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The doctor should first recognize that microns matter. Paying attention to details when adjusting a patient’s occlusion/bite is very important.
That means small dust changes in the bite or micron dust alterations on the orthotic matters to those who are hyper vigilent or hyper occlusally aware.
Secondly, if this is really so, jaw position as it has been stated numerous times also matters, because if the mandible is not opening and closing along an “isotonic” closure path, the hyper vigilant patient also knows it (they feel something is off, but can’t figure out why). If the doctor doesn’t know how to recognize these factors and is only using thick articulating paper, classical dental school adjustment methods or rudimentary occlusal adjustment techniques grinding away high spots on the appliance (rather than respecting occlusal cusp fossa form) with disregard for occlusal architecture of the appliance (turning anatomical form into flat plane splints), then we all know that is not going to work out well for the patient in distress.
The hyper vigilant person can feel micron occlusal changes of at least 20 microns or less. Occlusal changes of 80-100 microns or greater to most non hyper vigilant is no big deal. The non hyper vigilant doctors all believe they understand details, but to those who are really living the hyper vigilant life….realize differently…occlusion and getting this right is a huge deal that most may not fully comprehend.
The proper use of Myomonitor Dental TENS is used specifically to create an involuntary isotonic repetitious pulse movement of mandible. It is key to identifying the actual (involuntary) occlusal premature high spots, especially when certain hyper active muscles of the jaws are pulling, torquing and skewing the bite. Without TENS the 6 dimensions of the jaw will be off. (Microns and accurate jaw position matters).
Micron and or even nano detailed patients will want to know the proper jaw location accurately relative to their existing pathologic bite position when it comes to adjusting these high spots (prematurities). Accurate and skilled use of the K7 (kineseograph occlusal technology) to track mandibular jaw location objectively is used to observe exactly what and where the bite is off. What position the mandible is actually closing is critical. Typically the mandible is closing posterior of the more optimal/physiologic “isotonic” jaw closure path.
High occlusal spots will cause the mandible to function posterior and or lateral of a more optimal closing path. It is desirable to have even balance terminal contact of the bite without any skids or high spots when one closes their teeth together. The hyper vigilant will know when the bite is right. If there is hesitation as to “how does it feel…”….the bite or orthotic/splint adjustment may not be accurately completed or is not rfined to the level of satisfaction of the patient’s central nervous systems (CNS) comfort and awareness.
Having a sense of a high spots stirs the central nervous system (the reticular formation in the brain)…to much neural input triggering ill response. The bite also has to feel comfortable when the person shifts and moves their jaw around during chewing. If the bite doesn’t feel comfortable when laying down or sleeping at night….something is wrong with the appliance.
It is not always the patient, but rather the unknowing good intended doctor may not have recognized the wrong high spots in a night time appliance may still be present, but the patient knows night after night that it is not really working for the TMD pain sensitive patient. If one can’t chew with their bite, something is off. it is not that the patient is psycho…but these high spots can make a non hyper aware doctor believe so since they are clueless of the levels of details the person they are treating actually requires.
It is like a doctor using 80-100 micro adjustment skills and understanding to meet the needs of the 10-20 micron patient, yet the patient is focused on pain, symptoms, TMD, airway, CNS, etc. etc… So many factors, so many details to attend to. The treating clinician and patient must recognize this kind of treatment takes lots of time and effort. Occlusal adjustments for these type of patient’s can’t be reckless when contending with the hyper vigilant. It is not easy for anyone, that is for sure. But with determination, diligence and proper understanding of both gnathic and neuromuscular principles applied properly, I believe a comfortable bite can make a difference. I believe details matter!
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- ABOUT GNM DENTISTRY
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