Engineers are critical thinkers.

When confronted with a problem, most

engineers continually ask the question

“Why?” Recently, I spent a wonderful

morning with a new patient who happened

to be an engineer. Rami’s chief

complaint was pain “where the tooth

meets the gum.” He also expressed dissatisfaction

with the appearance of his

teeth.

A proper diagnosis always includes

the cause and effect The comprehensive

exam revealed an absence of any

significant periodontal (gum) disease

but at least 12 of his teeth were cracked,

and around every cracked tooth

there were bony ridges. I explained to

him that these had developed due to

occlusal (bite) disease. A poor bite was

the cause of his pain. His upper front

teeth angled forward. He thought that

thumb sucking as a child might have

had something to do with this. I was

able to explain that his adult bite had a

lot to do with it. Rami was very interested,

and we had a good time working out

what was going on with his occlusion.

At one point, the conversation turned

to my dog, a boxer. I explained that

the canine dentition does not allow for

my dog to chew in the manner that

humans chew. Dogs have no side-toside

movement. They chew up and

down. They are carnivores with many

more primitive teeth.

It’s true that they can get decay and

periodontal disease like humans, but

their masticatory system (chewing physiology)

is designed for ripping at food,

and it all starts with the tempormandibular

(jaw) joint.

I showed him a human skull and a

dog’s skull so he could see how the jaw

joints are differently shaped. It was

clear that dogs can only move their

jaws up and down. I showed him models

of a patient’s teeth mounted on a device

called an “articulator.” This device

allows for the models (dental casts) to

be moved in as complex a fashion as we

humans move our jaws, side to side, up

and down, and around.

He placed his fingers on his jaw

muscles and felt as he bit down. He did

the same on my jaw muscles and could

feel a difference due to the arrangement

of our teeth being different and

the surfaces where our teeth come

together being different. He could feel

that his jaw muscles were under considerably

more stress.

He was keenly interested in taking

the time to make sure we worked out

the correct diagnosis of his condition

and an optimal treatment plan. Perhaps,

this is because he understood what

was malfunctioning in his mouth from

an engineer’s point of view – but it’s my

hope that every patient will understand

what’s going on in his or her own mouth

– the cause and effect. It’s my mission

to explain dentistry in such a way that

every patient equally understands. R