Results of Occlusal Disease

Gum Recession, Abfractions and Wear
As we chew our food, our “eye” teeth (cuspids) and front teeth are the guides that keep a destructive bite from occurring. But when they wear or are slightly out of position, the back teeth start contacting where and when they should not, resulting in gum recession and abfractions.

Recession and abfractions are actually the result of micro-chipping of the tooth and root when the forces on the teeth are not in the proper direction. The constant trauma to the tooth that hits inclines (as above and below) or causes wear is what causes abfractions. Note the arrows on the left photograph showing the destruction caused in abfractions; on the right, the arrows point to the flattened tooth contacts, a result of the constant destructive force.

If we look at the bite on these teeth with carbon paper, we can see that instead of the tips and grooves touching, the lower teeth are hitting these uppers on an incline, a destructive contact for all back teeth.  

The following shows occlusal disease involving wear on the “eye teeth” (cuspids). As the cuspids wear, the back teeth begin to touch in destructive contacts, as on the molar diagrams above.

The photographs below show what this looks like in the mouth. The circles denote one of the results of the destructive bite, the hollowed out areas called abfractions which are actually micro-chipping over time due to the forces on the teeth. Also note on both the diagram as well as the photograph that the teeth contact in broad flat areas perpetuating more wear, more abfractions, and a progression of occlusal disease. These are destructive tooth contacts.

Stable and Destructive Tooth Contacts
In the following two diagrams, you can see the difference between stable and destructive contacts. On the left are the places that teeth must only touch when the mouth is closed. These areas consist of small round contacts on specific areas of the teeth that are designed to disperse the forces of chewing and biting. The diagram on the right is a typical destructive bite where the areas of contact are broad, flat, and in places where there should be no contact.

Bone Loss
Bone loss is mostly thought to occur from gum disease, an inflammatory process where bacteria destroy the gum and bone.

However, bone loss also occurs and existing gum disease worsens from a destructive bite. The following x-rays show the bone loss on the entire front root of the last molar over an 8 year period for a person who had no actual gum disease, but a destructive contact on that last molar that slowly destroyed the bone from trauma. You can see the part of the last tooth where this contact occurred – it is the highest place in the middle of the tooth. And yet the person never felt it.

Damaged Teeth From Occlusal Disease
As we get older, most people assume that our teeth will wear down as part of the aging process. However, when we are relaxed, the jaw is in a position where the teeth are not touching. The only time our teeth are actually supposed to touch is when we swallow. This occurs 2000-3000 times each day. Even when we are eating, our teeth don't come together because we have food between them. The only time that we would see severe wear on teeth is due to a malocclusion or a parafunctional habit. A malocclusion is when the teeth don't come together properly.

The photo on the left shows the result of a destructive bite as well as grinding and clenching. Note the extreme wear that appears as an almost total touching of the entire edges  of the teeth.

A parafunctional habit is when teeth come together in a grinding or clenching motion. Usually, grinding or clenching of the teeth occurs at a time when we are unaware of it, such as when we are asleep. Many people will wake up in the morning with a variety of symptoms as a result of teeth grinding or clenching. The grinding and clenching of the teeth is a direct result of the muscles of the jaw and neck trying to place the jaw into a relaxed position. The teeth get in the way of this position, thus we grind or clench. Often times the worn or broken teeth caused by clenching or grinding will be restored with crowns or onlays. This results in these restorations eventually failing but also perpetuating the same problem.

The differences between stable contacts and destructive contacts can be the cause of toothaches, loose teeth, bone loss, sensitive teeth, neck pain, facial pain, headaches and migraines and can lead to TMJ dysfunction and symptoms.