Pain on Chewing: It Could Be Occlusal Trauma

 

When an emergency patient comes into my dental office with some unwanted dental pain, it is important to listen carefully to the patient. I ask them what is going on, try to isolate where the pain is coming from, find out how long they have had the pain and how often.

One common condition is occlusal trauma, which means that the bite is too high someplace. This week I have had 2 patients who have had root canal therapy. They had crowns placed on the teeth, as is recommended for strength and protection of these teeth. But after time, they were still feeling something when they chewed.

Besides making sure that the teeth look OK on an x-ray, I have the patient bite on articulating paper (that’s the blue carbon paper that makes marks on the teeth to see if a patient is biting too hard on the tooth). On both of these patients I noticed large areas of dark blue marks that indicated that the patient was putting extra pressure on these teeth when chewing, and that can hurt a lot.

The immediate treatment is to adjust the crowns to get the bite more comfortable and so it doesn’t stand out. This extra pressure causes an inflammation on the ends of the root. With inflammation there is increased swelling around the root. There is no place for the inflammation fluids to go but between the root and the bone, and that lifts the tooth out of the socket a bit. It is now in “hyperocclusion” or too much tooth structure hitting the opposing tooth. This pain can also cause pain on the opposing tooth since chewing works in pairs.

I had a new patient who came in a few years ago who had crowns placed on 2 adjacent lower molars 2 years before that. She had a complaint of pain on those teeth. I checked the bite, found them to be high, and she couldn’t believe the relief she experienced in just a few minutes of adjustment. That is how profound the discomfort can be.

Last month I had a patient come in for a similar kind of pain. In this case, the patient had been coming for many years, and I had done a dental bridge approximately 8 years ago. I took an x-ray of the area which looked totally normal, then I checked the bite. Although this patient has had no dental work since that period, that tooth had shifted enough to create a hyperocclusion (too much tooth contact upon chewing)which needed to be adjusted (this is known as equilibration in all of these examples).  Within a few minutes the pain subsided and he should be fine. I have noticed that some patients need to be checked in a month or so to make sure that the teeth haven’t moved again. This additional movement is more common in patients with bone loss due to periodontal disease.

So, besides cavities, broken fillings and cracks in fillings, this is one of the first things I check when patients have pain on chewing or unusual temperature sensitivity, both of which can be caused by too much chewing pressure.