Last week I briefly discussed what is involved with a comprehensive oral health evaluation.  Patients whose goal is optimal health for a lifetime need to have more than the cursory “check-up” that is typically offered with an oral hygiene appointment.  Over the next few weeks I will be discussing various elements of the comprehensive examination.

As I mentioned last week, the comprehensive examination most often begins with a “pre-clinical” examination where the dentist and his/her team take time to get to know you and your specific felt needs.  It is a time to learn where you have been, where you are now and where you desire to go as far as your oral health is concerned.  The dentist gains valuable insights as you discuss your desires and also gives you the opportunity to see if the dentist is right match for providing your oral health care needs.  It is an opportunity for you to get to know each other.  An instructor told me years ago never to work on a “stranger”.  In essence his wisdom was telling me to get to know the patients you are blessed to treat.  In the same way, as a patient you will feel more at ease if someone you are familiar with is providing your oral health care.

The next element after the pre-clinical typically involves the “complete clinical examination”.  This is an involved process that evaluates more than just checking your teeth.  The temporomandibular joints (TMJ - jaw joints) are one aspect of the examination that should be considered.  Have you ever had a “popping or clicking” in your jaw joints.  If so, you have dislocated a protective pad, called the disc in your joints.  Often it will reposition itself, but it may also get progressively worse.  In many patients it is more of an annoyance, but others have debilitating pain.  Not only can it affect the comfort of your joints, it also alters the way your teeth come together.  Have you ever broken a tooth no apparent reason or do you have one or two teeth with excessive wear?  It may be because of instability in your joints.  Every time you bite down, the temporomandibular joints must function.  An alteration in their position from a dislocated disc or muscle spasm alters your bite.  This can lead to excessive, often detrimental forces on individual teeth.  Just ask anyone who’s had problems with their TMJ or had their jaws lock open or closed and they will tell you how important the joints are!  The temporomandibular joints are the some of the most intricate joints in the body.  They are the only joints that can move in multiple directions and that must function simultaneously and in harmony with the joint on the opposite side.  There are an enormous amount of muscles dedicated to the operation of the system.  They must all work together harmoniously in order for the joint to properly function.  The muscles will typically be palpated during the examination to verify they are comfortable and free from pain.  Do you ever get headaches or neck aches?  Often these can be related to dysfunction of the temporomandibular joints and related muscle spasms.  Throughout the examination your dentist will be asking what you are feeling, wondering and thinking.  You, after all, know better than anyone what you feel in your own mouth.  This is a time of learning for both you and the dentist caring for you.  Ultimately, if the temporomandibular joints aren’t stable and properly aligned, oral health and dental care are more likely to fail.  Oral health for a lifetime begins with stable joints, an important part of the comprehensive examination.  Next week we will look at more details of the examination.