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A CSI Approach To Diagnosing Dental Disease

Has your dentist ever told you that you grind your teeth?  Have you ever looked into the mirror and noticed that the edges of your teeth are worn or fractured?  Do you suffer from jaw-aches or get frequent headaches?  Are your teeth sensitive or mobile?  These are a few of the commonly overlooked symptoms of a condition called occlusal disharmony.  The term occlusion refers to the way your teeth and jaw joint come together when you bite.  If this relationship is not ideal, there can be many painful and costly repercussions.  It is important to have this diagnosed before you have any dental work completed, but unfortunately many dentists do not take the time or have the secondary education to identify and treat occlusal disharmony.  Most people understand that x-rays are used to diagnose cavities and that periodontal gum measurements are used to diagnose gum disease, but did you know that there is a device that can diagnose occlusal disharmony?  It is called a Deprogrammer.

Over the last twenty years, a strong emphasis has been placed upon prevention in the dental field.  Fluoride is used to prevent cavities, professional teeth cleaning and proper home care is used to prevent gum disease and there are technologies used to detect oral cancer in its early stages.  Because occlusal disharmony can cause many oral problems, it should be approached in a preventive method as well.  This is a relatively new way of thinking as many of the symptoms of occlusal disharmony don’t appear to be linked to the cause.  For example, if the edges of front teeth are chipped and worn, many dentists will place fillings to smooth and restore missing structure.  This makes sense unless the cause of the wear is that teeth are touching improperly.  If the occlusal disharmony is not addressed, eventually teeth and fillings will wear and fracture again.  This is why a dentist is like a “Crime Scene Investigator.”  There is evidence in the oral cavity that needs to be collected and examined in order to identify the cause of symptoms and then an individualized treatment can be prescribed.

The following article will discuss the role that occlusal disharmony plays in relationship to many of the most common dental complaints, how it can be diagnosed through a few simple steps and the different options for treatment.


Many of the most common oral complaints can be attributed to occlusal disharmony.  If any of the following symptoms are present, a thorough head, neck and occlusal examination is indicated to determine if symptoms are caused by the relationship of the jaw joint and teeth.

  • Teeth that appear short
  • The edges of your teeth appear worn or fractured
  • Pain, popping, locking or cramping in your jaw joint
  • Teeth that are sensitive to cold
  • Notching in the tooth at the gum-line
  • Clenching or grinding of your teeth
  • Earaches or ringing in the ears
  • Frequent headaches
  • Soreness in the jaw muscles upon waking in the morning
  • No “home” position for your teeth
  • Loose teeth 

Once it has been determined that there is occlusal disharmony, the next step is to identify its cause and the recommended treatment options.  The best way to determine the cause of occlusal disharmony is to take impressions and create study models of teeth and fit teeth for a Dental Deprogrammer.


A deprogrammer is a removable dental appliance, similar to an orthodontic retainer that is worn over the teeth to prevent them from touching when you bite together. It is designed to aid in the diagnosis and initial treatment of occlusion related problems.  Because it prevents the top and bottom teeth from touching, you cannot fully engage the muscles that move the jaw joint.  When these muscles have an opportunity to rest, they “deprogram” and relax into their physiologically ideal position without any influence from biting or clenching.  The deprogrammer is both a diagnostic tool and a way to temporarily relax the jaw and reduce muscle tension, headaches and excess wear on the teeth. The dental deprogrammer should be worn as much as possible and always removed when eating or cleaning teeth. It is especially important to wear it all night prior to and the day of your dental appointments.  Eventually, jaw muscles will feel comfortable and relaxed and the teeth will touch in exactly the same place every time.  After this process is complete, the next phase is to evaluate the possibilities for providing a long-term solution.  Some of the potential treatment options include:

  • Occlusal Adjustments
  • Orthodontics
  • Opening Bite with Crowns or Veneers
  • Implants
  • Wearing the Deprogrammer long-term as a night guard


Overall, the goal of treating occlusal disharmony is to provide beautiful, functional, long-lasting dental work and reduce or eliminate the causes of excessive wear on teeth.  The best way to accomplish this is to do a thorough exam and evaluate occlusion first.  Creating a strong foundation is the most important factor in the longevity and beauty of a smile.  It is counter-productive to place fillings, crowns and veneers if occlusal disharmony may compromise the outcome.

MARIE DURFLINGER RDH, DDS: A cosmetic and restorative dentist with over 25 years of experience in the dental field.  Owner of Auburn Family Dental and Bella Dental Care in Bellevue.  Voted “Top Dentist 2009, 2010, 2011, 2012” in the Seattle Metropolitan Magazine.   

 This entry was posted on Tuesday, June 19th, 2012 at 7:59 pm and is filed under Dr.Durflinger's Published Articles. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.