by Clayton A. Chan, D.D.S., M.I.C.C.M.O
Four main categories or types of neuromuscular dysfunction problems within the TMJ pain arena. It is these 4 types of cases that have challenged a majority of neuromuscular minded clinicians. Each of these types requires specific occlusal protocols to be understood and followed when implementing orthotic therapy. It is clear from numerous TMJ pain patients complaints that TMJ treating dentist across the board have often failed in this area because of their lack of understanding the dynamics of the proprioceptive occlusal responses feedback mechanism to the masticatory and CNS system. Specific design requirements as well as micro occlusal management skills and protocols must be followed if a lower orthotic is to re-establish physiologic health and optimal function in a timely manner. Myofacial pain related to TMD should not be a hit an miss phenomenon, but will continue as long as the dentist do not discipline themselves in the art and science of neuromuscular occlusion.
Today’s TMJ treating clinician often overlook and fails to recognized that each of these 4 conditions require specific occlusal management protocols to be followed and implemented if effective and positive outcomes are to be expected. Not all TMJ, TMD (temporomandibular joint dysfunction, MPD (myofacial pain dysfunction) or CMD (craniomandibular dysfunction), although in this clinicians perspective, should be treated in the same manner (cooking cutter protocols) although the lower anatomical orthotic has been found to be very effective and useful when implemented properly.
1) Cervical Dysfunction TMJ Disorders
2) TMJ Primary Disorders
3) Class II, Division 2 TMJ Disorders
4) Anterior Open Bite TMJ Disorders
The significance to optimal treatment planning is based on sound stabilization techniques and occlusal management of the mandibular orthosis. A thorough understanding of each type of dysfunction requires a specific feature that meets the requirement of physiologic function. Knowing these features will assist the clinician to better comprehend how best to manage and transition the case to a finalization stage of treatment.
Symptoms That Accompany These Problems
- Unresolving neck and shoulder aches in the upper trapezius region
- Unresolved occipital pain
- Unresolving temporal pain (unilaterally or bilaterally)
- Unresolving facial masseter pain and tenderness (unilaterally or bilaterally)
- Pain behind the eyes (retro, sub and supra orbital)
- Unresolved pain at the lower posterior border of the mandible (unilaterally or bilaterally)
- Unresolved pain in the SCM and Scalene muscles
- Unresolved pain in the digastric/suprahyoid muscles
These are the common unresolved sights of pain due to “Mandibular Torque” that will persist as long as mandible to cranial relationship is strained. Imbalanced bite/occluding forces are present even if the centric bite appears to be even and balanced. Functional movements are often overlooked and not understood by most TMJ experts, because of their lack of occlusal-muscular awareness as to how the physiology works. Many have attempted to use adjunctive therapies to band-aid these unrelenting pain problems when the clinician does not understand the occlusal issues at play, yet some within the TMJ bio-psychosocial community continue to perpetuate their philosophy to the masses and do not believe that occlusion relates to TMD. Even many within the NM dental community still have not been adequately trained to recognize these issues even at a basic level and will continue to pass these problems off as untreatable and part of the so called “TMJ syndrome”. Discipline on the part of the treating clinician is required.
Note: This author, treating clinician, teacher and researcher differs to believe what TMJ traditionalist have been advocating for years. 90% of TMJ is related to muscles and abnormal occlusal function. Leaving the patient helpless and paralyzed by promoting a pharmocologic psychosocial philosophy of TMJ is a dis-service to the TMJ paining community and negates the 45 years of science and technological advances that has brought a great understanding of what TMJ/TMD is really about.
To properly treatment plan these problems requires the clinician to understand what to look for during the clinical examination process as well as to recognize the hidden indicators of postural, mandibular and joint dysfunction. How to objectively evaluate the patient’s complaint by implement proper bite registration protocols using low frequency TENS and computerized mandibular scanning technology will better assist the dentist in identify the excessive vertical dimensions as well as the proper neuromuscular trajectory required to stabilize the TM joint and muscular systems. Implementing this knowledge and occlusal management techniques will lay the foundation toward sound comprehensive treatment planning.
For more information and Training see:
Initial Treatment for TMJ – Patient Understanding
OC Work up Protocol for the TMD Dysfunctional Patient - Patient Understanding
Treatment Planning Level 3 - Training for Dentist