Good Bites Gone Bad—Helping Unhealthy Occlusions Become Healthy

 

 

Dr. Cook’s passion for helping people whom brux or clench their teeth together goes back to his first patients in dental school. Much of his continuing education and the organizations he belongs to continue his studies and teachings of those who clench and grind their teeth together at night.

 

Over the years, he has been able to identify many common characteristic in diagnosing occlusions that are breaking down from these destructive habits and the common problems they share towards regaining lasting and appropriate health, comfort and aesthetics.

 

Different occlusions in-of-themselves, are neither healthy nor unhealthy. It takes excessive forces or poor hygiene to contribute to their breakdown. However, different occlusions have differing resistance to these destructive forces, with common characteristics to their breakdown and similarities for regaining health.

 

Dr. Cook’s Good Bites Gone Bad (GBGB) presentations highlight the areas of diagnosing and treating problem occlusions that are breaking down under the damaging forces of bruxism and clenching disorders. His presentation can span a day and a half as a full lecture, reduced to 1-2 hours for limited topics, or offered as a two-day hands-on training on the arts & crafts of the Tanner appliance.

 

 

 

This diagnostic module will present the characteristics of healthy and unhealthy occlusions. Distinguishing traumatic occlusal interferences from acceptable occlusal contacts is discussed. The practitioner will leave with a solid foundation of occlusal health verses pathology.

 

 

 

 

 

Attendees will be introduced to a repeatable diagnostic and scoring continuum for recording the progression of destructive wear, fractures and fremitus, including a detailed discussion of fremitus profiling. Armed with this information, practitioners are better able to complement their patient’s good occlusal health, inform patients of early destructive changes, advise when treatment should begin and record when these parameters have gone into advanced stages.

 

 

 

 

 

 

Incisal edges deserve special attention. The damaging effects of parafunction (bruxing, clenching and tooling) often show up initially on the incisors. Dentists easily recognize incisal wear, but it may be changes the in incisal roughness which deserve even closer attention. Attendees will learn a reliable method to quantify and record changes in incisal roughness over time. Roughened, damaged edges require special management.

 

 

 

 

 

 

Group function must be included in an honest discussion of occlusion, or rather how teeth disclude. Frequently cuspids and incisors are not available or not healthy enough to disclude the posterior teeth. Group function is discussed in healthy terms—how to assess it and alter it for patient health, comfort and stability.

 

 

 

 

 

 

There are multiple appliance designs (Tanner, Universal, Michigan, NTI…) that are successfully used for parafunctional management—protecting teeth from damage, creating stable and healthy TMJ’s, managing muscular pain, managing headache and even many migraine headaches. This section focuses on the design, fabrication, insertion and adjustment of the Tanner appliance. Emphasis is placed on the differences of the Tanner appliance design for patients with Angle’s Class, I, II, III, Open-Bites and Cross-Bites.

 

 

 

 

 

 

Traditional tactics of equilibration are compared to a behavioral, patient-centered approach. Healthy patterns of occlusion and disclusion are compared to unhealthy patterns. Visual and fremitus-born tactics of migrating an unhealthy to a healthy occlusal pattern are discussed. Emphasis will be on why we equilibrate, how we equilibrate, and when to start and when to stop an equilibration.

 

 

 

 

 

"What do you do when the cuspids, laterals or central incisors are not available or are not healthy enough to disclude the posterior teeth in patients who are informed, and have thoughtfully rejected orthodontics, surgery or restorative solutions?"

 

This portion of “Good Bites Gone Bad” puts it all together. Clinical cases, most of them with initial painful parafunction, are shown from the appliance phase through the equilibration phase. Anterior open-bites, which will never have a chance to disclude the posterior teeth, and total Angle’s Class III cross-bites, where the only teeth available to disclude are on the non-working (balancing) side, are successfully managed with the appropriate Tanner appliance design and equilibration.

 

 

 

 

 

 

This part of “Good Bites Gone Bad” highlights some usual and unusual cases of parafunctional management and tactics. Both common and unique clinical circumstances and the differing tactics used to help these patients are discussed. These cases will help solidify participants’ learning.

 

 

 

 

 

Dr. David Cook maintains a private practice in Minneapolis/Edina, MN. He has a special interest in treating problem occlusions plagued by inadequate parafunctional management. He graduated in 1981 from Marquette University, School of Dentistry and completed a hospital general practice residency at the Hennepin County Medical Center in 1982. He has studied occlusion and patient management under various dentists including Dr.’s Alvin Filastrie, Pete Dawson, and Frank Spear as well as the Pankey Institute. Dr. Cook has special and continued training in the RPO Study Club with personal mentoring by Dr. Henry Tanner from 1989 to his passing in 2003. It is to Dr. Tanner’s encouragement and guidance that this presentation is dedicated.