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 over time.
For overworked muscles, we have EMG sensors to record masseter and temporalis activity. For joint concerns, vibration sonography provides objective evaluation of the TMJs in motion. And as needed, we coordinate with specialists and imaging centers for CBCT/MRI.
Burdensome TMD symptoms and/or
impaired TMJs may arise from either:
(1) micromalocclusomuscular hypertonia
(2) acute macrotraumatic injury, &/or
(3) systemic/regional/local medical conditions.
TMD patients can have more than one of these origins contributing to head and neck symptoms related to chronic muscle hypertension, such as limited range of motion, spasms. soreness, headaches, eye pressure-strain-nystagmus, ear tinnitus & vertigo, joint clicking-popping-pressure, involuntary neck movement, facial tightness-burning-tingling, etcetera.
Malocclusion's neurological amplification of muscle tone can exacerbate idiopathic TMD symptoms commonly diagnosed by medical professionals (e.g. chiros, ophthalmologists, otolaryngologists, neurologists) as characteristic of Meniere's disease, trigeminal neuralgia, and sudden onset cephalgia, just to name a few.
Dentistry plays a uniquely important role in the diagnosis and treatment of TMD symptoms because your head and neck muscles position your mandible within a dynamic range of motion which is consequentially governed by trigeminal nerve stimuli from your occlusion. The trigeminal motor nucleus innervates muscles of the first pharyngeal arch, namely the muscles of mastication, the tensor tympani, tensor veli palatini, mylohyoid, and anterior belly of the digastric.
A cascade of TMD symptoms including but not limited to vertigo & imbalance, ear troubles, nerve pain, and compromised airway can occur when neurological parafunctional biomechanical (i.e., "malocclusional"), physiological, and/or psychosocial stressors exceed the adaptive capacity of your head and neck muscles, TMJ anatomy, and sympathetic homeostasis.
The stomatognathic system provides magnificent witness and creative testament to the wonderful complexity of the human body. At least 12 muscles can be associated with mastication, more than 20 involve facial expression, and many more coordinate everyday subliminal motions including swallowing.
Internal jaw (and neck!) muscles are largely responsible for mandibular motion into and out of the position called maximum intercuspation (i.e., MIP), where the lower teeth meet the upper teeth with as much contact as possible. In the world of dentistry, the complex and varied teeth contacts around and during MIP are known as OCCLUSION. Although the pterygoid muscles (lateral superior & inferior, medial superficial & deep) cannot be measured by EMG, their relative tonicities are significant in TMD diagnosis and occlusal treatment outcomes.
Increased muscle tone and blood pressure characterize the body's sympathetic response to biomechanical, physiological, and/or psychosocial stress, commonly known as "fight-or-flight". But evidence from both animal and human studies indicates how proper homeostasis may be impaired locally by pre-existing hypertension. In other words, recursive vasoconstriction signals to an already tensed muscle can lead to inflammation (e.g., "idiopathic inflammatory myositis") and ultimately fatigue when metabolic demand is high.
Under conditions of chronic stress (e.g., increased, sustained, and prolonged hypertonicity), a continuous state of alert can also provoke mental anxiety. Of course, this psychological state then stimulates the same muscles which were already over-tensed to begin with - resulting in a vicious cycle of dysregulation and a link between pain and emotion, thus highlighting the importance of addressing the original source of 'atypical' hypertonia in the first place.
Atypical and imbalanced hypertonic musculatures have long been observed with orthopedic disease states and joint conditions in medical literature. TMD are no exception.
The SPHENOID and PALATINE bones are anatomical origins for pterygoid muscles. The lateral pterygoid inserts onto the articular disc and neck of the condyle, whereas the medial pterygoid inserts onto the angle of the mandible.
Trigeminal nerve branches approximate several bone articulations in the skull as they pass through cranial foramina. Although bone compression is unlikely, hypertonic pterygoids can increase local compartment pressure, produce inflammatory adhesions, or create traction on V3 motor and sensory branches as the muscles shift the condyle—mechanisms that can irritate or entrap nerves in the infratemporal soft‑tissue corridors.
Recent animal studies even consider the coincidence of malocclusion with vertebral alignment and idiopathic scoliosis, suggesting a possible muscular influence on spinal curvature and postural balance from trigeminal inputs. Interestingly, biomechanical compression of a nerve root is reported as the most common cause of cervical radiculopathy manifesting as paresthesia and weakness within dermatomal distribution.
MUSCLES OF MASTICATION
TRIGEMINAL NERVE
MASSETERS & TEMPORALIS ARE MEASURED VIA ELECTROMYOGRAPHY. THEY CONTROL
MANDIBULAR FUNCTION & DENTAL OCCLUSION,
ALONGSIDE INFLUENTIAL PTERYGOIDS.
COMPARTMENT SYNDROME CAN BE LINKED TO NEURALGIA. SYMPATHETIC STIMULATION AFFECTS HOMEOSTATIC MECHANISMS INCLUDING MUSCLE TONE & BLOOD PRESSURE.
CERVICAL & SYMPATHETICS
MUSCLES OF THE NECK & OCCIPUT PARTICIPATE IN SWALLOWING REFLEX & JAW MOVEMENTS. GREATER AURICLAR NERVE BLOCKS ARE INVALUABLE FOR SYMPATHETIC DIAGNOSIS.
ARE YOU A CANDIDATE
FOR DTR THERAPY?
CONSULTATION
meet & discuss your concerns with Dr. Harden
learn more about your bite & TMD symptoms
FULL-MOUTH PHOTO EVALUATION:
1) bite & clench on your back teeth
2) lightly bite on your incisal front edges
send an email with your bite photos to Debbie:
DTR SCREENING
3 hours of our full attention
casual atmosphere, family welcome
sparkling water, orange juice, coffee, etc.
dynamic co-discovery, LOTS of discussion!
formal and objective TMJ diagnosis
full-mouth TRIOS imaging
T-SCAN occlusion & disclusion diagnosis
determines DTR candidacy in our office
T-SCAN calibration of existing bite guard
adjunctive bite guard fabrication if indicated
interdisciplinary referral as appropriate
TMJ diagnosis is a fundamental part of a thorough multidisciplinary process for all TMD patients! Our relaxed 3-hour DTR SCREENING diagnostics appointment gives us objective data to determine whether you're a candidate for DTR, or if your individualized plan for your TMJ symptoms should instead start with joint treatment.
Relevant research suggests around 15% of patients likely have a deranged or degenerated joint condition that cannot be repaired via occlusal therapy. The percentage of patients who aren't candidates for DTR may be substantially lower, but these few patients will still benefit from our DTR SCREENING appointment, learning more about the true nature of their symptoms with appropriate referral to a surgeon or physician they can trust.
Macrotrauma and medical conditions (e.g., arthritis, ICR, osteochondral asymmetry, fibromyalgia, neuroma, edema, avascular necrosis, CRPS) play significant roles in diagnosis and treatment planning. TMJ stability and dental occlusion are intricately connected to one another; Medically unstable joints demand primary attention over occlusal therapy because they can directly affect the bite (and vice versa).
Joint Vibration Analysis ('JVA') uses a sonograph of your TMJs to objectively diagnose your articular discs during your mandibular range of motion. It also aids in assessment of pterygoid tone and is a pre-requisite for DTR in our office. Cone beam computerized tomography ('CBCT') and sometimes magnetic resonance imaging ('MRI') are additional aids for patients whose treatment plan should start with joint repair rather than occlusal therapy. CBCT and MRI are typically taken at the specialist's office or an imaging center upon referral.
DTR THERAPY
DTR SCREENING is a pre-requisite in our office
several iterative appointments
first session is 2 hours, then one hour each
each treatment requires a followup
goal is measured balance
most outcomes merit long-term followup
T-SCAN bite pressure mapping synchronized with EMG sensors definitively identifies micro-malocclusion contact points into, during, and out of your bite, alongside corresponding muscle activity and pterygoid tone assessment. Data-driven, specifically targeted micro-adjustments to your bite can provide potential relief from clenching, grinding, head and neck muscle hypertonia, headaches, tinnitus, vertigo, nerve compression, airway constriction, and related TMD symptoms.
One of the most common questions asked is "What is the actual treatment for DTR?" The simplest answer is that it involves routine and very basic bite adjustments, just the same as after any other typical dental procedure which alters the biting surface of a tooth or teeth, like a filling or a crown or bridge. At the end of your appointment, your dentist asks you to bite on carbon paper to mark and adjust any high spots.
The critical difference is T-SCAN MEASURES FORCE OVER TIME to pinpoint exactly where (and when!) the bite marks on each tooth are actually a problem. But perhaps more importantly, T-SCAN data also identifies which bite contacts should NOT be removed.
Patients are usually astonished to learn that most dental offices don't measure bite force at all! Can you believe that? Standard carbon paper found in all dental offices gives zero data about force or timing. Unfortunately, if the wrong contacts are either removed or introduced, resultant consequences can affect not only the tooth in question but also the muscles responsible for controlling jaw movement, and consequently other teeth, too.
T-SCAN measurement by a DTR-certified dentist means the dentistry is guided and driven by digital data. When it comes to bite force diagnosis, THERE IS NO GUESSING INVOLVED. Relevant research suggests muscle imbalance, neurological response, and autonomic homeostatic regulation seem to be related to most TMD symptoms (and often the condition of the TMJs themselves). For qualified candidates, DTR THERAPY can relieve chronically overworked hypertonic muscles (and subsequences) by reducing micro-malocclusion very precisely with minimally conservative dental treatment.
