Malocclusion can affect the long-term health of the teeth and oral cavity. It increases the risk of caries and the level of load on the jaw, which may damage the temporomandibular joint.
A 38-year-old patient presented to the YAREMA DENTAL clinic with complaints of lesions on the inner surface of the cheeks and discomfort while chewing. It was possible to help him thanks to comprehensive gnathological diagnostics.
Myklosh Yarema, Chief Physician, Prosthodontist, Gnathologist
Why is malocclusion dangerous?
The way teeth are positioned in the mouth affects how bacteria accumulate on them. For example, if the upper teeth protrude too far forward over the lower teeth (overbite), the lower teeth may be more difficult to clean. Bite problems also increase wear of the enamel and gums. With malocclusion, the upper teeth may rub against the lower teeth and wear down their surfaces.
As enamel breaks down, bacteria gain easier access to the dentin, where caries develop.
In particular, a systematic review by researchers from the All India Institute of Medical Sciences (India) demonstrated that in children and adolescents with malocclusion, caries occur more frequently, and their severity increases with the degree of bite disorder. Clinical studies also show that adolescents with pronounced malocclusion may have approximately a 30% higher risk of caries compared to those with a normal bite.
In some individuals, excessive overbite or underbite affects the gums, leading to trauma, gingival recession, and infection. Wear, trauma, and difficulties with eating may contribute to the development of periodontal disease.
Malocclusion can lead to functional overload of the temporomandibular joint and the development of TMJ dysfunction symptoms.
Malocclusion can lead to functional overload of the temporomandibular joint and the development of TMJ dysfunction symptoms.
If teeth are positioned incorrectly, this can create increased pressure and load on the jaw. This load may damage the temporomandibular joint on both sides of the jaw.
If these joints are strained or damaged, the patient may experience symptoms of TMJ disorder, namely: jaw clicking, limited mobility, teeth grinding, and pain.
How are bruxism, TMJ disorders, and malocclusion related?
It is known that bruxism causes TMJ dysfunction, but did you know that teeth grinding can cause irreversible changes to your teeth and jaw? And that there is a relationship between bruxism and malocclusion? The relationships between these conditions are complex and multifactorial.
Many scientists have attempted to uncover the cause-and-effect relationship between overbite, underbite, and teeth grinding. According to a study by researchers from the Graduate School of Medicine, Dentistry and Pharmaceutical Sciences at Okayama University (Japan), bruxism may be associated with changes in occlusion and overload of the dentofacial system.
According to other researchers from Isfahan University of Medical Sciences (Iran), people grind their teeth due to discomfort caused by bite problems.
In any case, the data indicate that bruxism and malocclusion are closely related.
If you grind your teeth due to discomfort from an overbite or underbite, your teeth have an increased risk of trauma and caries.
Clinical case: full rehabilitation in reduced bite height and masticatory muscle hypertonicity
A 38-year-old patient presented with complaints of:
- redness of the cheek mucosa;
- painful erosions on the inner surface of the cheeks;
- discomfort while chewing.
The patient had a history suggestive of sleep bruxism, but no TMJ disorder had been diagnosed.
A characteristic white line (linea alba) on the inner surface of the cheek formed as a result of constant cheek biting due to improper jaw position and muscle hypertonicity.
On examination, clinicians observed a characteristic white line on the cheek mucosa, which is a sign of chronic trauma to the oral cavity. Traumatic erosions were also present. Palpation revealed hypertonicity of the masticatory muscles — chronic tension or spasm, often caused by stress, bruxism, or malocclusion.
Diagnostics
To accurately understand how the jaw functions and identify the problem, several examinations were performed:
- Cephalometry (teleradiography) — helped assess how the jaws are positioned relative to each other and whether malocclusion is present.
- CT of the temporomandibular joint (TMJ) — to check for inflammation or serious structural changes in the joints.
- Condylography — a specialized study of mandibular movements that shows exactly how the jaw moves and whether there are restrictions or overload.
Visual reduction of the lower third of the face due to tooth wear and malocclusion, which led to discomfort and functional disturbances.
The examinations revealed that:
- the bite height was reduced (the jaws close lower than necessary);
- the masticatory muscles and joints were functioning under overload.
Calculation of occlusal vertical dimension (OVD) and rest vertical dimension (RVD). Diagnostics showed the need to increase the bite height to relieve stress from the joints and muscles.
This means that the problem must be addressed comprehensively: restoring proper occlusion and normal jaw function.
Treatment plan
Considering the diagnosis (reduced bite height and bruxism), a staged approach was chosen.
Stage 1. Splint therapy (mouthguard)
First, an individual splint was fabricated, which gradually increases the bite height. Initially, the bite was raised by +4 mm. The patient wore the splint for 2 months. As a result, the tension of the masticatory muscles decreased.
After a follow-up examination, it became clear that the bite could be increased further.
Then a second splint was fabricated with an additional increase of +2 mm, and this stage of treatment continued for another 2 months.
As a result:
- the pain completely disappeared;
- the mucosa recovered;
- the muscles began to function normally.
The use of an individual occlusal splint allowed gradual elevation of the bite. This made it possible to relax the masticatory muscles and eliminate the cause of oral lesions.
Stage 2. Complete restoration of occlusion
When the jaw adapted to the correct position, permanent treatment was initiated. The bite was restored using prosthodontic constructions while maintaining the correct jaw position achieved with the splint. The work was carried out taking into account the function of the joint and muscles. The duration of this stage was approximately 1 month.
That is, first a new functional position of the jaw was formed using the splint, and only then this result was fixed with prosthodontic constructions.
What was the result?
Top: condition before treatment — pathological tooth wear and reduced bite height.
Bottom: result of total rehabilitation — anatomical tooth shape and proper jaw closure were restored.
First of all, the patient’s condition improved. He no longer experiences pain during chewing, the cheek erosions healed, and chewing became comfortable.
It was possible to stabilize TMJ function, and muscular imbalance disappeared. The trajectories of mandibular movement returned to physiological.
The key aspect was the restoration of the occlusion. Increasing the vertical dimension of occlusion balanced the proportions of the lower third of the face, improved lip position, and harmonized the nasolabial angle, which gave the face a more youthful appearance. In gnathology, occlusal rehabilitation is evaluated not only from the perspective of function, but also aesthetics. In particular, studies show that the treatment of occlusal disorders can simultaneously improve both masticatory function and the appearance of the face and teeth.
This clinical case demonstrates that local symptoms (erosions, pain) often have a deeper functional underlying cause.
Comprehensive gnathological diagnostics helped identify the true cause (reduced occlusal height, bruxism), rather than merely eliminating the symptoms.
Proper step-by-step occlusal rehabilitation produced a pronounced functional and aesthetic effect.