Missing Teeth Contribute to TMD Pain: Physiologic Occlusion a factor for Health

A TMD pain patient (female age 26 years old) presents with missing lower second molars and a missing upper first molar due to failed root canals.  Over time due to teeth sensitivities and pain these teeth fracture by her dentist and eventually extracted.  The patient reported the following symptoms and history:

  • A constellation of musculoskeletal and occlusal signs and symptoms including headaches, pressure around the eyes, face pain, cheek pain, neck, occipital pain and shoulder region pain.
  • Numbing and tingling sensations down the left arm and fingers mainly.
  • Problem has been in existence constantly for 7 years now.
  • A number of teeth, including second molars have been removed because of the problem which included molar fractures, failed endo on molars resulting in extractions.

Kareen RN 2 - Clayton A. Chan, DDS

Kareen RN 3 - Clayton A. Chan, DDS


Kareen RN 1 - Clayton A. Chan, DDS


This is what I did….

Kareen RN 4 - Clayton A. Chan, DDS

A week out from initial delivery of the GNM orthotic appliances the patient reports:

“I’m doing very good. There were a few days here and there where I was a little sore: one day my lower left molar was sore, then it went away and never came back; another day, my muscles were sore and fatigued, but I knew it was muscles that have never hurt before, so I believe it was my body’s way of adjusting.  Friday night was monumental for me…I was able to chew with ease with both mouth pieces in!! Another awesome moment: I went the the gym twice this last weekend and it’s really neat to see how my body is responding. I used to feel so achey after working out (jaw,face,etc.), but I felt okay after. Full of energy!

Kareen RN 5 - Clayton A. Chan, DDS

Kareen RN 6 - Clayton A. Chan, DDS


Patient is able to immediately chew with her upper and lower GNM anatomical orthotic!

Note: It is important that a TMD pain patient is able to chew and function normally when wearing an intra oral repositioning appliance.  If the patient is not able to comfortably chew with the appliance it may be due to abnormal biting forces in the bite which can hinder and slow down the recovering time for healing of the muscles and comfort.  If a physiologic mandibular position has not be properly established in the (antero-posterior, frontal/lateral and vertical dimension including pitch, yaw and roll) discomfort can continue), but this is abnormal and indicator that something is wrong.

Here are a few tips to consider for better comfort in chewing with a splint or orthotic:

  1. Intra oral appliance must be designed to support calm stable muscles (reducing abnormal muscle strains).
  2. Intra oral appliance needs to be occlusally adjusted (like any restorative crowns and fillings) so abnormal forces are eliminated to allow healing of muscles and joints.
  3. Intra oral appliance should eliminate abnormal muscle tension, compression and strain to the TM joints.
  4. Intra oral appliance should support normalized resting modes so the spastic muscles can relax.
  5. Intra oral appliances should allow physiologic mandibular function and normalized range of mandibular motion free of restrictions.
  6. Intra oral appliance should not induce noxious proprioceptive stimuli that triggers afferent and efferent signals of discomfort.

A properly adjusted GNM Orthotic is designed to meet those parameters of physiologic health for the TMD pain pain once the disc are reduced (recaptured).