Every concept of occlusion embraced the biological condition because without it-nothing would work!Dr. Robert Supple
- Biologic Health is Everything! The human system has the ability to work with you and against you.
- All oral tissues, soft and hard, are subject to nutrition, circulation, maintenance, function, repair, stress, adaptation and age.
- Biology is the foundation behind comfort, health and function (3 of the 4 pillars of occlusion).
- Biology is dentistry’s direct link to medicine.
Adaptation in a bio-mechanical format is how the majority of dentistry is treated in the world today. If the automobile maintenance and replacement example used in the concept of adaptation were so simple then dentists would not be called doctors, but mechanics. Biology is the study of living organisms and their structure, function, growth, origin, evolution, and taxonomy. Five fundamental principles of modern biology are:
- Ability to consume and transform energy
Every concept of occlusion embraced the biological condition because without it-nothing would work!
Dental schools and dental research have given the profession excellent roots into the biology of oral health. The challenge for the future may be very similar to what we have been taught in the past. The interaction between genetics, cells and molecular biology and how the human structures function and heal are even more important today. Dentists must not lose sight of the biological solutions and applications to oral health problems. Occlusion is a biological function and is subject to the terms, conditions and requirements of the human body.
A biologic occlusion has five sub categories and every concept of occlusion must satisfy all five components.
The Oral Care Report sponsored by Colgate and edited by the Harvard School of Dental Medicine states: “The unraveling of genomic information provides a basis for detailed studies of molecular mechanisms involved in oral, dental, and craniofacial disorders, and opens vast opportunities for changing the face of dental practice.”
Most diseases have a genetic component and oral disorders can have a single gene mutation or a complex multiple genetic interaction. Examples of a single gene mutation include Hereditary Gingival Fibromatosis (slow progressive benign enlargement of gingival tissues.), Amelogenesis Imperfecta (defective enamel) and Dentin Dysplasia.
More common disorders are caused by a complex interplay between multiple genetic and environmental factors. Dental disorders include cleft lip and palate, congenitally missing teeth, dental caries, periodontal diseases, head and neck cancers and autoimmune disorders.
In the future, genetic testing may become a routine part of dental practice. Genetic testing can state whether a genetic variation associated with a disease is present or absent in an individual and also provide a measure of disease susceptibility. “As we develop a more refined understanding of how genetic, environmental, and behavioral factors interact in the etiology of common diseases, genetic testing is expected to become a useful tool for the design of individualized treatment and prevention plans.” (Oral Care Report; volume 14, number 2, 2004)
As dentists, we know the bio-chemistry of the oral cavity because our dental school education focused heavily on the subject. The bio-chemistry of caries and periodontal disease are the foundation for many of the procedures we perform on a daily basis. Prevention of decay, soft tissue and osseous bone destruction are all predicated in changing the bio-chemical environment. Home care instruction, fluoride treatment, toothpaste mouth rinses, (prescription and over the counter medications) and even dental floss change the oral environment from a pathologic biochemistry to a more neutral physiologic condition. In my opinion, understanding the Bio-Chemistry of the oral cavity is excellent throughout the dental profession, especially with patients 50 years old and younger. Medications and systemic disease change the biochemistry of the oral cavity and we as a profession will grow to better understand systemic change. Understanding the biochemical changes within the T.M. joint, especially in pathologic and dysfunctional joints, is in its’ infancy and should prove to be extremely helpful to our profession in the future.
Human anatomical structures are subject to stress when asked to function. Anatomy parts either by themselves or as a group may stress beyond the individuals’ Bio-Load or Bio-Resistance. In diagnosis, it is very important to predict the prognosis and the longevity of a specific treatment plan is often predicated on the Bio-Resistance of the anatomy. As dentists we are experienced with the prognosis of teeth, gums and bone. We need more experience with ligaments, muscles, T.M. joints and the integration of all the anatomical structures together.
Teeth are living tissue and under stress they age, adapt and change. The idea that a tooth can develop a non-carious lesion is not a new concept for dentists. Teeth age from young to old and they change internally and externally throughout a lifetime. Abfractions are extremely diagnostic and the profession is stuck on the toothbrush abrasion idea of the 1950’s. Dentists understand receding pulps, affected dentin, enamel craze lines and wear facets. However, dentists differ about the etiology as a tooth changes shape at the CEJ over time. Understanding muscle physiology is growing in dentistry as we become more experienced with bite splints, trigger points and mapping muscle pain patterns. T.M. joints change, adapt and age at every decade of life. In my opinion, most dentists think of the jaw joint, as, out of sight, out of mind so they prefer not to focus on the biomechanics of the condyle, disc and related anatomy. Every general dentist should take responsibility of the health of their patients’ T.M. joints because they are part of every treatment plan.
Dentists are really engineers and artists in disguise. The majority of occlusion concepts are engineering principles. Bio-esthetics, CRO dentistry, Gnathology and Neuromuscular occlusions all deal with the same fundamental philosophy, but in different ways. They all strive to develop an occlusion in which the anatomy of teeth, joints, muscle, ligaments, and bone have correct condylar guidance and correct anterior guidance. Equilibration, orthodontics (including orthognathic cases), restorative dentistry and splints are the only treatments we have to re-engineer a single tooth, an arch of teeth or the entire occlusion. All dentists live in a world of artistic engineering inside the body. In my opinion, dentistry is stuck inside the box of trying to find a single ideal Bio-engineered philosophy that works for every occlusion and every patient.