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by Clayton A. Chan, D.D.S., Las Vegas, Nevada, (702) 271-2950
How Often to Adjust the Orthotic:
- If the structural cervical is compromised (kyphotic) – more orthotic adjustments should be anticipated even when working with chiro or PT.
- If the patient has unresolved condyle/disc relationships – more orthotic adjustments should be anticipated even when working with chiro or PT.
- If patient has unresolved temporalis, masseter, LP and Med Pterygoid muscle tension I would anticipate more orthotic adjustments.
- If the patient has unresolved SCM, scalene, occipital and suprahyoid/digastic muscle tensions – I would anticipate more orthotic adjustments.
What would increase the need for more follow up orthotic adjustments with or without a chiro or PT?
- If the habitual voluntary mandibular closure pattern is not synchronized to a more isotonic involuntary myo-trajectory path = Optimizing the myo-trajectory (not forcing the jaw forward neither allowing the mandible to be forced posteriorly).
- If the terminal occlusal contact force is not balanced and evenly distributed during mandibular closure on the optimized myo-trajectory.
- If there are unidentified occlusal incline plane contacts that are causing functional mandibular deflections and muscle strains.
- If the mandibular functional chewing movements are not free of occlusal contact interferences.
- If the retrusive contacts are not balanced.
- If the forward downward head posture is contributing to abnormal anterior prematurities.
- If there exists unrecognized posterior occlusal prematurities during supine/sleeping positioning.
- If the orthotic is not micro occlusal managed properly and the orthotic is not designed to support proper gnathic movements outside of the NM Myocentric position.
These items would all contribute to a need to adjust the orthotic.
The quicker the listed items above are resolved the treating clinician will discover having to have less follow up orthotic adjustment visits. The more items on the list that are not immediately addressed the more follow up orthotic adjustments are to be expected. Of course, if the treating dentists decided to unknowingly ignore these items and or excuse the unresolved musculoskeletal occlusal issues (patients subjective summary items) as related to something other than a micro occlusal proprioceptive signaling issue then one can reduce the follow up visits by referring the patient to some other professional hoping that these dental occlusal issues can be addressed.