PATIENT EDUCATION

Most TMJ problems are not just a TMJ problem. Most cosmetic restorative problems are not a just a cosmetic restorative problem and neither is an orthodontic problem, just an orthodontic problem. Most of these problems are combination of issues requiring an understand of all three disciplines that involve your dental health – relating teeth, muscles and the temporomandibular joints. Comprehensive dentistry relates all of these areas of dentistry properly to your treatment.
 

Finding a qualified Dentist who understands your TMJ, restorative and orthodontic/orthopedic problem can be a daunting, frustrating and extremely challenging problem. If you have had a history of having seen numerous practitioners (of both classic occlusal training and classic neuromuscular training) who have given their best in helping you, yet you still have not been satisfied with you treatment outcomes and you still have pain, there is hope!

Treating chronic muscle and joint pain problems requires the clinician to have additional training, expereince and expertise in recognizing that muscle and joint pain can correlate to imbalances in the bite/occlusion as well as its relationship to the cervical alignment of the head and neck. It should not be a trial and error approach for the patient.

Treating complex restorative (crowns, implants and missing teeth) problems requires the clinician to have expertise in recognizing jaw relationship problems in 6 dimensions (antero-posterior, vertical, latera/frontal, pitch, yaw and roll) as they relate to your bite. Comfortable muscles of the face, neck, shoulders and jaw joints is key to harmony and health. Naturally, the apperance (esthetics) of the teeth is important cosmetically, but your teeth and bite must function to support your comfort of the muscles and joints.

Treating abnormal nose breathing and abnormal tongue posturing problems are other underlying issues that the clinician must recognize when teeth are crowded and overlappying one another. Narrow upper and lower arches and overclosed bites are just a few of the structural issues that must be addressed with your qualified dentist who is treating your TMJ, restorative and or orthodontic problem.

PHILOSOPHIES AND APPROACHES YOU NEED TO BE AWARE OF:

1. The classic gnathologic approach to these problems often position the patient in a supine (laying down) position when adjust or grinding (equilibrating) the teeth. Careful manipulation of the mandible is often used to guide the jaws and occlusion into a position. These clinicians usually have good training in the mechanics of jaw movements and occlusal morphology which is a key element in resolution of some of the bite oriented problems.
2. Classic neuromuscular approach often positions the patient in a sitting up position (up right) position when adjusting the bite/occlusion. Relaxing the muscles using TENS or other supportive computerized instrumentation to objectively record muscle activity and jaw positioning responses in the diagnosis and treatment are often used depending on the doctors training and education.
3. The Gneuromuscularly trained clinician have been trained with BOTH an appreciation and understanding in both concepts recognizing the proprioceptive details of the bite that are required to calm the central nervous system as well as how the masticatory muscles relate physiologically to the bite and jaw joints. These clinicians use their clinical chairside skills of both disciplines in additition to the use of TENS, jaw tracking technology (computerized mandibular scanning – CMS) and electromyographic (EMG) technology to assist in their decision making to treat and manage the patient’s bite effectively. (Note: The TENS unit specifically mentioned here refers to the Ultra Low TENS (Transcutaneous Electro-Neural Stimulation) which is different than the more common high frequency TENS units used by physio-therapists).

Clinicians who understand and are trained in the “Gneuromuscular” approach encompassing both gnathologic concepts as well as neuromuscular dentistry concepts are qualified to address these issues.

• Clinicians who have an overall focus on TMJ, restorative as well as orthodontics (3 main disciplines) will have a more complete and objective perspective when approaching your case. Clinicians who focus mainly on one of these disciplines (ie. restorative cosmetics) rather than the other aspects of your case may be missing a key aspect to your diagnosis and treatment. Inquire with your dentist what is his/her focus to treatment.
• These Clinicians are trained to recognize the various musculoskeletal occlusal signs and symptoms that are connected with your problem.
• Clinicians who recognize that the occlusion and how the upper and lower arches relate to one another “Physiologically” are better qualified, respecting your bite and how important it is to stablize the muscles and joints. These clinicians are trained to diagnose your case from a physiologic rested position (homeostasis – when the upper and lower jaw relationship is neutral and not strained) versus from the habitual accommodate bite position (your teeth come together into an accommodated worn in position of the bite), which may not necessarily support comfortable muscles and a proper jaw joint position.
• These Clinicians recognize that the antero-posterior dimension (front to back positioning) of your lower jaw as it relates to the upper jaw is critical to the success and resolution of strained muscles and displaced discs within the temporomandibular joints.
• These are clinicians who have spent time in acquiring numerous hours of post graduate training in micro-occlusion adjustment details and physiologic bite management concepts. These high proprioceptive details in the bite for some people are necessary to bring comfort.  Finding a dentist who is willing to meet this challenge is important in some cases. They appreciate the important fact that gravity and muscle function must function in harmony with proper cervical neck alignment and head balance to maintain ang give you a stable bite (occlusion).
• These clinicians have been properly trained in the use of biophysiologic instrumentation that objectively measures the quality of your jaw function and quality of muscle activity/rest. These quanitified test will assist you and your dentist in better understanding the underlying problems, getting to the source of the problem rather than treating the symptoms, for effective treatment.

DEGREES AND CREDENTIALS:
Although degrees and credentials are important the following are even more critical to your treatment success:

• Does the clinician have not just academic understanding, but even more importantly the clinical skills required to treat your case?
• Does your dentist have comprehensive training and abilities in Phase I: Orthotic stabilization and Phase 2: Bite management and full mouth rehabilitation?
• Does the clinician have proper laboratory understand and support to do your case when addressing the restorative aspects of cosmetics and occlusion (your bite)? Does the lab have training in orthotic fabrication, full mouth rehabilitation and bite management?
• Is your dentist a hands on person (focusing on each step of your treatment) or more of a deligator of procedures (having others treat and manage your case)?
• Does your dentist have a specific and well thoughtout protocol to finding your bite or is your bite not that important to remeding your TMJ problem?
• Does your dentist use low frequency TENS when need to relax tight muscles before adjusting your bite?
• Does your dentist have the capability to using jaw tracking technology (CMS) with TENS to find your bite position physiologically?
• Does your dentist use Electromyography (EMG) to measure your muscle activity to diagnose underlying jaw postural problems objectively?
• Consider the clinicians ability to comprehend the depth of your problem presented from a multi dimensional perspective – TMJ, comprehesnive restorative as well as an orthodontic/orthopedic perspective.
• Is the Clinician approaching your problem from a Psychosomatic perspective or Physiologic somatopsychic perspective? This is very important to know, because the TMJ occlusal philosophy they believe and approach your case with will be the path you will take with them as they recommend, diagnose and treat your case.
• The hand dexterity skills and abilities of the dentist is crucial to how they will manage your bite. Are they detailed in their awareness of fine nuiances of how your bite feels or are they general about these matters that the bite will accommodate and adjust into a position? (You shouldn’t be told to get use to a painful appliance).
• How much time do they give to answering your concerns and do the clinician’s answers make sense to you? Are they logical? Do they have time to treat your case. When you are in pain and call for an appointment how soon can the doctor see you?
• Acadamic studies and references are one thing, but do they have the skill, knowledge, judgement and expertise to treat your case comprehensively? Seeing the bigger picture of your health comprehensively versus what is convenient for you and the doctor is crucial to your overal treatment.

PATIENT QUESTIONS:

• As a consumer patient you have the right to ask questions.
• You have the responsibility to be well informed before choosing a doctor. “It is your health”!
• Don’t always take the doctors word, but do your research.
• Interview your doctor and ask him/her the tough questions.
• Find out what level of “TMJ” training they have received.

For more information see: http://www.occlusionconnections.com/

Filed under: Finding a Neuromuscular Dentist, Physiologic Bite, Treatment and Diagnosis by Clayton A. Chan, D.D.S.
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