When I was a dental student, I was once given an assignment to create a tooth out of a block of wax.  I spent days refining my creation, carving what I believed looked like an anatomically accurate tooth.  I was happy with the finished result; however the instructor was less than pleased with my effort.  Having looked at the work of my peers, it was at least encouraging to know we were in the same boat.  This impressed upon me a fundamental question in dentistry:  do we really know what a tooth should look like?

I took a step back and looked at what was missing from my waxed tooth.  I was lacking a fundamental understanding of the anatomy of teeth.  Just as the body has a complex network of tissues and nerves that make up its anatomy, teeth fit together like a complex puzzle of cusps and fossae, or hills and valleys.  It wasn’t until my postgraduate education that I realized the true value of understanding tooth morphology and its implications in function and parafunction.  By knowing how teeth work in health, it empowers us to properly restore them when things go wrong.

Early on in my career I had a particularly eye opening experience with a patient, a beautiful 40 year old woman, who presented to my office for two simple molar restorations.  The procedure itself was simple enough, and I was able to give her functional crowns, while working within her Metlife PPO.  In addition to the immediate treatment, we normally recommend a standard occlusal analysis for patients who have work done by another dentist.  Every dentist practices differently and the impact this variation has on tooth function can significantly alter ones treatment plan.  However due to the confines of her limited insurance policy, she was unable to accept this treatment.

Several months later, this same woman comes in with chipped lower front teeth, asking for cosmetic veneer restorations.  The two restorations we had placed earlier still looked to be in great condition, but closer inspection revealed gum recession, fractures in her other teeth, and various worn flat surfaces and restorations.  Upon referral to a periodontist, the news got even worse.  She had over 60% bone loss in her dentition.  This impressed upon me that although we were able to give her quality crown restorations for her molars, there were many more factors involved in the overall functioning of her teeth. What I simply realized was that if you can chip and break your own teeth, without properly restoring your bite, you can break even the highest quality restorations.

Some time later I was attending a course with Dr. Pete Dawson, the father of occlusion, and was fortunate enough to present this very case to him.  Dr. Dawson explained that her teeth did not properly fit together, and how this determined not only her bite, but also the function of her jaw muscles, joints, gum tissue, as well as her blood circulation.  This was a complex system where proper occlusion was the ‘cement’ which held all other aspects of one’s bite together; you must know how teeth are shaped and aligned in order to have good muscle activity, coordination, and TMJ function.  It is imperative that all of these factors be taken into account and put into balance because otherwise, treatment meant to promote health can easily cause destruction instead.

As a clinician, I realize that dental insurance has had an enormous effect on the quality of care given to patients.  Many patients’ decisions are dictated by only what the insurance covers. Often patients do not always realize the limitations and exclusions of these insurances especially HMO/PPOs.  We frequently observe fillings or crowns that are received under these plans, crafted by labs that focus on volume vs. quality, inexpensive material vs. material that promotes longevity and gingival health, and technicians who do not know the true shape of a tooth vs. technicians who attend the same course as doctors who understand the damage caused by malocclusion. Many dentists, especially those who want to offer the best treatment available to their patients choose not to act as participating providers in order to release you from these restrictions. Even if your dentist is not a provider, most offices will submit your dental claims as a courtesy to you.

In the end, David Hornbrook, Rob Lowe, Dr. Dawson, Ross Nash, and all those who have decided to continue the extensive study of teeth, jaw muscles, and their function and aesthetics know that a patient can have it all. For my patient, I was able to save her teeth. I was able to give her a beautiful smile, restore her bite, and arrest her periodontal disease. I truly felt like a doctor of dental surgery by looking beyond an isolated sign and symptom, to treat my patient as a whole.

Ultimately, it is important for the patient to empower themselves with the knowledge necessary to make sound decisions when it comes to their own oral health.  A major contributor to achieving this is to pick the right dental provider which will evaluate the individual’s dentition as a complex working system instead of a collection of individual teeth to be restored.  This will ensure not only a beautiful smile, but a fully functioning dentition that works efficiently and consistently like the cogs of a machine to promote long-term oral health.