by Clayton A. Chan, D.D.S., M.I.C.C.M.O.
There are 4 main categories of dysfunctional mal occlusions that requires special attention when designing and managing the lower removable orthosis in the treatment of the TMD suffering patient.
The correction of malformations of the jaws and skeletal structures involving the masticatory system is especially important when attempting to preserve as well as restore optimal function of the skeletal system, its articulations and associated structures, including the trigeminal system. Clinicians who treat these 4 main problematic types must recognize in the diagnostic phases what structural, biochemical and emotional factors are involved to effectively treat and resolve the various musculoskeletal occlusal symptoms.
Micro occlusal management of the orthosis (orthopedic jaw realignment device) and training is required of the TMJ dentist at the highest levels to properly address the proprioceptive occlusal signaling and communication that occurs with the TMD patient who experiences various levels of occlusal awareness and at the same time present with cervical dysfunction, TMJ primary disorders, Class II Division 2 dental mal alignments and or Anterior open bite problems.
Resolving any one of these or a combination of these problems can challenged the TMJ treating clinician if they are not familiar with sound protocols. The following is a general guide as to what work up and protocols may be necessary in addressing the needs of the dysfunctional TMJ/TMD patient.
When I mention “Apply gnathological principles when managing the Optimized bite” I am referring to the detailed proprioceptive mechanics that the trained dentist must pay attention to during all jaw movements. Based on a sound Optimized Bite position (GNM) which can only be best achieved with jaw tracking technology and TENS combined gives the best results. Using just the Myomonitor TENS alone is not sufficient even in the best of trained clinicians since visual observations alone can not obtain consistency in precision and objective reliablity when attempting to establish a starting lower to upper jaw relationship. This is crucial if success is desired.
Additional adjunctive support maybe required within the medical and dental community to obtain a successful resolution. Establishing an Optimal physiologic mandibular position is critical to TMJ therapy. Micro occlusal management is of key importance of the TMJ pain patient is going to experience a calming of the muscles since it is clearly recognized within the TMD community that occlusion can effect the masticatory muscles responses either positively or negatively.
When there are are subtle occlusal imbalances in the bite which can contribute to jaw torque, the muscles of the jaw, head, neck and shoulders can strain and cause severe pain, further disrupting the central nervous system.