BLOG

How Many Appliances Does the TMJ Patient Need to Become Stable and Comfortable?

by Clayton A. Chan, D.D.S. – General Dentist

Over the past 24 years it has become apparent to me as a clinical dentist that it just take one good intra oral appliance to stabilize the cranio-mandibular/TMJ pain dysfunctional problem case. Nature’s design is to develop one good set of teeth and one good occlusion to stabilize the bodies posture – to allow it to function optimally. The dental profession is fraught with confusion as to how best to remedy the numerous musculoskeletal occlusal and TMJ paining problems. Dentists have come up with a constellation of modalities, techniques and numerous appliances in an attempt to address the TMJ problem such as masticatory pain, headache pain, cervical pain, facial pain, clicking and popping joints, jaw restriction problems, clenching and grinding problems and the list goes on.

Many different kind of appliances and intra oral devices have been devised to address these problems, but are often based on the dentists occlusal and TMJ philosophy, understanding and experience about orofacial pain, musculoskeletal occlusal and temporomandibular joint dysfunctional issues.

The lower anatomical orthotic is the one appliance that has been proven successful and consistently able to meet the needs of my TMJ pain patients. I don’t advocate a night time splint or a day time guard. Why? If one can accurately identify by objective measurements the correct physiologic bite relationship (relating the maxillary to mandibular arches in an optimal manner) and properly adjust the orthotic to physiologic parameters so that the appliance can be worn 24/7 during the day and or during the night and the patient feels comfortable with it during speaking, eating, play and work, then it can be assumed that the one orthotic appliance based on gneuromuscular (GNM) science and technology must have some validity to this approach.

One correctly designed and adjusted intra oral appliance (an Optimized GNM Orthotic) is all that is required to stabilize the dysfunctional TMD case in almost every case.

The only time an additional appliance or prosthesis is required is when there exists missing opposing teeth. In these situations an opposing stay plate, retainer with teeth, or a partial denture and in fully edentualous cases a full arch denture may be required to oppose the lower anatomical orthotic appliance.

The Leader in Neuromuscular and Gneuromuscular Dentistry

Filed under: Uncategorized by Clayton A. Chan, D.D.S.
No Comments »

Case Study 1: Bite Optimization and Postural Alignment

Occlusion is the foundation to advanced dentistry. Optimal occlusion can improve postural alignment, strength and functional balance. Abnormal occlusion – skews, torques, strains in the human bite/occlusion can contribute to compromised body balance, strength and abnormal walking gait. The proprioceptive signalling of occlusal responses are tremendous and exquisitely detailed in their physiologic responses as to how each cusp and fossa of the teeth related to one another. When the teeth are worn down and flat the vertical dimension of the associated jaw structures of face are also compromised causing cranial bones to skew, head posture to be altered along with changes that have a domino effect to distant parts of the body (pelvis, legs and feet) to also strain and weaken.

A properly adjusted removable orthotic using gneuromuscular concepts and technology that quantifies mandibular position (0.1-0.3 mm accuracy) and measures muscle physiology (mV) has been used to achieve specific goals to help aid in the correction of facial asymmetries, improve chewing function, improve body posture, strength, body alignment functional movements.

Patient: Age 49 male
Initial Main Complaints: No bite, can’t chew, generalized neck pain, shoulder pain, headaches (migrainous), speech problems.

Findings: Asymmetric skeletal/dental alignment, Class I dental with mimimal overjet/overlap of anterior teeth, missing upper left and lower left first bicuspid with open space on lower left, previous orthodontics. Moderate gum recession and anterior bone loss. Numerous sites of muscular pain and tension.

Radiographic Findings: Left and right condyles posterior and superiorly displaced. Degenerative changes (flattening) on anterior surfaces of condyles with mid recipricol click on closing.

K7 Instrumentation Recordings: Electrosonographic recording indicates high frequency 0-300 Hz filter and high amplitude signature patterns on right TMJ. Computerized mandibular scanning (CMS) indicates abnormal mandibular jaw closure pattern posterior (1.6 mm) to an isotonic path of closure and laterally to the right (1.2 mm). Electromyographic (EMG) recordings indicate an abnormal hyper muscle activity in the cervical group region.

Dentists often do not realize how powerful it is when treating occlusion, relating the upper maxilla to the mandible physiologically. It is apparent that when teeth and dental arches are mal-aligned and mal positioned to their habitual accommodated position the muscles and jaw joints will skew, torque and strain themselves causing other distant parts of the body (cervical, shoulders, pelvis-sacrum and ilium, leg length and foot posture) to mal-align and malfunction.

Finishing Computerized Jaw Track and EMG Recordings: Final jaw track after orthotic is adjusted and balanced in 6 dimensions. Note: Patient’s mandible is closing along the isotonic neuromuscular trajectory with TENS (involuntary closure) and without TENS (voluntary closure) without deviating posterior during closure using the Optimized Orthotic (intra orally).

EMG Scan 12 shows synchronous muscle recruitment balanced during jaw closure. Accuracy of muscle recruitment is within 5.5 mV of the temporalis and masseter muscles. Balanced muscle activity.

Patient is no longer having chewing problems. He has found his bite! Improvement in shoulders, lower back, with increased balance, strength and improved walking gait further confirms that a proper occlusal position established to an optimized bite position implementing gneuromuscular concepts is valid and significant to the TMD pain patient and athletic community.

The Leader in Neuromuscular and Gneuromuscular Dentistry

Filed under: Athletic Performance, Bite Optimization, CHAN Optimized Bite™, Diagnosis and Neuromuscular Treatment, Gneuromuscular Dentistry, Jaw Tracking, Neuromuscular Dentistry, Neuromuscular Technology, Occlusion, Optimized Bite™, Orthotics, Posture, Proprioception, Science of Bite Optimization, TENS, TMJ and Stabilization by Clayton A. Chan, D.D.S.
No Comments »

FIVE KEY PRINCIPLES of PHYSIOLOGIC OCCLUSION

By Clayton A. Chan, D.D.S.
Founder and Director of OCCLUSION CONNECTIONS™, Las Vegas, Nevada, U.S.A.

“The main thing is to keep the main thing the main thing.” - Steven Covey

Every neuromuscularly trained and treating clinician should recognize, practice and implement the following five principles in their dental practice. These are fundamental keys to every level of TMD, orthodontic and comprehensive restorative dentistry. Failure to acknowledge these keys principles will result in misdiagnosis and mistreatment. At Occlusion Connections we encourage all to grasp these concepts in order that an optimal level of dentistry can be performed by the dentist and appreciated by the patient.

Doctors who have received training at Occlusion Connections have recognized these principles to be fundamentally important distinguishing their dental practice with this kind of neuromuscular thinking from standard neuromuscular dentistry thinking.