A New Look at Occlusion

Episode #313 with Dr. Jim McKee

Joints are connected to everything in dentistry, yet no one wants to do it — or knows how! And to help you understand and rethink occlusion at the joint level, Kirk Behrendt brings in Dr. Jim McKee so you can build this into your dentistry. Don't let occlusion be the weak link in your practice! To learn more and gain confidence in treating occlusal problems, listen to Episode 313 of The Best Practices Show!

Main Takeaways:

Occlusion is the weak link for most dentists.

How dentists define occlusion is actually not reality.

When thinking about occlusion, think at the joint level, not just the tooth level.

If you have a bad joint, you're going to have a bad bite.

Gain confidence in occlusion at the joint level, and your practice will skyrocket.

Quotes:

“I really realized that occlusion was the weak link for most dentists because it’s what we come out of dental school with being the most — we’re not confident in it. We see occlusal problems, and we’re not totally sure what to do with them.” (05:09—05:24)

“So many patients that sit in our chair have occlusal problems. But here’s the problem. When that young dentist talks about occlusion, what they're typically talking about is how the teeth fit together. Because as dentists, that's how we define occlusion. That's not reality though, because when you think about it, really, it’s how the lower jaw fits to the upper jaw.” (06:44—07:09)

“I have to credit Mark Piper for this, because Mark was the first person that showed me an MRI back in 1990. And it changed the way I thought about occlusion, because I started thinking not just at the tooth level, but at the joint level. And really, I think we’ve had the thought process backwards. The discussion was always, ‘Does an uneven bite cause a change in the joint?’ Because typically, it might cause us to clench our teeth, we might start to brux, the muscles would pull on the disc, and eventually the disc will displace. What I've learned over the years is that I think we have to look at it the other way around.” (07:37—08:14)

“There was just an article published in Cranio in January of this year that talked about if you have a malocclusion, your odds increase that you have structural changes at the joint. So, we’re really starting to get a better handle on it. And that's why I think we need to take a new look at occlusion. Because I will tell you, if as a restorative dentist you can gain confidence in occlusion, not only at the tooth level but at the joint level, your practice will explode.” (08:37—09:05)

“I absolutely believe two things. There are more structural changes in the joints than, as a profession, we believe. We were taught five to 10% of people might've had significant intracapsular problems. The number is at least a third. The other thing is that, really, in order to gain confidence at the restorative level, I think we have to understand the joints.” (10:20—10:48)

“Pete Dawson was the one who told me this many years ago: there has to be a reason why people are going to come to you — other than your insurance, other than the times you're open. They have to come to you for a clinical reason.” (11:07—11:18)

“It’s interesting. Everyone wanted to be an esthetic dentist. Everyone wants to be an airway dentist. Everyone wants to do implants. No one wants to do joints. And yet, if you have an airway case, if you have an esthetic case, if you have an implant case, we have to know the condition of the joints in order to be able to treatment plan predictably.” (11:23—11:43)

“The jaw joint, we don't think about it like an orthopedic joint. But in essence, that's what it is. And if we really think about it, it’s the first orthopedic joint that's injured in life. People don't tear their ACL when they're three years old. People don't tear their rotator cuff when they're three years old. People do fall out of the tub and hit their chin on the tub and start to injure a ligament, though, when they're three years old, at the jaw joint. They fall off a bike when they're five.” (12:40—13:06)

“I don't think we see as much degenerative joint disease as we see developmental joint disease. That's the problem. We’re seeing patients that aren't growing. And one of the easiest ways to look at that on a CT scan is simply to measure the ramus length.” (19:45—19:59)

“I'm going to borrow a quote from Mark Piper. Mark says the most expensive thing a patient can do is not get diagnosed. And what I have seen is patients who have spent thousands of dollars, and quite honestly, probably thousands of hours too, chasing after treatment that literally had no chance of being successful, but we didn't know that because we didn't see the joint anatomy. We have to do better at that.” (23:40—24:06)

“There's no one looking at the joints. There is absolutely no one looking at the joints. And again, the question is, who does that fall to in dentistry? We had a study club meeting last night at home, and one of the questions was, ‘I don't understand why my orthodontists don't image the joints.’ And I'm going to throw a little different twist at it. Honestly, I think we’ve kind of hung orthodontists out to dry, and I think we need to support orthodontists better than we have in the past. I think that when you start to see these patients that may have a joint-based problem, instead of just sending them to the orthodontist to get the bite fixed, wouldn't it be great if we could take a look at their joints and then talk to the orthodontist about that before they start looking at how to move the teeth?” (27:17—28:05)

Snippets:

Dr. McKee’s background. (04:10—06:19)

Why occlusion is an important conversation. (06:43—09:24)

Are joints changing? (10:00—11:59)

Ask the right questions about jaw joints. (12:26—13:34)

What dentists get wrong. (13:54—15:27)

Look closer at joints in young patients. (15:57—18:09)

Females have a higher incidence of joint-based issues. (18:17—20:20)

The relationship between the palate and joint. (20:45—22:04)

Myths about crazy patients. (23:15—25:15)

How treatment planning has changed. (25:32—26:53)

Don't hang your orthodontists out to dry. (27:15—29:14)

Occlusion impacts different cases. (29:51—30:43)

The future of occlusion. (31:00—31:52)

Dr. McKee’s courses at Spear Education. (32:08—35:38)

Reach Out to Dr. McKee:

Dr. McKee’s Facebook: https://www.facebook.com/jim.mckee.104

@jim.mckee.104

Further Reading:

“Malocclusion complexity as an associated factor for temporomandibular disorders. A case-control study” by Iván Daniel Zúñiga-Herrera, et. al: https://pubmed.ncbi.nlm.nih.gov/33407059/  

Dr. Jim McKee Bio:

Dr. McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.