”…it is far harder to kill a phantom than a reality.” -Virginia Woolf
I am a craftsman of the jaw-closing business. Every day I make restorations to the teeth of patients of mine. After this intervention, it is the fundamental trick of my trade to make my patients close their mouth in a relaxed manner. Like a skilled carpenter, who is specialized in fixing doors and door-frames, so that the door closes unobstructed, I earn the trust of my patients by making them close their mouth effortlessly. After each restoration, I spend 5 to 10 minutes painstakingly adjusting the form of the restoration so that it does not interfere with jaw-closing and lateral movements of the mandible. It is not always an easy task, as I have explained earlier in my blog article “The Soundbites of Sound Bites” and “Filibustering in the House of Parliament of Occlusion”. Too much occlusal force in the front teeth area alerts the jaw-closing muscles to switch off, whereas too much occlusal force in the back teeth area enhances jaw-closing activity.
The Tscan system was an answer to my prayers to find a better tool to assess the bite forces hitting the restorations I have made. I was amazed to find out, that the ink marks of bite foil were only a vague, unreliable hint of the actual forces taking place in the occlusal contact points of dentition. Very often, a microscopic, barely discernible wispy dot would have been the spot of extreme bite forces. That was why the filling that I had made six months earlier, before I had a Tscan in my disposal, had become chipped to pieces. Previously, having relied myself on the appearance of the ink marks of the bite foil only, I had been securing myself to a false sense of security.
With the advent of Tscan, however, another problem emerged, of what I had previously not had any idea of.
I was disappointed to find out that a subset of my patients, despite my meticulous adjusting of the occlusal contact forces, were extremely reluctant to show a steady bite force graph. For some individuals the Tscan movies looked like perfect nonsense. At first, I thought to myself, maybe I was just not doing the measurements properly. The max force curve of the Tscan movies showed wobbly jaggedness. It looked like a tremor, it couldn’t be a relaxed bite. Three microseconds of closing followed by three microseconds of opening activity. It looked like the closing down and opening muscles would be undergoing a tug-of-war. How many times ever I repeated the scans, and however much time I spent equilibrating the tooth contacts I was unable to make this subset of my patients to perform the beautiful, healthy max force curves with an initial steady rise from the first time point of contact “A” to the maximal amount of contacts at time point “B”, and thereafter to remain close to the 100% force all the way to the point “C”.
I was perplexed. Some of these patients might say that they sometimes felt like their bite would be “popping off”, yet most of these patients often would say that their bite felt OK. At recall visits I could see that everything was not alright. There was chipping and wear down of the fillings and tooth surfaces. At first, I could not give a rational explanation why an apparently perfect jaw closing brings about such a muscular tremor. That was spooky.
It was a kind of thing what a carpenter would feel like when visiting a house where a little earlier he had renovated the crooked old doors and door-frames, and now he would see the wear down of door-frame paint at the very spots he had renovated and painted. It is an uneasy feeling that sometimes makes you ponder and sometimes it makes you wake up shivering in the middle of the night. The owner of the house would have said that the door the carpenter had fixed, kept opening up by itself and it was likely that the old house was, in fact, haunted.
A true craftsman is reluctant to accept supernatural powers to interfere with his trade. Nevertheless, what it comes to the sciences of occlusion, the physically unexplained phenomenon of non-matching of the dentition has been given the epitome of “the phantom bite syndrome”. By the latter half of 70’s this description was given to individuals who:
“…seek bite correction from a succession of dentists. Their pathological narcissism focuses on their bite, in a manner reminiscent of phantom limb phenomena.”
Reports have been written to scientific journals where the authors have not been able to find any specific clinical fault in this kind of patient´s dentition, despite that affected individuals typically complain of their “bite being off”. The Phantom Bite -condition still seems to be a feasible term to describe the subset of TMJ patients who respond poorly to treatment efforts of bite doctors.
Carpenters are more down to earth style of persons and they very quickly pick up their water-levels and give a diagnosis to the master of the house. The door frame, that was perfectly level six months ago is not level any longer. The problem of the door popping open by itself is not due to due to ghosts, but a failure in the foundation of the whole building. The corner of the house has been tilting all the time and now all the rest of the structures of the building are tipping off the level, respectively. Also, the hinges of the door may be worn and slackened by the strain. Slack hinges allow different spots of the door to hit the door frame each time the door is slammed to close.
A bite doctor should not forget that the dental occlusion system is analogous to a door and door frame system by actually there being two points of reference. There is the “door and the door-frame variable” that can be measured exactly from a Tscan movie. We can create a perfect match between the upper and lower jaw by altering the form of the occluding teeth. The second variable of jaw-closing, the “door hinge variable” can’t be directly operated on. The wobbles and the jaggedness of the max force curve in a Tscan movie reveals that there is uncomfortable variability in the way that the mandible meets the upper jaw. There is slackness in the rotational and translational movements of the condyle head in the glenoid fossa. In multiple subsequent bites unpredictable and different sets of teeth occlude. The direct mechanical repair of the jaw-joints is out of our means. Unlike carpenters, who can just change the worn out hinges of the door, the bite-doctors do not have any immediate tools to work on the hinge -parts of the bite-system.
We can’t touch the broken hinge, but that does not mean that we could ignore it. We must be honest to our patients and we should not disguise our ignorance trying to convince the unlearned patient by vague explanations of “phantom bite”. I can’t go telling to my patient that actually you don’t have any pain, you just feel like you would, and it is just about your pathological narcissism that has become focused to your dentition…
However, the wonders of nature may go beyond the phantasms of the supernatural.
Unlike the worn down door hinge, the human jaw-joint has a wonderful self-repairing capacity. With patience and regular check-ups and correction of digitally measured occlusal contact forces, a skilled craftsman of the dentition can be able to gradually relieve the strain from the damaged joint-tissues. The jaw-joint can be healed. I have managed to straighten out the wobbles and tremors of the Tscan max force curves of many of my patients.
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