Unlocking the Mysteries of Open Bite: A Case Study
Donald R Tanenbaum, DDS, MPH
Board-Certified TMJ & Orofacial Pain Specialist at New York TMJ & Orofacial Pain
By John Dinan , DMD MS
Open bite conditions present a unique challenge within the dental health sphere, requiring a nuanced understanding of both diagnosis and management strategies. This piece delves into the complexities of an open bite, guided by a case study highlighting the need for a thorough approach to identifying causes and crafting effective treatments.
The Case Study
A 66-year-old man reported to our practice because he’d had difficulty getting his back teeth to touch together for the past two years. Additionally, over the same period, he’d been suffering a continuous “pressure†headache across his forehead and temples and continuous stiffness in his neck muscles.
All of his symptoms gradually worsened over time. At first, he sought treatment with an orthodontist, who referred him to our office. Our clinical examination confirmed that he had a posterior open bite and generalized pain to muscle palpation.
Exploring the Causes of Open Bite
Understanding the precise nature of an open bite requires a multidimensional assessment encompassing clinical examination, patient history, and possibly diagnostic tools to identify the underlying causes and tailor a treatment plan that addresses both the symptoms and root issues.
Is the open bite anterior or posterior? Is it symmetric or unilateral? Did it come on suddenly or gradually? These questions guide the comprehensive exploration of potential causes, such as:
Anterior Open Bite Causes
- TMJ Degenerative Joint Disease (Bilateral)
- Anterior-Only Oral Appliance Therapy
- Nightguards That Don’t Cover the Terminal Molar
Unilateral Posterior Open Bite Causes
- TMJ Degenerative Joint Disease (Contralateral)
- TMJ Neoplasm (Ipsilateral)
- TMJ Inflammation (Ipsilateral)
- Lateral Pterygoid Hyperactivity or Contracture (Ipsilateral)
领英推è
Bilateral Posterior Open Bite Causes
- Lateral Pterygoid Hyperactivity or Contracture (Bilateral)
- Posterior Partial Coverage Appliances
- Anterior Repositioning Appliances
- Mandibular Advancement Device
In Addition, Open Bite etiology might also include the aftermath of dental procedures, traumatic facial injuries, or tooth extractions, further complicating diagnosis and management.
Diagnostic Journey & Tailored Therapeutic Approaches
Our patient had a bilateral posterior open bite and generalized head and neck muscle tension. He had no history of oral appliance usage or dental treatment that could explain his symptoms.
That left us with one conclusion: the patient likely had tight lateral pterygoid muscles. Here’s how we treated it:
- To ensure our diagnosis was correct, we injected lidocaine into the patient’s lateral pterygoid muscles. Shortly after the injections, he could easily close his back teeth together, confirming our diagnosis.
- A thermoplastic acrylic wafer (which softens at 160o and hardens at body temperature) was used to capture the patient’s correct bite. He was asked to bite into this appliance several times daily to ensure his bite issue didn’t relapse.
- The patient was given lateral pterygoid stretches to perform and was referred to physical therapy.
After six months of follow-up, our patient’s bite issue is still in remission. His neck tension and headache were also improved with conservative muscle-focused treatments. He is thrilled.
Concluding Thoughts on Open Bite Management
Exploring open bite conditions underscores the importance of a tailored, evidence-based approach in tackling such dental health challenges. It highlights the need for healthcare professionals to continually update their knowledge and skills, ensuring the delivery of effective patient care.
This case study is a testament to the intricate nature of diagnosing and treating dental anomalies, emphasizing the value of expertise and thoroughness in achieving successful outcomes.
Your Thoughts
I invite you to reflect on your encounters with open bite conditions and consider the impact of comprehensive diagnostic and management strategies on patient care. How do these insights align with your experience, and what approaches do you find most effective in similar cases?
ATM ESCUELA NEUROFISIOLóGICA - ORTOPEDIA MIOFUNCIONAL -DIPLOMADA MEDICINA DEL SUE?O (U.AUSTRAL)- LáSER ODONTOLOGICO-ASOCIACIóN ARGENTINA DE MEDICINA DEL SUE?O DIPLOMADA EN SUE?O INFANTIL UAI (IPSI)
3 个月Nobody looks at the tongue, but in many cases of anterior bite it is the cause not only of incorrect body posture but also of a lack of and poor craniofacial development. Learning to evaluate anterior frenulums or mucous membranes is also essential.
Médico - Odontólogo
3 个月Muy útil
International Marketing Manager | Dental Implants, Sales Growth
3 个月The patient’s symptoms—difficulty with posterior occlusion, persistent pressure headaches, and neck stiffness—raise concerns about potential underlying issues such as temporomandibular joint disorder (TMD), bruxism, or even postural imbalances affecting the masticatory system. Further evaluation, including a thorough clinical examination, imaging studies, and assessment of his dental and medical history, would be necessary to identify the root cause and develop an appropriate treatment plan.
Superb appraisal of a condition that occurs all too often. Many thanks, Patrick