Revealing occlusion

Dr Andy Lane is one of the UK’s foremost experts on dental occlusion and he will be delivering a seminal session on this commonly misunderstood field as part of Step Education’s exceptional new learning programme. Here, he details a few of the points he will be discussing… 

“The relationship between all the components of the masticatory system in normal function, dysfunction, and parafunction, including the morphological and functional features of contacting surfaces of opposing teeth and restorations.” (Jablonski 1982).

This is an accurate definition of occlusion, but what we’re really concerned about when we study this field, and in particular, how we apply those principles in practice, is great dentistry. That’s dentistry that is appropriate and timely; looks good and feels comfortable; lasts as long as possible; needs as little maintenance as possible; and causes as little damage to other structures as possible.

“Occlusion” is a funny word, as in dentistry it means the way teeth bite and function together, but it’s also related to the word occluded, another word for closed, or hidden. Let’s face it; occlusion seems to be a subject that remains pretty closed and hidden to a lot of dentists doesn’t it?

Occlusion is really the secret of great dentistry. When we learn to understand occlusion fully we begin to understand that patients have been giving us multiple clues, both spoken and unspoken, that we may have missed over the years.

When designing the courses I have been involved with since 1985 in the UK, Niles Guichet and his Associates in NGA Seminars wanted to make very high-end, high quality, comfortable, long-lasting, aesthetic, functional, valuable dentistry available to all at affordable prices, not just to the super-rich in Hollywood as it had been. Great dentistry for all? It’s a noble goal.

The key to that kind of dentistry, the cornerstone, the guiding principle if you like, is occlusion. Without a thorough knowledge of occlusion much of what we do in dentistry is more unpredictable, open to chance, and potentially a lot more stressful. Occlusal principles provide the road map; they increase the certainty of knowing where you are, where you’ve been and where you’re going to end up.

As such, occlusion relates to almost every aspect of work that a dentist can carry out:

Diagnosis and Treatment Planning: To provide great dentistry we have to consider the role of occlusion in the aetiology of disease and the effect that occlusion will have on the prognosis of any intervention.

Fillings: Whenever we restore a tooth we have to assess how well that restoration will restore the function of that tooth, including any contacts with opposing and adjacent teeth. Failure to do this might result in heavy contacts that cause pain, fractures or mobility, or spaces that create instability.

Extractions: Whenever a tooth requires extraction we need to assess whether the resulting space will create instability in the occlusion. We must ask ourselves: A) if an extraction will affect function? B) are we removing the only tooth in contact on that side of the mouth? C) if so, what will be the consequences of that action?

We will also need to ask ourselves if the muscles of mastication or temporomandibular joints are healthy enough to allow you to perform a difficult extraction (e.g. a third molar) without causing an exacerbation of joint or muscle problems?

Orthodontics: Any form of orthodontic intervention will have a potentially major impact on the way teeth contact and upon the function of muscles and joints; it’s a form of full mouth reconstruction after all.

Crowns, bridges, veneers, implants, dentures: Whenever we provide advanced restorative solutions for patients, we’re certainly going to be changing the functioning surfaces of teeth most of the time. It is, of course, essential to have an understanding of the existing occlusal scheme and the occlusion that will be required in the new restoration in order to either conform with it or to plan a reorganized occlusion.

Occlusal Disease

It is commonly considered that the primary cause of dental disease is infection, resulting in periodontal disease and caries; certainly this is the focus of undergraduate training in most universities around the world. There is, however, a much wider range of diseases and symptoms that can be caused by, or are related to, occlusion. This is particularly true when parafunction, occlusal disharmony or a combination of both is present and those changes are enough to move the body beyond a position of adaptation and coping into a diseased state.

The range of such diseases will normally reflect the weakest link in the chain for that individual, so a similar cause may result in a wide variety of effects.

The weak link could be in muscles, joints, teeth or supporting structures. When the muscles are least able to adapt the result might be a headache, when the teeth and muscles adapt the jaw joints might suffer, and when the joints, muscles and periodontal tissues are able to adapt well, in the presence of parafunction, the teeth will wear away.

Occlusion is important in all aspects of dentistry, and by understanding the fundamental principles of this field, we can ensure better practice in our everyday provision of better dentistry.

To learn more about Step Education visit www.stepeducational.com, email This email address is being protected from spambots. You need JavaScript enabled to view it.

or call on 0800 130 3573

Andy Lane MPhil, BDS, DGDP(UK)

Andy qualified from the University of Bristol in 1978, was awarded the Diploma in General Dental Practice in 1993, gained a Master of Philosophy degree for research into the aetiology of caries and the properties of light-cured materials at the University of Manchester in 1999 and won the Manchester Postgraduate Dental Society Award for research, also in 1999.

He now works full time in general practice, has been fully private since 1991 and his practice recently became part of the Portman Healthcare group. Andy has been amalgam-free since 1991, and currently spends approx. 50% of his time providing fixed appliance orthodontics and treating chronic pain conditions of the head and neck on referral.

Andy is the head of Stockport Dental Seminars, which has provided training in occlusal principles since 1981, and was co-founder of the British Society for Occlusal Studies in 1986. As secretary of the society for 10 years he organised many postgraduate training courses, bringing many of the world's foremost experts in the field of TMD to the UK for the first time. 

Other positions held include founder of Private VT, Dental Vocational Training Advisor in General Dental Practice (NW Region), UK Chairman of the American Equilibration Society, Founder and Chairman of Dental Relief for Romania Appeal, leader writer for Dentistry Monthly magazine and founder/editor of the Biological Dentistry newsletter.

Andy's main hobby is classic rally driving and he is noted for having won Europe's toughest event, the Land's End to John O'Groats Reliability Trial, 4 times.