In addition to standard dental equipment, our office employs a number of technologies to enhance diagnosis, screening, treatment planning, and communication. We routinely use bite force sensors for quantitative measurement, analysis, and documentation of relative occlusal forces in time.
For TMD patients with muscle tension and fatigue, we have EMG sensors to record masseter and temporalis activity. For those with joint concerns, vibration sonography provides objective evaluation of the TMJs in motion. And as needed, we coordinate with specialists and imaging centers for MRI & CBCT.
Burdensome TMD symptoms and/or damaged TMJs may arise from either:
(1) chronic microtraumatic malocclusion,
(2) acute macrotraumatic injury, &/or
(3) systemic & regional medical conditions.
TMD patients can have more than one of these origins contributing to symptoms like migraine headaches, eye pressure, muscle tension-fatigue-spasms, facial tightness-burning-tingling, joint clicking-popping-pressure, tinnitus, vertigo, brain fog, limited or involuntary jaw & neck movements, compromised airway, etcetera.
Malocclusion can exacerbate symptoms commonly diagnosed by medical professionals (e.g. ENTs, neurologists, DCs) as characteristic of Meniere's disease, Trigeminal Neuralgia, and Sudden Onset Cephalgia, among others.
Dentistry plays a uniquely important role in the diagnosis and treatment of TMD symptoms because your jaw muscles position your mandible within a dynamic range of motion which is in part governed by trigeminal stimuli provided by your occlusion. The stomatognathic system provides magnificent witness and creative testament to the wonderful complexity of the human body. Internal jaw muscles (e.g., lateral and medial pterygoids) play a significant role in diagnosis and treatment outcomes, but they cannot be measured by EMG sensors in the same way as masseters and temporalis muscles.
A cascade of TMD symptoms including but not limited to ear canal disturbance, nerve compression, and compromised airway can occur when parafunctional biomechanical and/or psychosocial stressors impose demands in response to malocclusion that exceed the adaptive capacity of your jaw muscles and TMJ anatomy.
The vicious cycle theory holds that increased and sustained muscle activity leads to ischemia (reduced blood flow) and pain. The pain then leads to further muscle tension, as well as emotional stress, frustration, and ultimately depression. This recursive cycle of muscle tension and pain can trigger neural processes that distinguish affective from sensory pain dimensions, linking pain to emotion, thus highlighting the importance of diagnosing the source of increased muscle activity in the first place.
IF YOU HAVE TROUBLE LOADING THE FOLLOWING ANATOMICAL MODELS, REFRESH & CLICK THE BLUE BUTTON IN THE LOWER CORNER TO OPEN A NEW WINDOW. THESE 3D IMAGES ARE MUCH MORE IMPRESSIVE ON BIGGER SCREENS.
STOMATOGNATHIC MUSCLES
TRIGEMINAL NERVE
MASSETERS & TEMPORALIS ARE MEASURED VIA ELECTROMYOGRAPHY. THEY CONTROL
MANDIBULAR FUNCTION & DENTAL OCCLUSION,
ALONGSIDE INFLUENTIAL PTERYGOIDS.
CERVICAL & SYMPATHETICS
MUSCLES OF THE NECK & OCCIPUT PARTICIPATE IN SWALLOWING REFLEX & JAW MOVEMENTS. GREATER AURICLAR NERVE BLOCKS ARE INVALUABLE FOR SYMPATHETIC DIAGNOSIS.
CONSULT & DTR SCREENING
For TMD patients with stable TMJs, occlusal analysis is an important part of a thorough multidisciplinary diagnosis. Measurement of malocclusion allows dentistry to offer data-driven, precisely targeted occlusal adjustments and potential relief from headaches, neck tension, tinnitus, vertigo, and related TMD symptoms.
For qualified candidates, Disclusion Time Reduction (DTR) therapy can readily address malocclusion in patients with stable and adapted TMJs - usually with zero injections, zero medications, and zero plastic!
STEP 1: CONSULTATION
- phone, video, &/or in-office
- no commitment, no urgency, no pressure
- meet & discuss your concerns with Dr. Harden
- learn more about your TMD symptoms
- photo eval: big smile biting on back teeth
- in-office T-SCAN evaluation
Macrotrauma and medical conditions (e.g., arthritis, ICR, osteochondral asymmetry, fibromyalgia, edema, avascular necrosis, CRPS) play significant roles in diagnosis and treatment planning. TMJ stability and occlusion are intricately connected to one another; Unstable joints demand primary attention over occlusal analysis because they directly affect the bite (and vice versa).
STEP 2: DTR SCREENING
- formal & objective TMJ diagnosis
- full mouth TRIOS imaging
- INNOBYTE measurement of absolute bite force
- T-SCAN occlusion diagnosis
- T-SCAN disclusion diagnosis
- EMG recordings during mandibular movements
- determines DTR THERAPY candidacy
- interdisciplinary referral as appropriate
