What Caught Your Attention in the Science, Art of TMD Management and Research?

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 first of 15 responses to their questions.

1. Kindly let us know what it was about the science and art of TMD management, research, and publications that caught your attention?

My dental career started out in laboratory dental technology as a technician at the plaster bench, then moved to crown and bridge waxing, later to cast partials and dentures and later to ceramics. With a further background working for a major dental corporation in dental materials research and product development, specifically in dental composite development I began to see into the laboratory and manufacturing world of dentistry. Eventually, I entered the clinical world dentistry after I graduated from dental school, achieving my D.D.S. degree and began to ask a lot of questions.

The difficulty in developing a practice that is so different from the average dentist is the unjust criticism by fellow colleagues with little or no clinical experience in the application of gathering objectively measured data using technology. It was this technology that allowed me to distinguish between pathologic engrammed mandibular movement patterns from physiologic patterns. It was this type of clinical scientific measured approach that allowed me to see how it is possible to determine an optimal mandibular to maxillary jaw relationship when it was necessary to find a physiologic unstrained jaw relationship (“the bite”) without manually manipulating my patient’s mandible in a supine position. It was the objective recordings that gave evidence and confirmation to me that it was possible to find a proper mandibular position in intra oral space when the muscles, jaw joints and teeth were no longer reliable references to be used when attempting to capture a physiologic bite registration. Understanding what the recorded data means and how to properly interpret that data became a whole new quest.

Using computerized jaw tracking to see actual jaw movements with temporomandibular joint sound recording technology (electrosonography – ESG) allowed me to record and analyze specific joint sound signature patterns that more accurately defined joint pathologic sounds in their duration, amplitude, frequency and position. It was through the measured recordings using surface electromyography (sEMG) that I could see in real-time different levels of muscle activity of my patients who were having clinical problems. I not only was able to analyze in real-time but also synthesize the documented jaw/occlusal relationship recordings. The data also allowed me to definitively see whether spastic muscle activities were resolving after restorative and orthodontic treatment or not. I was able to see what level of stability my patients had after I rendered occlusal treatment to them. This kind of information brought a new awareness and shifted my clinical practice from the realm of subjective assessment to a scientific objective approach – from the unseen awareness of hypertonic muscle states to normalized healthy states that now could be visualized objectively. These measuring technologies allowed me to understand the outcomes of my treatment effectiveness.

Knowing the outcomes based on objective measurements is an essential scientific paradigm in dentistry today for improving clinical care, because it enhances the connection between doctors and their patients and will help further the dental professions awareness. That is what caught my attention to get my TMD pain patients stable and pain free. I was able to find better occlusal positions that helped me bring stability to my patients.

The literature supports the efficacy of mandibular tracking in the diagnosis and treatment of TMD. There are over 22 controlled published studies that further support the rationale for mandibular jaw tracking. There are numerous other studies that document the clinical efficacy and validity of computerized mandibular scanning. There is a broad body of literature that supports the use and efficacy of sonography in the diagnosis of temporomandibular joint disorders. (Over 30 studies). There is a broad body of literature that supports the physiologic basis for using surface EMG as an aid in assessment of muscle function/ dysfunction. (38 + studies support this). There is substantial evidence based upon controlled studies that confirm that surface EMG is reliable and reproducible. (18 studies ending with Dean et al., 1992). 87 studies verifying the use, safety, and efficacy of EMG to monitor masticatory muscle function/ dysfunction. In summary, based on well controlled empirical and clinical studies that have been conducted in several universities over the past four decades throughout the world, there is unequivocal evidence to strongly support the use of CMS, ESG and EMG for the evaluation and diagnosis of temporomandibular disorders.

I can honestly say that my challenges have been minimal compared to the tremendous success I have had in treating symptomatic and asymptomatic patients to an optimal healthy “physiologic” position. Combining measuring technologies to better identify physiologic jaw relationships with sound gnathic (G) principles has allowed me to test the various debated occlusal paradigms over time and prove to myself the basic laws of nature are scientifically verifiable. To me, this made the most sense. My practice has grown and expanded over the years in notoriety with patients in pain from all over North America and various parts of the world. Patients who were treated unsuccessfully for orofacial pain, masticatory dysfunctions and joint derrangements have now been resolved and brought to a new level of dental health following our GNM concepts (gneuromuscular (G) + neuromuscular (NM) = GNM).

To me, the gnathic concepts are very important. Objectively measuring the resting and functioning modes of the masticatory system is what neuromuscular science is all about. The practice of dentistry is an art, but even more important it is based on “objectively measured” science that one must acquire to help guide one’s decision- making process. Based on the findings of my research the bio-physiologic principles are better understood for me to effectively apply the occlusal concepts using up-to-date scientific knowledge. I am able to better implement the gnathic principles with objective science when managing my TMD patients.

Skills are further assessed, refined and tested based on the gathered scientific objective recordings. This scientific self-scrutinizing and researching approach has guided my practice and application of occlusion toward the intended goals of establishing stability and comfort for my patient’s health. GNM is the detailed combined approach of implementing both the gnathic occlusal skill-sets with real-time measured data (the science) of neuromuscular K7 technology. It’s not one or the other, but it’s the attention to sound clinical application of both concepts blended together that has allowed me to advance my dentistry and awareness.

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