For many years before I attended dental school, I worked to support myself and my family as a dental assistant. During that time, I was often fascinated not only with the techniques used to heal disease and repair damage in the mouth, but also with the overall function of the teeth and mouth in general. What made it easy for some people to chew and why was it so painful for others, even when their teeth seemed to fit together?
The dentist I worked for did not treat TMJ disorders, but we certainly saw patients who suffered from the consequences of an unbalanced bite. When the time came for me to go to dental school myself, I was excited to finally learn more about TMJ disorders and the science of occlusion (the bite), in addition to the study of dental technique. I assumed that all three areas of study were a standard part of the dental curriculum. I was wrong.
At school, while I did receive some instruction on occlusion, the majority of my education in that area focused primarily on tooth position with little or no regard for the joints and muscles responsible for the action of chewing. Teeth were teeth. As long as they fit together, everything else was supposed to be fine. But it wasn’t long after I graduated that I encountered my first challenge to this idea.
Shortly after I started in practice, a young woman appeared in my office, crying in pain about her horrible headaches and jaw problems. She could chew, but the pain was greatly exacerbated by the activity. Her doctor’s solution? Stop chewing.
Stop chewing at 28 years old? For how long? The rest of her life? It was ridiculous advice, and even though I didn’t know exactly how to help this young woman at the time, her situation set me on a quest to better understand three-dimensional jaw function that still continues to this day.
There are many often conflicting lines of thought about how the teeth should be aligned, how long the cuspids should be, how sharp the cusps of the teeth should be, and where the “balls” of the lower jaw should fit into the bony concavity in front of the ear. In the more than 30 years since I graduated dental school, I’ve spent countless hours in classes, reading textbooks and journals, and observing the mouth movements and function of my patients. I was, and still am, somewhat obsessed – watching how people move their mouths in movies, in restaurants, and in everyday conversation. I still watch the way the front teeth fit together, study the wear patterns on the teeth, observe the development of crowding – all in an attempt to understand how the entire system functions both in health and in disease.
Early in my quest to understand, and to help this young woman who was now my patient, I came upon the work of Dr. Bernard Jankelson. A noted prosthodontist, Dr. Jankelson had also struggled with the success of bite reconstruction based purely on the mechanics of the teeth. His work, considered by most to be the foundation of neuromuscular dentistry, finally created a system of analyzing jaw movements and bites that also respected muscle function. And I discovered through my study with his son, Dr. Robert Jankelson (a noted prosthodontist himself, and the leading contributor to the promotion and continuation of his father’s work), that the pain my patient was experiencing as a headache was coming from the muscles that couldn’t function correctly while chewing in their current three-dimensional relationship to the teeth.
That young woman I saw so many years ago is still my patient today. And guess what? She’s still chewing. So well, in fact, that sometimes I have to warn her about chewing a little too much gum! The idea of chewing gum when she first came to see me would have been excruciating to her. Today, we’re both grateful that she didn’t just accept the ridiculous advice her doctor initially gave her to simply stop chewing altogether. I wish I could say this is the only time I have heard this advice, but unfortunately the recommendation to stop chewing is still too common. A lifetime of a liquid diet isn’t just boring, it is nutritionally insufficient. In all but the most extreme cases, chewing should never be considered an optional activity.