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Our expert monthly view on everything dental wellness related
Why toothache feels existential, and other pre-historic dental/gnathologic matters.
Hello, and welcome back to this regular column, where I reflect on health, the mouth, teeth, and the general state of being human.
Toothache drove the Scottish Romantic poet Robert (Rabbie) Burns to write:
Where’er that place be priests ca’ hell, where a’ the tones o’ misery yell, An’ ranked plagues their numbers tell, In dreadfu’ raw, Thou, toothache, surely bear’st the bell Amang them a’!
His lyric A Man’s a Man for A’ That might remind us how dental pain is even-handed as well as rigorous.
There is a reason for the apparently existential nature of tooth pain.
Teeth evolved from specialised fish-scales that encrusted the skins of estuary-dwelling fish. When these fish detected changes in water composition (eg saline to fresh or vice versa), they were compelled by their primitive brains to move accordingly. For the fish, the information transmitted from those primitive teeth was, indeed, existential and so provoked a response to match. Over time, evolution located teeth preferentially in the mouth and endowed them with harder, sharper enamel, but the experience of tooth pain remains the same, due to the original technology and purpose.
In a similar way, the discomfort associated with jaw clenching, tooth grinding, and temporomandibular disorders (TMD) relates to the journey of our evolutionary forebears. Hominid jaws and teeth were larger, with an observable distinction between the front and back teeth of the upper jaw. The cooking of food allowed the brain to expand at the expense of the jaws. The physical separation of front and back teeth was lost (crowded teeth are a constant problem for humans, and keep orthodontists busy), but the functional and neuromuscular separation remains. Contact of the back teeth allows full recruitment of jaw-closing muscles; separation results in a dramatic reduction in clenching force. An ideally designed “bite” exploits these pre-historic control systems to produce the least stressed, least wear-prone, and lowest-muscular-exertion result.
The propensity to crowding, badly timed loss of baby teeth, and – unfortunately – badly shaped dental work can result in feeling like one has a “mouthful of Lego.” That is a direct quote from a new patient after she defected from her previous practice. The resultant, and entirely subconscious, over-triggering of jaw muscles is the most common cause of broken teeth, cracked and split teeth, accelerated gum disease, and TMD. Once established, it requires intervention to unwind effectively. As a US-trained specialist prosthodontist, a significant proportion of my work relates to rebuilding back teeth. One becomes adept at noticing what good – and bad – looks like, whether the teeth are natural or restored. The widespread uptake of adult orthodontics with “invisible” aligners can present difficulties if not done correctly, where the appearance of crowded front teeth is corrected, but back-teeth function is altered.
As part of every check-up or consultation, a review of the bite and its dynamics is vital for preventing and treating the multiple mechanical problems that result from the pre-historic nature of our chewing control systems. Often, just thirty minutes of intervention prevents or alleviates broken teeth and chronic discomfort that may have been a problem for years.
If there’s a topic you’d like me to cover or a question you’d like answered, please get in touch at myles@specialistdentalpartners.co.uk or visit our website at www.specialistdentalpartners.co.uk.
Until next time,
Myles
