What Are the Effects of a Buccal Occlusion?

Question

I've been to my orthodontists, and for a year I have been told that my braces will be coming off (out of over three years of treatment). My file says buccal occlusion on left side (and I've had them give a painstaking demonstration to me so I understand that part).

	I just want to know how can a a slightly off bite affect me? Can it effect me more than the migraines I get from on-going orthodontic treatment? (I use rubber bands, 3-3-4 triangles)

Greg Jorgensen, DMD, MS · Answer

There is less relationship between the bite and joint pain than a lot of dentists would have you believe. As an orthodontist that examines over 40 new patients every month and has treated over 8,000 patients in the past 20 years, I have seen thousands of horrible bites. If there was a definite relationship between the bite and jaw pain, the majority of my patients would be miserable. The fact is that very few of them (less than 2%) ever report pain. On the other hand, I often see new patients who come in with "TMJ" but have a perfect bite! There are lots of things that can cause jaw pain: anatomical problems, injury, clenching, grinding, stress, and non-related headaches of extrernal origin (i.e. migraines). I am not an expert on migraines, but I have not seen an increase in my patients who are wearing rubber bands. I have had them report fatigued muscles, but their symptoms go away almost as quickly as they stop wearing them. I would ask your orthodontist if you can take a little break from your elastics and see if your migraines go away. If they don't you should seek help specifically for the headaches. As for ending your treatment, even though few orthodontic conditions can be scientifically linked to joint problems, I would would advise you to continue until you have a healthy, stable (although maybe not perfect) bite relationship.

Mazyar Moshiri, DMD, MS · Answer

In my estimate, it seems like your missing a key component to your description. As an orthodontist, when I refer to buccal occlusion, it is classified as either one, two, or three (generally, it can get more specific). A "textbook" buccal occlusion is class I, but that really doesn't mean it is physiologic. Plenty of individuals with class I occlusion have temporomandibular joint dysfunction and headaches(TMD).

	TMD is very multifactorial and has many causalities, occlusion being one. Thus, many patients have and present with "slightly off bites", and have had no problems their whole life.

Clark L. Jones, DDS, MSD · Answer

Difficult question, difficult to answer.  How much "buccal" is the "buccal occlusion"?  Sounds like your orthodotnist is trying very hard to get you the best bite that he can and teeth aren't coopeprating too well.  We do have cases sometimes that are very hard to get the teeth to go where we want them to.  Sometimes we just can't get there.  One of the most difficult decisions in orthodontics is "when do we stop".  The orthodontist has some very ambitious goals in terms of where the bite should be and he is really going to try to do everything he can to get you there.  He is not usually content to just line up a few front teeth and let it go at that and the patient wouldn't likely know the difference anyway.  Ask your orthodontist what he thinks the down side would be if you decided to stop treatment and if a night guard or long term retainer might help to reduce or avoid future issues with the bite.  I recently saw a patient that  I treated first over 20 years ago and I considered it a resounding failure. I treated him twice and we still really couldn't get the bite right.  We discussed jaw surgery which he could not do due to insurance so I put him on a night time splint (night guard) and he has been wearing it for over 20 years and is still doing fine. I got him back in last month so we could take a CT scan of the jaws and look at the mandibular condyles in the TMJ.  (These scans didn't exist in dentistry until recently.)  We can now see that the jaw itself was changing during treatment but that it now appears to have stabilized.  I am still disappointed about his treatment not going better than it did  but pleased to see that he is doing well. We also helped him get his 6 yr old daughter to stop sucking her thumb so at least we got a "win" for them there.

What Are the Effects of a Buccal Occlusion?

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