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Bite and Occlusion Damage: Accrual Process

Damage to the occlusal plane (our bites) can occur at nearly any age and can have a rapid onset or developmental onset.

The pictures outlined below show how developmental issues affecting jawbone structures and shape, plus common occurences of underdeveloped tooth structures which, if left untreated, can initiate and accelerate unhealthy changes in the occlusal plane.

Depending on the delay of recommended treatment, other damage to teeth and occlusal plane can occur for some patients.

Amelogenesis imperfecta is a developmental disorder that can affect the development of teeth. Teeth tend to be abnormally small, discolored, have surface pitting or grooves. Wear and tear, with eventual breakage can be common. This type of genetic disorder can affect baby teeth and secondary (adult) tooth structures.

Treatment possibilities are numerous and can be quite complex, beginning as early as 2-6 years old. During the developmental years, focus would be on maintaining overall dental functional and an acceptable aesthetic. After developmental stages have passed, a wider scope of possibilities including prosthetics, implants, bridgework, dentures, etc., are possible depending on occlusal need and the cosmetic aspirations of the patient.


Amelogenesis Imperfecta
Mitchell PohlDDS


Bilateral Cross Bite (lower jaw is bigger than the upper jaw) also defined as a " jaw size discrepancy". This is most difficult type of treatment as there is a Orthopedic Problem rather than a Orthodontic Problem The jaw size discrepancy is a orthopedic or (jawbone) problem. Additionally, the teeth are crooked, superuped and she has a classic "underbite". Typical solutions are orthodontics and jaw surgery to make the lower jaw smaller. Jaw surgery becomes necessary if the face is out of proportion. In this case, her face was fine and surgery was eliminated as she chose a complete bite reconstruction with porcelain veneer crowns.

Angular Appearance
Dr Sam Muslin


Young adult female with congenitally undersized teeth and angulated positioning. Upper arch is relatively larger than lower arch. Popular treatments can include orthodontic treatments and/or veneer laminations.

Patient ultimately selected non invasive veneer treatments for upper arch, with the Lumineer Veneer product line. (Click here to see before and after photos of treatment)

Angled Teeth
Angulated Teeth
Mitchell Pohl, DDS


Tetracycline Stain, Peg Lateral Incisors, Retained Baby teeth, Defective Enamel, The teeth were stained with the antibiotic tetracycline during the development of her permanent teeth at about 4 years of age. The lateral incisors were peg shaped and out of proportions with the sizes of the other permanent teeth. The treatment involved non-invasive porcelain veneers and porcelain veneer crowns that required no grinding of her natural teeth. The color of the veneers was able to hide the color as the dentist bonded the stained defective enamel before the veneers were made

Baby Teeth - Peg Laterals
Dr Sam Muslin


Deep overbite, bite collapse, Congenitally missing lateral incisors, teeth drifting, lost canine guidance, lower anterior teeth superupted, Broken edge of the central incisor

Congenitally Missing Lateral Incisors
Dr Sam Muslin


Lower teeth superupted, deep overbite, missing congenitally the upper lateral incisors and back molar teeth, gum recession and tooth erosion, teeth are drifting, bite is not stable, tooth abrasion, bruxism and heavy tooth wear as the angles on the lower front teeth are from clenching and tooth grinding or bruxism

Super Eruption - Missing Incisors
Dr Sam Muslin


Unusual case of twelve (12) missing teeth. Early treatment for this 40 something patient consisted of wearing a custom partial for most of his life. Normal dental function not possible. Limited in ability to eat different foods. Unusual orthodontic movements due to missing teeth. Treatments can incorporate choice of crowns, implants, bridgework, fixed bridges and standard dentures.
Birth Defect 12 missing adult teeth
Multiple Missing Teeth
Mitchell Pohl, DDS


A common cause of missing two laterals but with exaggerated spacing. Flaring of the 4 anterior teeth is quite significant. Delays in treatment promoted an increase in orthodontic issues affecting overall bite.
Large Tooth Gaps Orthodontic Flared Anteriors
Missing Teeth Gaps
Kristin Petulla, DDS


Another example of congenital malformations of upper anterior tooth structures (peg laterals) and multiple diastemas. Many patients delay treatment well into their adult years. Compounded occlusal problems may emerge for some patients, depending on the existence of early signs of impending malocclusion. In this case, 4 anterior teeth appear to be "out of occlusion", creating a reverse smile line.

Treatments can include crowns, implants, bridgework, partials, custom porcelain laminates.

Birth Defect Peg Laterals Male Adult
Adult Male Peg Laterals
Paul Sussman, DMD


Missing laterals for an adult female. Fortunately, ortho treatment was not performed during early years to move teeth together (not an uncommon practice). The patient was equally fortunate not to acquire other generalized teeth alignment issues.

Treatments can include implants, crowns, partial or bridgework.

Birth Defect Peg Laterals Female Adult
Female Missing Laterals
Edward Leventhal, DDS


A young male adult with an unusual genetic defect that caused the eruption of a good sized tooth into an area that created unique bite problems in addition to the cosmetic impactit had on his good looks. Extraction was required but left a gaping diastema that could be treated in several ways.

Recommended procedures could include adult orthodontics, dental implants, bridgework.

Birth Defect Extra AnteriorTooth
Congenital Defect - Extra Anterior Tooth
Ara Nazarian, DDS


An unusual disorder that creates the appearance of bluish green teeth. The congenital defect occurs during infancy whereby biliary atresia occurs, disrupting the draining of bile from the liver to the small intestine. Numerous developmental events can occur, depending on the extent of the condition. Not hereditary and not contagious.

Recommended procedures for treatment could include implants, crowns, bridgework, bone grafting, reconstructive dentistry. Veneers would probably not be sufficient for resurfacing discolored tooth enamel.

Bilirubin Disorder
Congenital Defect - Biliary Atresia
Mitchell Pohl, DDS





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