Please read this post before you consider the convenience of carrying out ANY dental treatment and before you choose the dentist who should carry it out. This post may save your life.
A negligent dental treatment that I underwent two years ago caused -within 24 hours- the onset of Cervical Dystonia. That dentists was just performing the procedures and applying the teachings that he had learned at Dental School.
Since none of the dentists I resorted to could fix my occlusion after that negligent treatment, I started my own research.
And I am now sharing some conclusions, facts and thoughts that resulted from this research.
Dental School Teachings are Not Science
It is difficult to respect the teachings of Dental School as science when I consulted and asked questions to 20 eminent professors of different schools of occlusion who professed (with great personal and epistemic arrogance, as if they were God given absolute Truths) concepts that are antithetic.
Do not mind the technical terms that follow. At this stage, I only wish to let you appreciate how the KEY ISSUE of dental occlusion – where and how the mandible and teeth close – is open to completley opposite OPINIONS:
1) “Teeth have to close in Centric Relation”
as opposed to
“Centric Relation does not exist”
2) “Koiss deprogrammers to establish where the mouth should close are a heap of BS”
3) “Centric Occlusion has to coincide with Centric Relation”
as opposed to
“Centric Relation and Centric Occlusion have to be completely different.”
4) “The curve of Spee has to be flat”
As opposed to
“The curve of Spee has to be steep”
The above are textual quotes of words that eminent professors of different occlusion “schools of thought” spoke to me. Those different schools of thought with opposing views on key issues define themselves: Gnatologists, Functionalist, Gerber, Organic, Mio-Functional Rehabilitators, Koiss… it goes on…
Much of modern dentistry ia based on myths and opinions that have no empirical evidence or contradict common sense, nature (healthy mouths that have never been touched by a dentists) and a great body of research an scientific evidence.
First Do No Harm
The most frightening conclusion of my research is that the principle of “first do no harm to the patient” is absolutely absent from modern Dental School teaching.
Most dentists will arrogantly profess as God given absolute Truths some principles which are – at best – open to debate. They will act upon those principles, carrying out irreversible procedures in your mouth.
Many dentists will happily drill their way through irreversible damage to your teeth based on concepts and principles that are WRONG, dangerous myths with no empirical evidence or at best- open to debate.
Run for the Door
Whenever you hear a dentist profess one of the following “dogmas,” as God given absolute Truths, we suggest to head for the door of the clinic as fast as possible. The dentist has no clue and is dangerous to let him touch your mouth. His ignorance is proportional to his arrogance.
Absolutely and dangerously wrong:
“Teeth have to occlude with vertical forces.”
Natural mouths (i.e. the ones which have never been touched by a dentists) present contacts between antagonistic teeth of the opposing dental arches that have many directions, be it vertical, lateral, diagonal, torsion or torque.
Look at the two pictures to realize that the force that teeth accommodate when the mandible presses against the skull may or may not be vertical. And you may become a top NBA basketball athlete with non-vertical forces in your mouth.
In my case, the elimination of all non-vertical contacts by a dentist with a drill resulted in a collapsed occlusion (picture on the left) that triggers dystonic symptoms. The use of a dental splint to reestablish diagonal, lateral and torque contacts between the dental arches (picture on the right) results in discontinuance of all dystonic symptoms.
The wrong paradigm of “vertical forces only” is all – pervasive in dental practice and leads to the fallacies that I describe next.
Absolutely and dangerously wrong:
“Contacts between teeth that shift the mandible sideways when the mouth is closing should be eliminated. They are prematurities and interference.”
Those lateral deflecting contacts are present in natural mouths and have a purpose: they articulate through the teeth a sideways and rotational movement of the mandible. The movement is necessary and of the utmost importance for it aligns the axis of the plane of occlusion with the axis of the cervical spine and the skull by ROTATING the mandible around its axis.
These deflecting contacts on teeth articulate a sideways and rotational shift of the mandible that is technically defined “Bennet Movement.” The Bennet movement is a sideways shift of one condyle while the other condyle stays almost fixed. The following picture gives you an idea of this necessary and important movement.
Most importantly, those deflecting dental contacts are fundamental, necessary and present in natural mouths because they articulate a movement of the jaw between TWO positions of the mouth as it closes: from the position of the jaw when the first contact between teeth occur to the one where the mouth is fully closed (and muscles of the masticatory system fully contracted).
Absolutely and dangerously wrong:
“The correct occlusion has the mouth closed in Centric Relation (or Centric Occlusion or Miofuntional Balance or Koiss Deprogrammer or any other SINGLE position arbitrary chosen by a dentist).”
Natural mouths (i.e. never touched by a dentist) have a natural movement between TWO very specific positions when the mouth closes:
– First contact. Sometimes called “Centric Occlusal Relation” (dental pseudo-science has controversy even about names and definitions). It is basically the position of the mandible that we use to chew . As you can appreciate in the picture below, the mandible in this position works as a pair of “Chinese chopsticks,” or, technically, as a class 3 lever.
– Maximum Intercuspation (called by some dentists also “Centric Occlusion”) It is the position that the mandible assumes when you close your mouth completely, reaching maximum pressure between your dental arches. This is the position that the mandible assumes when you swallow. In this position the mandible produces orthopedic forces in a very different way. Technically, it works as a class 1 lever machine. If a dental treatment “breaks” this bio-mechanical lever, the result is a colapse of the skull that lacks proper support on the dental arches. (Read our post on the Molar Lever to understand how it works)
Movement between these TWO positions is articulated by the molar teeth and can be forward, lateral, rotational and torque. If the teeth do not distribute force evenly during this movement, the tempo-mandibular joint (TMJ) suffers.
If the occlusion has been vandalized by butcher-dentists who thinks that there has to be only one position with vertical forces to close the mouth, the result is what dentists call “Tempo-mandibular Joint Disfunction” (TMD) and “Bruxism,” collapsed occlusion, disfunctional bite and impaired molar lever effect to support the skull.
In conclusion: The bio-mechanics of the jaw movement are based on TWO positions and the movement between them.
Absolutely wrong and dangerous:
“We have to make a model of your mouth in an articulator”
Most dentists will maintain that it is necessary to build prosthethics and occlusal splints using a model of your teeth mounted on an device called an articulator. They will charge you for an expensive “study” of your mouth.
The reality is that articulators are imprecise, over-simplified models that mis-understand and miss-reproduce the mechanics of the movements of the mandible. They simply don’t work.
Specifically, they do not reproduce diagonal, rotational and torque forces between teeth or the Bennet Movement (mentioned above).
Moreover, the use of the articulator is based on the obviously wrong postulate that the only force that moves the mandible is vertical gravity. It is obvious that the strongest force that moves the jaw is produced by the muscles, and its direction depends on where the muscles are attached to the skull and mandible. That affects the direction of the forces and point of contact between teeth when the mouth closes
If that was not enough, articulators have a fixed “hinge” relation between the head of the condyles (the attachment of the mandible to the skull), while the tempo-mandibular joint (TMJ) is NOT a “hinge.” The TMJ is, at best, an elipsoidal joint that can rotate and assume different positions that transfer force in any direction to the skull.
Up until 30 years ago, most dentists used “fully adjustable” articulators. Nowadays, 99% of dentists use “semi-adjustable” articulators. Dental pseudo-science goes backwards with time.
Some dentist who practice Orthognathic surgery have such blind faith in the articulator model of occlusion that they are willing to cut bones, completely remove whole dental arches, mandibles and maxillas and reposition them in a position that fits the articulator model – and hold them in place with screws or plates. I have personally not met a single person who underwent this obscenely traumatic surgery who says that he would recommend it or would do it again.
In my case – in an experiment that can be easily replicated by any dentist or patient – once I started building my own dental splints solidifying self curing resin on a base lower splint directly in my mouth, I could achieve occlusal stability in a matter of one hour, where top experts had failed using an articulator during months.
In conclusion: studies on articulators are wrong, imprecise, expensive, useless and dangerous.
Absolutely wrong and tautologic:
You are a bruxist
Patients (and sadly most dentist) may think that “bruxism” is a well defined, scientificly researched condition or desease (like pneumonia or the flu). It isn’t. The definition of “bruxism” by dental schools is tautologic.
A tautologic definition is one that uses formal logic, but is redundant and self fulfilling. For example: “A sunny day is a day when the sun is in the sky.”
By definition, if the false and oversimplified theories and myths of occlusion described above create instability in a patient’s mouth, it is because he is a “bruxist.” Please note that dental schools know that their oversimplified model does not work on a significant number of patient’s mouths.
The “Functionalist” school of occlusion goes even further in its nonsense: any activity of the mandible that does not fit its extremly narrow and over-simplified model of dental occlusion is labeled as “para-function,” a term reminiscent of paranormal phenomena from a bad episode of the “Twilight Zone” TV show.
The reality is that “Bruxism” is caused by a dental trauma (usually originated or aggravated by a dentist) that has caused dental occlusion to collapse from TWO positions to ONE position.
The autonomous (involuntary) nervous system will try to find a different, second position where teeth have grip to allow a stable contraction of all muscles to carry out the act of swallowing.
We swallow about 3000 times a day. During sleep, this involuntary reflex is triggered once every minute.
As we saw before, the acts of chewing and swallowing are carried out in natural mouths (i.e. never touched by a dentist) in TWO very different positions. And that happens because the mandible works biomechanical in TWO very different ways in those TWO positions.
Fortunately (isn’t that ironic), it is very easy to recover the swallowing position and be permanently cured of “bruxism”: just build your own dental splint solidifying self curing resin on a base lower splint directly in your mouth while you sit straight and close your mouth in the position that is produced by pronouncing the letter “E” or “O.” Those two positions force the muscles to stretch in a simmetric way, therefore pushing the mandible in the desired swallowing position.
Again, it wiuld be very easy dor any dentist or dental school to reproduce this splint-in-the-mouth experiment in a scientific way. But dentistry is not science.
In conclusion: “Bruxism” is caused by the absence of non vertical contacts (be it lateral, diagonal, torsion or torque) between antagonistic teeth of the opposing dental arches that provide a stable “grip” for the muscles to contact during the act of swallowing. Most of the times it is caused or aggravated by dentists who act upon the false belief that during chewing and swallow the teeth have to occlude in the same position.
Absolutely wrong and “criminal”:
“Wisdom teeth have to be removed because they are useless.”
Removing wisdom teeth condemns the patient to a collapsing skull, sooner or later in their lifetime.
The arrogance of considering that wisdom teeth serve no function because the dentist does not know or understand its function is overwhelming. Removing wisdom teeth acting upon ignorance is nothing short of “criminal”.
Extraction of wisdom teeth is a traumatic and irreversible removal of 2 cubic cms x 4 teeth of skeletal structure between the neck and the head.
Does anybody really think that removing 8-10 cubic cms of skeletal structure (considering ridge and bone reabsorption) where the skull and the mandible are connected to the cervical spine does not affect skull stability and support?
But, most importantly from a SCIENTIFIC point of view, can anybody PROVE that it has no negative effects?
Within the scientific method, “absence of evidence” of harm does not imply “evidence of absence” of harm.
Whenever scientists recommend a traumatic and irreversible medical procedure, THEY have to prove that it is not harmful.
Again. Dentistry is not science.
Regardless, the practical totality of orthodontic treatments start with wisdom teeth extractions.
The only reason why it is not evident to the general public that removal of wisdom teeth has extremely negative effects for skeletal and cranial stability is that the negative effects play out slowly, over the years. That makes it almost impossible to file a dental malpractice lawsuit.
Removal of wisdom teeth is probably the main cause that lies behind the epidemic of the need for knee and hip replacement surgery in the population over-70 years of age. More research on this correlation is due.
Absolutely wrong and a lie:
“There is no relation between posture, verticality of the spine, symmetry of the body and dental occlusion.”
There is overwhelming evidence, academic and scientific practical research and experimental treatments on how to best modify posture and the skeletal structure by acting on dental occlusion. The whole field of orthodontics is based on orthopedic consequences of orthodontic treatments.
No dentist could ever tell you with a straight face that such relation does not exist. He would be lying and he would know that he is lying.
Regardless, I could experience first hand an “eminent professor,” who even writes a blog about dental occlusion, trying to tell me that such relation does not exist in order to sell an expensive and wrong dental treatment.
In this post, I have not even touched the subjects of implants and endodontic killing of dental nerves (root canals); which are extremely common and highly dangerous and controversial treatments -often unnecessary.
It is healthy not to trust whatever comes out of a dentist’s mouth.
When you are told that you need a dental treatment, think twice and do your own research.
The final conclusion of this research is paradoxical:
The best dentist (and often the most expensive and with the longest waiting list) is the one who touches your teeth and mouth the least.
He has a healthy respect for the complexity of the mechanics of dental occlusion. He does not profess any arrogant God given absolute truth about anything. He understands RISK and SAFETY. He would never carry out irreversible procedures based on ANY opinion, belief or theory, even if it is recommended by a prestigious and empirically arrogant dental academic institution. He is aware that all sorts of nasty neurological syndromes and movement disorders can be triggered by dental treatments. He does not use the articulator and prefers to work and study directly in the patient’s mouth, with reversible diagnostic and conservative procedures. He knows that the correct position for dental occlusion is “wherever the mandible wants to go.” He has worked hard during years to be able to forget the teachings of dental school.
The first words that one of those extremely rare good dentist told me when he saw me were:
Look at this dental drill. This is your worst enemy.
A bit of advise for the patients:
Whenever the dentist wants to put in your mouth articulating paper (carbon copy paper that leaves black spots on your teeth), asks you to tap your teeth and takes the drill… stop him. There risk of that procedure producing irreversible damage far overweights the possible positive results. Please note that I am using the words “Risk” and “Safer.”