Biomechanical Disharmony: Problems, Evaluation, and Treatment

Reasons for a Dental Biomechanical Evaluation

Many patients are referred to Dr. Hegyi because of problems caused by biomechanical disharmony (see “Dental Biomechanical Harmony – the Key to Predictable Dental Comfort, Health, and Esthetics”). As a result, they may be suffering from a wide variety of problems including jaw or facial pain, headaches, sensitive, damaged, or loose teeth, failing restorations, or an unattractive smile or facial appearance. In many cases, these conditions are compromising the patient’s quality of life.

Whenever any of these conditions is caused by biomechanical disharmony (which they frequently are), restoring harmony is a critical part of the treatment. If biomechanical disharmony is thought to be the cause, the first thing that should be done is to verify that this is in fact the case. This requires a thorough evaluation that includes use of a “DATA Appliance” (Diagnosis And Treatment Assisting Appliance). As the name implies, the DATA Appliance is used to assist in both evaluating and treating patients.

How we do a Dental Biomechanical Evaluation

Before describing how we do a comprehensive biomechanical evaluation and how the DATA Appliance is used in this evaluation, it may be helpful to again describe what biomechanical disharmony is. Biomechanical disharmony is a functional disharmony between the jaw muscles, the jaw joints (TMJ’s) and the teeth. It results when the way in which the upper and lower teeth fit together is not in harmony with where the jaw muscles and jaw joints most peacefully function. It might also be described as a “bad bite or “malocclusion”, although these terms are often used to describe other dental conditions such as crowding where there there may not be disharmony.

The nerves in and around teeth have exquisitely sensitive pressure sensors (called mechanoreceptors) that communicate with the brain and jaw muscles. These sensors can detect unevenness in the bite less than the thickness of a human hair.  As a result of this input, the brain will activate the jaw muscles to function however is necessary to shift the mandible so that the teeth contact as evenly as possible (a process called engram programming). Therefore, changes in the relationship of upper and lower teeth change the way in which the jaw muscles and joints function. In a sense, the jaw muscles and joints are a slave to how the upper and lower teeth fit together. Problems occur when the way in which the muscles and joints must function in order to have the teeth contact most evenly results in mechanical stress or strain. It is these stresses and strains that lead to the painful and destructive problems associated with biomechanical disharmony.

During an evaluation, the DATA Appliance “unlocks” or “deprograms” the jaw muscles and joints, allowing them to “go where they want to go and do what they want to do”. This allows the muscles to move the mandible and teeth in their healthiest, most natural manner. This temporarily eliminates the biomechanical disharmony while the appliance is being worn. When this occurs, several important things are learned (see “Posterior Dysfunction Evaluation 2 – DATA Appliance Seating and Adjustment” video).

First we learn which of the painful symptoms are results of this disharmony (as they will be reduced or disappear while wearing the DATA Appliance). Second, we determine and record the relationship of the upper and lower jaws and teeth to each other when the jaw muscles and joints are functioning in their healthiest manners. We believe that the DATA Appliance is the most accurate and meaningful way of finding and recording this critical information (see “Posterior Dysfinction Evaluation 4 – Bite registration with a DATA Appliance” video). Third, we determine what treatment option(s) are possible to correct the disharmony, what this treatment would involve, and what benefit(s) this treatment would provide. Furthermore, all this information is determined before treatment is committed to or begun. Finally, we gain valuable information regarding the health of the jaw joints and the nature of the patient’s tooth clenching and grinding activities.

Based on Dr. Hegyi’s experience, it is his belief that the DATA Appliance provides more meaningful information about most patients’ biomechanical condition and what can be done to help them than any other evaluative means available.

Treating Biomechanical Disharmony

When the evaluation is completed, if biomechanical disharmony is determined to be a problem, multiple treatment options may be possible. Proper treatment should be directed at addressing the underlying cause(s) of the disharmony and depends upon the type of problem (the diagnosis) as well as the patient’s overall goals and objectives. Treatment should always address the biomechanical disharmony, but it should do so in a way that is as conservative as possible and also considers any restorative and esthetic wants and needs the patient may have (see “Segment 3 – Debbie’s Functional Treatment Options” video).

In most cases, correction of biomechanical disharmony will involve reshaping the functioning surfaces of the teeth and occasionally orthodontic movement of the teeth. It is these treatments (alone or in combination) that will allow the upper and lower teeth to precisely fit together while the jaw muscles and joints are functioning in their healthiest manners. As described above, the DATA Appliance plays a critical role in first determining this healthiest functioning position and then assisting in treatment that allows the teeth to function there.

Common Biomechanical Disharmony Treatment Scenarios

- Occlusal adjustment or “RedAddibration”:

If the teeth are in good condition and are esthetically acceptable, the most common type of treatment is referred to as “RedAddibration”. This treatment is commonly done on patients whose primary problems are facial pain, TMJ pain, or headaches. It is typically a conservative process that reshapes the teeth by reducing portions of teeth that are over contoured and interfering with healthy jaw function and adding to those portions that need to be brought into function (usually with bonded composite). Dr. Hegyi has adjusted tens of thousands of teeth with RedAddibration and these adjustments have never resulted in tooth sensitivity or decay. To the contrary, by restoring biomechanical harmony, these treatments have eliminated sensitivity and improved the health of countless numbers of teeth. RedAddibration treatment is a fundamental tool for improving the health of not only the teeth, but of each part of the jaw system. Although details of its use are not described here, the DATA Appliance is a fundamental tool in providing RedAddibration treatment (see “Segment 5 – Debbie’s Bite Adjustment (RedAddibration)” video).

- When Biomechanical Disharmony meets broken down or unattractive teeth:

In cases where there is biomechanical disharmony along with damaged or esthetically unacceptable teeth, it is important to repair the teeth and/or improve the smile as well as correct the disharmony. Treatment in these cases is going to vary, but often includes composite or ceramic veneers or crowns and sometimes orthodontic treatment. It is Dr. Hegyi’s goal that this treatment restores the patient’s teeth, smile and biomechanical harmony in the most conservative manner possible (see “A Systematic Approach to Esthetic and Functional Treatment” article, “Esthetic vs. Cosmetic Treatment” and “Restoring Damaged and Unattractive Teeth”).

- When biomechanical disharmony meets degenerating jaw joints (TMJ’s):

Finally, there are cases in which the patient is also experiencing active degeneration of one or both jaw joints (TMJ’s). In these cases, treatment must always begin with rehabilitating the TMJ’s. Depending upon the type and cause of degeneration, treatments to rehabilitate the joints may include nutritional therapy, removable oral appliances, RedAddibration, joint repair surgery, or total joint replacement. While TMJ surgery is not often necessary, in some cases it is the best treatment. If it is, Dr. Hegyi works with one of only a very small number of surgeons in the US that are trained to provide this very specialized surgery.

Regardless of the treatment needed to rehabilitate the TMJ’s, once rehabilitation is complete, additional treatment will be necessary to restore biomechanical harmony. Rehabilitating the joints creates a stable foundation but does not in itself restore biomechanical harmony or completely correct the bite. Often times, this will involve RedAddibration. However, it can be done by whichever means is appropriate. Doing so is an important part of preventing renewed breakdown of the joint and assures comfortable and healthy function of the jaw muscles and teeth.