Читать книгу Practical Procedures in Dental Occlusion - Ziad Al-Ani - Страница 14

What is the role of the teeth? An important question which underpins our clinical dentistry because we are routinely involved in possibly changing it if we don't follow a careful process.

The roles of the teeth can be thought of as follows.

 Mastication.

 Swallowing.

 Speech/phonetics.

This is a simplified view because the impact of teeth is far greater for both the individual but also when interacting with the wider community.

 Aesthetics – emotional and psychosocial perspective; this is specific to the individual and also has an impact on their self‐esteem.

 Psychophysical – the ability to appreciate the food via texture, volume and taste.

 Occlusal stability and jaw support – maintain the elements that maximise function.

 Cognition – decreased mastication is a risk factor for dementia.

 Mortality – Osterberg et al. 2008 in numerous studies demonstrate the statistically significant correlation between the number of teeth remaining and mortality, with the data suggesting a 4% decrease in mortality for each remaining tooth above 20 occluding pairs. I am not suggesting that we tell our patients they will live longer if we provide more teeth but the link between quality of life and having fixed teeth is certain.

So how do we avoid altering this system in an uncontrollable manner? We use protocols and processes. The acronym for the process is STOP! STOP picking up that drill before you assess the occlusion. A preassessment of the occlusion is crucial to ensure we have not potentially affected the role or performance of the teeth. Therefore, we use our senses to preassess the occlusion. This is essential in both conformative and reorganised occlusion.

 S – Survey – visual assessment using coloured paper to analyse contacts.

 T – Touch – fremitus.

 O – Observe and listen.

 P – Patient feedback.

The goals of occlusion are as follow.

 To provide equal contacts on as many teeth as possible when the patient swallows – centric occlusion position. This will aid muscle health.

 To provide incisional guidance (protrusive guidance) on the anterior teeth. This will aid temporomandibular joint health.

 To provide group function when chewing using cuspal inclines.

 To avoid introducing new contacts (unless in a controlled manner) which may strain the adaptive capacity of the patient.

 To biomechanically distribute the forces so as not to cause failure of the restoration or other teeth.