: contact between teeth. There are two types of occlusions:

Physiologic

This involves occlusion of the teeth in harmony with the functions of the masticatory system. Characteristics include:

• Comfortable function. Teeth fit together naturally without causing pain or discomfort during regular activities such as chewing, speaking, and swallowing.
• Balanced force distribution. The forces generated during biting and chewing are evenly distributed across the teeth, preventing excessive pressure on any single tooth.
• Healthy supporting structures. The gums, periodontal ligament, and jawbones support the teeth effectively, maintaining stability and health without inflammation or recession.
• Muscle harmony. The muscles of mastication work in a coordinated manner, minimizing stress and tension. This reduces the risk of muscle fatigue and temporomandibular joint (TMJ) disorders.
• Adaptability. The occlusal relationship can adapt to minor changes over time, such as tooth wear or minor dental work, without significant negative effects.

Pathologic

This refers to the occlusal relationship of the teeth, capable of producing pathological changes in the teeth and the supporting tissues. Characteristics include:

• Discomfort and pain. Patients may experience pain or discomfort during normal activities, indicating that the occlusion is not in harmony with the masticatory system.
• Uneven force distribution. Occlusal forces are not evenly distributed, causing excessive stress on certain teeth or areas. This can lead to tooth wear, fractures, and an increased risk of periodontal disease.
• Damage to supporting structures. The supporting tissues, including gums and bone, may show signs of damage, such as inflammation, gum recession, or bone loss.
• Muscle and joint disorders. Pathologic occlusion can lead to muscle strain and temporomandibular joint disorders, causing symptoms like jaw pain, headaches, and clicking or popping sounds in the jaw.
• Limited adaptability. The occlusal relationship does not adapt well to changes, making it more susceptible to further complications if untreated.

One of the primary goals of full mouth reconstruction treatment is to transform a pathologic occlusion (if present) into a physiologic occlusion. Think of it this way: when form creates function, you can predictably treat the issue. Alternatively, when function creates form, treatment becomes unpredictable. Predictable systems and outcomes are mission-critical to building the practice of your dreams.

To assess occlusion and for your dental team to have an understanding of common occlusion terms, below you will find a list of things to check of aspects of occlusion to examine and identify.

• The Temporomandibular Joint – Ensure it is healthy, pain-free, noise-free, and stable.
• Centric Relation (CR) – Identify the joint position that is comfortable and repeatable.
• Maximum Intercuspation (MIP) – Assess how the teeth fit together when the jaws are closed in their most natural position.
• Vertical Dimension of Occlusion (VDO) – Determine this by the equilibrium between contracting elevator muscles and the eruptive force of the teeth.
• Dental Envelope of Function – Determine the range of mandibular movement by guiding inclines of the teeth.
• Neuromuscular Envelope of Function – Gauge the mandibular movement by the patient’s neuromuscular pattern.
• Envelope of Parafunction – Measure the range of motion of nonfunctional purposes.

My REM Program for Restorative and Esthetic Mastery goes into much more detail on occlusion. Feel free to reach out for details.

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