Suggested Protocol for TMD

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I was invited by Dr. Sushil Koirala, Founder and Coordinator – MiCD Global Academy, Chief- Editor of MiCD Clinical Journal, as one of many globally renowned clinicians, academicians and researchers to answer 15 exclusive interview question for their clinical e-journal sharing my experience, clinical and research findings on the subjective of “TMDs – Confusion & Consensus: Expert’s Advice“. The following is the tenth of 15 responses to their questions.

10. What is your suggested protocol for TMDs diagnosis in a clinical setting?

A brief summary of my office treatment protocol that I follow for all TMD patients is listed below:

TMJ CONSULT: This visit will be about 1-2 hours long.  The patient meets the doctor to discuss their problem. The doctor presents a general assessment based on his observations, approach, experience and philosophy to his treatment method with options.

COMPREHENSIVE EXAMINATION:  A complete history of the problem, medical/dental history, physical assessment, psychosocial cursory evaluation, pharmacological assessment, thorough review of all previous doctors and health care providers seen, recommendations and treatment outcomes, head and neck examination – including muscle palpation and postural, occlusal evaluation, TMJ evaluation – electrosonography (joint sound recordings), periodontal examination, thorough review of all radiographs (FMX, panoramic, tomography, cephalometric, submental vertex, lateral cervical spine, AP coronal trauma series), recording of pre-existing dental conditions. Additionally, an evaluation of the patient’s physiologic resting and functional body responses that go beyond subjective complaints. A further discussion and interaction with the doctor about treatment options.

NEUROMUSCULAR ANALYSIS: This involves the recording of jaw movements at rest, in function, before and after dental TENS using Myotronics K7 (Kineseographic Occlusal Evaluation System). Data is gathered from EMG recordings and coordinated with CMS (computerized mandibular scanning – jaw tracking) recordings using these specific measuring instruments.  An “optimized-bite” registration is recorded accurately to determine an optimal physiologic resting position that is unique to each patient.  This physiologic rest position (not the habitual rest position) is recorded and verified with objective data to establish proper vertical, antero-posterior and frontal/lateral relationships. 

The following is a brief outline of the recordings that are gathered:

  • Computerized Mandibular Scan (CMS) – K7 Scan 2, 3, 6, 8, 13.
  • Electromyographic (EMG) Analysis with low frequency TENS – K7 Scan 9, 10, 11, 12.
  • Sonographic Analysis/ Range of Motion Analysis – K7 Scan 15, 16.
  • Computerized CMS with simultaneous low frequency TENS (Optimized-Bite) registration to determine a six-dimensional “physiologic” jaw position – K7 Scan 4/5.

PHASE I GNM THERAPY (GNM Orthosis Therapy with Dental TENS and K7):  This visit comprises the delivery of the gneuromuscular (GNM) orthotic appliance. The GNM orthotic is designed specifically to exact jaw recordings that were accomplished at the previous visit. The K7 computer diagnostics and dental TENS are also implemented when refining the appliance to the patient’s physiologic resting and functioning musculature (~ 3+ hours’ time is typically required for most of my complex cases when implementing micro-occlusal adjustment protocols in a detailed manner).

Very little doubt is left as to the accuracy, precision and what this GNM protocol accomplishes for each of my TMD patients. I am able to stabilize the jaw and muscles to their optimal physiologic rest position which is confirmed by measurable diagnostic recorded data in real-time. This data is then used to confirm and locate a proper lower jaw to upper cranial relationship.

FOLLOW UP VISITS are implemented to monitored and access the progress of each case using J5 low frequency dental TENS as well as other micro-occlusal adjustment techniques as per the patient’s specific needs.

Clayton A. Chan, D.D.S. – Founder/Director

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Telephone: (702) 271-2950

Leader in Gneuromuscular Dentistry