It is inevitable that dentistry like all medical fields is continually changing and improving.  Change is beneficial as long as it corresponds to sound anatomic and physiologic relationships.   Not all change is constructive.  A change made primarily for monetary gain seldom benefits the patient.  Change that appears to violate form and function must be carefully and critically evaluated.  Education is the key to recognizing beneficial change from chaotic change.  This web site is dedicated to providing patients and professionals a format to view change, obtain corroboration or an avenue to raise questions. 

Many medical and dental corrections that are accepted are taught because they are familiar and comfortable.  As new information challenges the existing protocol, changes must be made when they are proven to be better, more efficient, longer lasting and a benefit for all involved.  However, it is possible to drown in information without using a beacon of truth.  Change must be evaluated with the beacon of truth known of anatomy and physiology, form and function. 

Dentistry is in the middle of one of these changes as it relates to the interrelationships that should be encompassed in the evaluation and treatment.  Conventional wisdom viewed the oral structures as limited to the area of the mouth and treatments provide dental corrections at the habitual bite relationship (the way the teeth fit together).  This is fine as long as all of the interrelationships function optimally at this bite relationship. 

However, as we learn more about the function of the oral structures we find they are not independent, but interrelated with all of the structures of the upper quadrant.  Muscles of the face, neck and upper back are involved with dental approximations, as are joints, ligaments and other structural relationships.  A change or challenge in one area will foster changes in another region.  It is important to determine which improvements will promote health, while also determine those compensations that will foster dysfunction. 

Dentistry today extends far beyond “just the teeth”.  The bones of the face, the jaw joints, the primary and secondary muscles of mastication, the relationship of the head to the cervical spine and some of the tensions and stresses on the back are related to dental associations.  Therefore, dentistry today must take into consideration the interrelationships of all of the associated structures if harmony of form and function is to be promoted. 

Evaluating form and function.

There are four primary areas to investigate regarding upper quadrant function as it relates to the oral (stomatognathic) system. 

1.      These involve the occlusion (bite)

2.      The relationship of the lower jaw to the upper jaw and the effects these have on the temporomandibular joint (TMJ).

3.      Function and compromise associated with the primary and secondary muscles of mastication as they approximate the lower jaw to the upper jaw and maintain the stability of the head to the cervical spine during oral movements.

4.      The structural and functional compatibility of the head, cervical spine and with regard to balancing and supporting mandibular / maxillary associations.

Evaluations Methods

            Various evaluation methods exist to help determine the structural associations and functional relationships of the structures of the upper quadrant.  Some of these are highly specific while other evaluation methods are general.  Seldom is one method able to satisfactorily evaluate the complex nature of function and dysfunction. 

1.      Range of motion studies.  The range of motion of any joint infers information regarding the joint function.  Comparisons are made to expected normative movements.  Decreased movements usually indicated joint inflammation, pain, pathology or compromise.  Greater than anticipated movements may indicate genetic hypermobile tendencies, the capacity of the ligaments or tendons to extend to greater than anticipated (normative) movements, or some types of joint instability such as ligament laxity or injury.

2.      Radiographic evaluations.  The relationship of osseous members can be determined with radiographs.  Radiographs are two-dimensional representations of three-dimensional objects and are therefore limited in dependability.  Radiographs are able to discern certain pathologic conditions, alterations in form, and movement dynamics as it relates to roll, spin and glide movements.  Radiographs usually help evaluate the clinical observations and differential diagnosis.  Seldom are radiographs alone able to be used to render a diagnosis.

a.      General radiographs

b.      Computerized imagery

c.      Enhancements

3.      Models.

4.      Photographs

Interrelating the information from the various diagnostic aids has required years of professional skills, as the information from one method did not directly apply to all other methods.  The doctor had to determine the significance of the information independently, and then reach a composite diagnosis.  Newer methods, such as the three-dimensional evaluation system, have dramatically improved the capability to interrelate the information as all information has a common reference. The information is related to the common reference, and then it can be directly applied to all other evaluation methods.