What is preventive dentistry?
It is self explanatory. Meaning maintaining good oral health by adapting preventive ways to keep your dentition healthy. This involves developing good habits like brushing and also flossing in combination with regular dental check up. One of the main factors that clinicians can help within Preventive dentistry is balancing your occlusion.
Occlusal rehabilitation is a process of reconstruction and restoration of the worn out teeth to maintain overall hygiene of oral mucosa, tongue, gingiva and lips. However in a full mouth rehabilitation, one should reestablish functional and biological efficiency where teeth, periodontal structures, muscles of mastication and mechanism of temporo mandibular joint all function together in synchronization. It is the selective grinding of teeth for adjusting of occlusion , efficient chewing of food without hampering the masticatory function of an individual.
According to BULL’s law upper buccal and lower lingual cusps the define a good occlusal grinding. One should evaluate a definitive diagnosis as etiology of occlusal tooth wear is multifactorial and variable. For an appropriate treatment planning one should assess patient’s diet and eating disorders and present state of occlusion .
Must ask questions before recommending Preventive Dentistry solutions:
What are patient’s dental problems/complaints and why are they seeking treatment?
Do they have discomfort or pain or saliva bleeding?
Do they lack self-confidence in social gatherings?
Are they looking to improve functional (biting) or speech or both?
How important are cosmetic aesthetics?
Are they focused on anterior or posterior, or for complete occlusion rehabilitation?
Do they prefer fixed or removable prostheses to restore missing teeth?
Classification of occlusal rehabilitation based on occlusal wear:
1. Excessive wear with loss of vertical dimension:
Closes speaking space is more than 1mm and interocclusal space is more than 4mm. Loss of facial contour and dropping of corners of mouth. Single sitting preparation of one arch should be made as it will increase the vertical dimension of occlusal (vdo) and give better esthetics.
2. Excessive wear without loss of vdo but with space available:
Gradual wear caused by bruxism, oral habits or enviormental factors where in the vdo maintained by continous eruption. This also causes shorter crown length where in resistance and retention is difficult to achieve. These cases may require gingivoplasty. However in some cases enameloplasty of opposing teeth can provide space for restorative material.
3. Excessive wear without loss of vdo but with limited space:
There is excessive wear of anterior teeth but minimal wear of posterior teeth centric occlusion and elcentric relation are coincidental with closer speaking space of 1mm and interocclusal of 2-3mm. This vertical space can be obtained by restorative materials. After classifying and evaluating patients’ existing clinical situation one must decide appropriate approach and choose an appropriate scheme.
Importance of Occlusal Rehabilitation for Preventive Dentistry
An essential part of occlusal rehabilitation is to re-establish the correct upper and lower vertical dimension. This dimension is defined by the vertical distance between the upper and the lower while the occlusal surfaces are in contact. The aim of restorative treatment is to provide good posterior occlusal contacts, stabilise the occlusion and provide anterior guidance. A harmonious occlusion balance is significant to improve the longevity and function of natural teeth and dental prostheses.
The Patient’s Lip Line is Important
The anterior teeth support the lips, which in turn, frame the teeth. The shape of the lips, the dimension of the oral opening, the visibility of supporting teeth, and the gingival health together influence the lip line. Evaluate the lip line while the patient is smiling, as this increases the width of the mouth by a quarter or a third compared to when the lips are at rest. In younger patients, you will witness more tooth structure than older patients. Patients with large smiles can also display an excess of gingival tissue, which can make planning anterior restorations challenging. Generally patients with smaller smiles and longer upper lips, are less challenging to restore, since fewer teeth are shown when smiling.
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Your dentist will typically correct malocclusion or mis-balancing of teeth seen mainly in children and adults. Receiving early dental treatment in during childhood can help reduce the treatment duration and may lead to fewer dental concerns later on. Adults can also get good results! The earlier you treat malocclusion, the better the outcome, Alignment of your upper teeth with lower will prevent you from biting your cheeks and lips. You may be required to visit your dentist for 2-3 sittings as the bite regularly changes and adjusting the same is important.
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