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 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 CT/MR.
Burdensome TMD symptoms and/or
impaired TMJs may arise from either:
(1) chronic microtraumatic malocclusion,
(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 like migraine headaches, eye pressure, muscle tension-fatigue-spasms, facial tightness-burning-tingling, joint clicking-popping-pressure, tinnitus, vertigo, brain fog, limited or involuntary neck movement, etc.
Malocclusion can exacerbate idiopathic symptoms commonly diagnosed by medical professionals (e.g. chiros, ophthalmo- / otolaryngo- / neuro-logists) 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 ear &/or eye disturbances, nerve pain, neck tension, and compromised airway can occur when parafunctional biomechanical (i.e., "malocclusional"), physiological, and/or psychosocial stressors impose demands that 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 tense muscle can lead to inflammation (and ultimately fatigue) when metabolic demand is high.
Under conditions of chronic stress (e.g., increased, sustained, and prolonged hypertonia), a continuous state of alert can also provoke mental anxiety. Of course, this psychological state then stimulates the same muscles which were already tense 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.
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 nerve inputs. Indeed, biomechanical compression of a nerve root is 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.
COMPRESSION CAN BE LINKED TO NEURALGIA. AUTONOMIC (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?
Digital bite measurement allows dentistry to offer data-driven, specifically targeted occlusal adjustments and potential relief from clenching, grinding, head and neck muscle tension, migraines, tinnitus, vertigo, nerve compression, airway constriction, and related TMD symptoms.
DTR SCREENING with measured TMJ vibration analysis is an important part of a thorough multidisciplinary diagnosis for all TMD patients!
For qualified candidates, DTR THERAPY
can relieve head & neck hypertension
by precisely reducing malocclusion.
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: bite on back teeth & also front edges
- in-office T-SCAN evaluation
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; Unstable joints demand primary attention over occlusal analysis because they directly affect the bite (and vice versa).
STEP 2: DTR SCREENING
- formal and objective TMJ diagnosis
- full mouth TRIOS imaging
- INNOBYTE absolute force measurement
- T-SCAN occlusion diagnosis
- T-SCAN disclusion diagnosis
- EMG recordings during mandibular movements
- determines DTR candidacy
- T-SCAN calibration of your existing bite guard
- adjunctive bite guard fabrication if indicated
- interdisciplinary referral as appropriate
