by Clayton A. Chan,D.D.S.,M.I.C.C.M.O.
Sensory inputs from the,teeth,muscles,joints and discs represent 70 percent of all the information that is perceived by the central nervous system. Sensory inputs are responsible for how the body reacts to the environment in which we live. The way the human jaws come together repeatedly is a reflection of how each component of the entire body is able to maintain rest and function.
Optimization of the bite physiologically based on science and the art of relaxing spastic muscles physiologically to establish an optimal jaw/joint relationship to the head and neck allows not only the stomatognathic system improve the quality of rest,but the entire body to optimally function,respond and balance. Recognizing this physiologic neutral bite relationship to meet the prioprioceptive occlusal demands along an isotonic trajectory up from a physiologic rest position is key to why gneuromuscular principles are important in getting the bite right.
Recording the Optimized Bite®
Recording and objectively measuring a jaw relationship (the bite) is best done with computerized electronic technology that allows today’s advanced dentist to identify,test and capture the patients mandibular relationship using the Optimized Bite training protocols that take past gnathic occlussal concepts into 21st century bio-physiologic clinical reality. The following technologies are used in this order of importance:
- Low Frequency TENS is used to relax spastic jaw musculature.
- K7 Kineseographic computerized jaw tracking technology allows the clinician to accurately locate and record the mandibular position physiologically without manual manipulation (The bite registration is taken in a sitting up right position).
- Objective data records within 0.1-0.2 mm accuracy the mandibular and TM Joint position in both the vertical,sagittal,frontal planes.
- The bite registration is then taken by the trained dentist following specific Optimized Bite® taking protocols (training is completed at Occlusion Connections™,Las Vegas,NV under the instruction of Dr. Clayton A. Chan) to advance the neuromuscularly minded (NM) clinician beyond classical K7 and TENS bite taking techniques.
- Electromyographic (EMG) recordings can be used to diagnostically record muscle activity status.
Questions of Measurement Appropriateness
Questions of measurement appropriateness can be responded to with the three scientific requirements for validity of measurement instrumentation and protocol:
- Can you measure a know physiologic parameter?
- Are you measuring what you say you are measuring?
- Does that measurement add to the diagnostic information?
If you answer “yes”to all three questions it is a valid and useful measurement adding to the differential diagnosis. Both the ADA Council on Scientific Affairs and FDA have evaluated neuromuscular measurement instrumentation and found them to meet each of these criteria. There is no argument of validity and reliability or these devices would not have the ADA Seal of Acceptance or FDA 510k clearance.
TMJ Health vs. Pathology
The principles of health vs pathology that apply to every joint in the human body also applies to the temporomandibular joints. Joint structures should not impinge upon neurovascular structures during function. The neurovascular structures of the TMJ are located in the retro disal tissues which are posterior to the condyle and articular disk in normal patients. The logic of not posteriorizing the condyle and encroaching on these structures is self-evident. You don’t go to the chiropractor or physical therapist to have them compress boney parts together and further press on the entrapped neurovascualr structures. Their job is to relax the muscles,create space where compression is occurring and keep the boney structures separated. Patients with intractable back or neck pain have surgery to separate boney parts that are pressing on nerves and/or blood vessels. A spinal fusion separates these boney parts by surgically using metal or bone.
The dental literature has hundreds of studies strongly supporting the finding that patients with TMJ dysfunction have reduced posterior joint space as compared to non-pain control patients. Not surprising. There is also universal consensus that the optimal position of the condyle relative to the disc is proximate seating into the biconcave part of the disk. This is an avascular structure that is designed to accept functional loads. When the
condyle and disc to not remain proximate during the full range of functional movement TMJ “click”or “pops”occur.
When a dentist tells you that the condyle must be “seated”the most accepted understanding is that the condyle is proximate to the biconcave portion of the disc in the intercuspal position. However,to imply that there is one,and only one,seated position is really rather silly when you consider what happens when you eat a meal. When is the greatest power needed? When you bite into resistant food. If there is resistant food between the teeth the patient is definitely not in a CR or CO condylar relationship. Yet,you can exert power during any of an infinite number of condylar positions that depend upon thickness of the food bolus,its resistance and where you placed that bolus between the teeth. As long as the condyle remains proximate to the biconcave part of the disc you function just fine. It’s when the condyle and disc leave each other that problems occur.
What is the most common disc/condyle problem as supported by the dental literature. Easy!
Anterior disc displacement combined with posterior condyle displacement. That’s the profile of all these patients with reciprocal (open/close) clicks and restricted jaw openings. Do you want to push the condyle even further back?
