Temporomandibular disorders (TMD) are physically based
conditions effecting the jaw joints and the muscle nerve
system responsible for function of the jaw.
TMD is not a psychological, chronic pain disorder. Today,
treatment using advanced electronic testing instruments
make possible precise measurement of TMD and aid in their
effective treatment.
Through state-of-the-art computerized measurement techniques,
the establishment of a neuromuscular occlusion synchronized
with healthy muscle function has been proven to be among
the most effective treatments available for pain and dysfunction
associated with TMD.
TREATMENT
The of treatment is to achieve maximum improvement
with comfort and normal function. For some patients,
the ideal can be achieved, for others it cannot. This
depends on the nature and stage of the illness. Management
rather than cure is sometimes the treatment goal. Depending
on the nature and severity of an individual patient's
condition, the type of therapy appropriate is determined.
For some, simple treatment designed to relax muscles
and reduce inflammation is used. For others, more comprehensive
diagnostics and treatments are utilized.
THE ORTHOSIS OR SPLINT APPLIANCE
Using the
information obtained from the tracings of jaw movement
and muscle function and the registration of the new
bite position, Dentists constructs a clear plastic orthotic
appliance (orthosis). It is prepared with detailed tooth
anatomy to provide a stable biting position. The orthosis,
commonly called a "splint" comfortably fits over the
lower back teeth and passes behind the front teeth,
where it can remain invisibly for several months. Worn
24 hours a day, this precise appliance is removed only
for cleaning the teeth and the splint. The orthosis
permits the jaws to come together in a muscularly healthy
position, retraining the muscles to move along a more
natural, muscularly oriented pathway into the new occlusion.
Patients often report experiencing a significant symptom
improvement within a month, while wearing this comfortable
appliance.
RE-EVALUATION/ TREATMENT OUTCOME MEASUREMENT
Following three months of full time use of the oral appliance
(splint), patients are asked to return for a second electronic
computerized study of their jaw and associated muscle
function. Based on test data together with the patient's
experienced symptom improvement, Dentists and each patient
evaluate the outcome of the initial treatment and discuss
options for additional therapy.
LONG TERM TREATMENT
After three to six months wearing the orthosis (splint),
a patient may elect to perpetuate the new healthy biting
position either through restoration or shaping of certain
teeth or the use of a removable durable long-term appliance.
Another way to change the natural bite (occlusion) to
the new bite is through the process of passive eruption.
Dentists removes the splint's plastic covering over
the rearmost tooth on each side. This permits the last
teeth on the top and bottom to erupt naturally as they
did when they first entered the mouth, since they do
not meet in occlusion while the splint is worn. This
process, when successful, can take some time. It is
repeated with uncovering or exposure of the next pair
of teeth when the rearmost teeth reach the new bite
position.
Some patients chose not to wear the orthosis full time
and not to change their natural occlusion. Instead of
full time use, they change to part time use of the orthosis
or may elect to discontinue usage of the appliance completely
unless symptoms reappear. If symptoms reappear, the orthosis
can again be used.
SURGICAL OPTION
A very small percentage of patients with TMD require
evaluation and possible surgical intervention to treat
their illness. Except in cases involving severe traumatic
injury, which prohibits mandibular function, surgical
intervention is usually not indicated as an initial
treatment. If conservative treatment, such as splint
therapy, has not promoted comfort and proper jaw function,
surgical evaluation may be appropriate.
MULTIDISCIPLINARY TREATMENT
As with diagnosis, some patients require simultaneous
multidisciplinary therapy by more than one health care
provider. Decisions may be made to seek consultations
and possible collateral care with other health care providers
at that time or at any time throughout treatment. When
indicated, Dentist and or your physician will recommend
appropriate doctors.
THE COMFORTABLE BITE
NEUROMUSCULAR OCCLUSION: FINDING THE COMFORTABLE
BITE
Dental Occlusion refers to the coming together of the
upper and lower teeth. Neuromuscular occlusion occurs
when the dental occlusion is synchronized (coordinated)
with healthy relaxed masticatory (chewing) muscles.
The concept of neuromuscular occlusion has applications
in the treatment of dental patients as well as in the
treatment of patients suffering from TMD.
Dental patients as well as TMD patients may not have
a comfortable, stable, neuromuscular occlusion. Their
muscles can be overactive when they are supposed to
be rested and can be weak or uncoordinated when called
upon in chewing foods or even in swallowing saliva.
This condition of a muscle system, which is not rested,
can predispose a healthy person without symptoms to
future TMD.
For patients whose dental occlusion requires major
alteration, such as in the fabrication of dentures or
extensive dental reconstruction, attempts to improve
muscle function can be incorporated into the dental
treatment. The creation of a muscularly healthy neuromuscular
occlusion, a using the electronic measurement instrumentation
described here, can be a valuable aid in accomplishing
improved dental occlusion with comfort, function and
health.
UNDERSTANDING NEUROMUSCULAR OCCLUSION
Rest position of the jaw is the position, which exists
most of the time with the upper and lower teeth not
in contact. At true rest, which is the position at which
a person should ideally keep the jaw (mandible), except
during eating and swallowing, the mandible is suspended
in space, anchored at the two temporomandibular joints.
The jaw is postured or positioned in place by a set
of both opening and closing muscles on both sides of
the head, all of which are at full resting length. This
is like the strings, which attach a hammock to two trees.
In this rest position of the jaw, the upper and lower
teeth are usually apart with about one to two millimeters
of space between them.
At true rest position, all the muscles, which support
and move the jaw, are at rest. That should be the status
most of the time. This is like the two sets of muscles
attached to your arm, one set pulls the arm upward and
the other set pulls it downward. When your are is truly
at rest hanging at your side, both sets of muscles are
rested and at their resting length. Returning to the
description of the jaw muscles, only during function
such as speaking or eating is the jaw moved from rest
position. When eating or swallowing saliva the jaw moves
upward and forward to bring the teeth together. That
is called occlusion. Each time swallowing occurs, 2,000
times throughout the day and night, the jaw is normally
braced against the skull through the teeth to permit
the reflex of swallowing to occur.
However, If the distance between the upper arch of
the upper and lower teeth when the mandibular muscles
are completely at resting length is more than two millimeters,
the distance and/or time necessary to travel into occlusion
is too great. Because of the excessive space between
the teeth, people develop an adaptive, accommodative,
false resting (pseudo-resting) or partially resting
accommodative position of the jaw, to maintain the one
to two millimeter resting space between the teeth. This
keeps the muscles in a constant state of work, not rest.
If the muscles that posture (hold the jaw up) and move
the jaw are not allowed to fully rest, tension, resulting
in muscle fatigue, dysfunction and sometimes spasm can
result. That is a key to understanding one of the ways
in which Temporomandibular Disorders (TMD) can occur.
It is one of the common hidden causes of TMD or a predisposition
to developing TMD.
There is far more in the makeup of a good, healthy,
comfortable bite than just the manner in which upper
and lower teeth fit together and the esthetics (beauty)
of the teeth. When the dental occlusion is synchronized
with healthy balanced muscle function, muscles can fully
rest at the rest position of the mandible and then work
effectively with balanced strength when called upon
during chewing. The creation of a neuromuscular occlusion
is a key element in the treatment of those Temporomandiublar
Disorders, which are caused by an unhealthy dental occlusion.
The comfortable bite is a healthy, neuromuscular occlusion.
NATURAL HABITUAL OCCLUSAL POSITION
- Possible tooth interdigitation
- Pressure in Temporomandibular Joints (TMJ)
- Muscles are strained causing symptoms
- Disks are forward in joint causing symptoms
A. Temporalis Muscle
B. Masseter Muscle
NEUROMUSCULAR OCCLUSAL POSITION
- Front teeth touch, space between teeth in rear
- Precision orthotic(splint) fills this space
- Muscles remain relaxed
- No pressure in the TMJ
- Disks in proper place
- TMJ Socket
- TMJ Socket
- Outer ear canal
- Condyle(top of jaw)
- Disk
