malocclusion and Perio

By Joseph Gronka posted 09-07-2013 07:21 AM

Even as a dental student I was troubled by the lack of my understanding of directional forces on the teeth and their relationship to periodontal disease. I began looking at this relationship with this analogy. This is the way I explain it to patients, even today:
"If you had a gate post in your yard and everyday on the way in and out, you shook that post side to side, it would eventually get loose because you would be expanding the ground which is holding it. Now, add water every time you shake the post. I ask them "do you think the post will loosen more quickly?" The answer is yes. It makes sense because you soften the dirt. Now think of the tooth/teeth. If they are struck together so that they produce lateral forces on each other, is that not like shaking the post? Now think of the water as bacteria. To have teeth "hit" at angles instead of vertically, is enough to produce mobility. introducing bacteria exacerbates the situation by causing inflammation in the supporting structures of the teeth, namely the gingiva and ligaments." If no treatment is offered/rendered, the tooth will be shed just as the body sheds a sliver in the skin and in much the same manner. It just takes a longer time to accomplish this with a tooth. This analogy is understood and accepted by concerned adults. I do not try to convince or sell treatment, I simply educate. For those who do not understand or appreciate, i accept that. At some point I hope that they request treatment. Some people must come to the conclusion/discovery by themselves. OK At least they have been informed, even if not educated.
local Periodontitis or gingivitis and juvenile periodontitis, I could never accept this idea as strictly a bacterial etiology. As I learned more about treating malocclusion I began to consider malocclusion as the etiology. Recall the experiment of placing enamel under pressure to generate galvanic action and the attraction of bacteria. I began to think of the process in this manner. I began treating all localized inflammations of soft tissue as resulting from malocclusion even to the extent of incorporating occlusal equilibration as part of my perio therapy. Very good results ensued. I realize that this may raise eyebrows and generate discussion/argument OK. I practice what I preach, learn and try for yourself. Don't take my word for it. Worst case was "John" a mid thirties guy. He found me through Dr. Dan Watt's office in Reston ,Va after reading an artical in Readers Digest, concerning non surgical treatment of 'gum disease'. Dr. Watt referred him to me as, at the time, the only practicing Keyes dentist in NE Pa. I studied with this group for about two years. John was told by his dentist that his perio situation was hopeless and that he should consider full dentures as a solution. Can you imagine, especially at that age, that you were a hopeless case and should have all of your teeth removed. At our first meeting and exam, John certainly had problems, big time. All teeth, he had all but LL 2nd molar and #1,2&16,  At this first meeting, John and I had a very serious discussion. I let him know that I would try to save his teeth, all but #18, it was almost on it;;s side. Also told him that he had to strictly abide by my rules. At the first sign of relapse to old ways, I would quit. He was extremely well motivated. I ende up removing #18, more that 10 years later. It is now about 25 years later and John still has all of the teeth I promised to help him save. Education increases motivation as does getting the hell scared out of you.
Learning gnathology and using what you learn in your practice, will give you a better understanding of what it is you are looking at, thereby changing your perspective and planning, for proper treatment in proper sequence in order to achieve the desired result. Gnathology is simply looking at the parts that allow us to chew without destroying the teeth and supporting structures. It designates the masticatory system as a part of the Gnathic system, made up of the neuro-musculo-skelatal system. As in any system it's optimum function is only as good as it''s weakest link. Next: Why females are more susceptible to TMD