In addition to standard dental equipment, our office employs a number of technologies to enhance screening, diagnosis, communication, and treatment planning. We use T-SCAN bite sensors routinely for quantitative measurement, analysis, and documentation of relative occlusal forces over time.
For strained JAW muscles, EMG measures masseter and temporalis activity. For TMJ concerns, vibration sonography provides audio recordings of the joint noises in motion. And as needed, we coordinate with specialists and imaging centers for static CBCT/MRI.
Burdensome TMD symptoms
and/or impaired TMJs can arise from:
• acute macrotraumatic injury
• developmental/systemic/physiological conditions
• micromalocclusal MUSCULAR HYPERTONIAS
TMD patients can have more than one of these origins and HEAD, NECK, JAW, & TMJ concerns with
chronically strained muscle tension imbalances:
TMD HYPERTONIAS
• intermittent HEAD aches & spasms SPACTICITY
• involuntary NECK strain/movements DYSTONIA
• limited range of JAW motion RIGIDITY
• TMJ clicking-popping DISC DISPLACEMENT
• EAR tinnitus, episodic imbalance VERTIGO
• FACIAL tingling-burning-shocks NEURALGIA
• EYE pressure-strain-sensitivity NYSTAGMUS
• sympathetic physiological conditions STRESS
IMBALANCED HYPERTONIC MUSCULATURES
can trigger and/or exacerbate symptoms appropriately diagnosed as idiopathic by MEDICAL disciplines.
Otolaryngologists, chiropractors, physiotherapists, ophthalmologists, neurologists, and others typically encounter TMD symptoms in conditions with unknown etiologies like 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 & NECK muscles coordinate together to move your JAW through a dynamic range of motion which is consequentially governed by trigeminal nerve stimuli from your own specific occlusion and disclusion patterns.
Violations to your JAW's range of motion known as 'malocclusion" or 'occlusal interferences' present a challenge to the muscle group responsible for that particular movement. The connection between measured malocclusion and imbalanced masseter/temporalis hypertonias has been clearly and reiteratively established in the literature.
A cascade of symptoms—TMJ clicks, EAR troubles, FACIAL nerve pain, EYE strain, and/or compromised airway/swallowing—might occur when neuromuscular parafunctional biomechanical (i.e., "malocclusional"), physiological, and/or psychosocial stressors exceed the adaptive capacity of your HEAD & NECK muscles, TMJ anatomy, and sympathetic homeostasis.
The stomatognathic system provides magnificent witness and creative testament to the wonderful complexity of the human body. Technically, a total of 24 muscles are attached to the mandible (with an additional 14 providing secondary support). At least 8 muscle groups (4 on each side) are typically associated with mastication, more than 20 involve facial expression, and numerous more coordinate everyday jaw motions including swallowing.
Several HEAD & NECK muscle groups coordinate JAW movement into and out of the posture called maximum intercuspation ('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 very significant in TMD diagnosis and occlusal treatment outcomes.
SYMPATHETIC HYPERTONIA
Commonly known as "fight-or-flight", the body's autonomic response to biomechanical, physiological, and/or psychosocial stress demands increased muscle tone. But data from animal and human studies suggest how proper homeostasis is disrupted by hypertonic conditions. In other words, recursive vasoconstriction signals to an already tensed muscle can lead to inflammation (i.e., 'myositis') and fatigue when metabolic demand overwhelms capacity.
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.
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 the PTERYGOID MUSCLES, which are greatly responsible for opening, closing, clenching, grinding, sideways, and forward motions of the mandible. 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 trigeminal motor and sensory branches as the muscles shift the condyle—mechanisms that might 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 NEURALGIAS. SYMPATHETIC HOMEOSTASIS
IMPACTS PHYSIOLOGICAL CONDITIONS
SUCH AS MUSCLE TONE & BLOOD PRESSURE.
CERVICAL & SYMPATHETICS
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
starts with casual conversation, family is welcome
~~ sparkling water, orange juice, coffee, etc. ~~
dynamic co-discovery, LOTS of discussion!
determines DTR candidacy in our office
digital impressions: virtual models
alginate impressions: physical models
JVA: formal & objective TMJ diagnosis
T-SCAN: occlusion & disclusion bite diagnoses
EMG: masseter & temporalis tone diagnoses
calibration of existing bite guard upon request
adjunctive bite guard fabrication if indicated
interdisciplinary coordination as appropriate
please arrange transportation ahead of time
your muscles might be sore afterwards
and you will want a reliable driver
Your path to relief begins with a casual conversation. Typically, we visit for about a half hour in our relaxed consultation room before moving to the dental chair. But there is no time limit because your history is a very important starting point and your specific TMD symptoms will bring diagnostic context to your first DTR THERAPY treatment session.
Occlusion and TMD paradigms are quite complex and commonly misunderstood—your first visit with us brings a professional opportunity to clarify any questions, concerns, or confusion before we walk you through the basics of TMJ, occlusion, and disclusion diagnostics. Our most important goal with DTR SCREENING is to establish your confidence in & comfort with the bite-calibration process of DTR THERAPY.
The percentage of patients who aren't DTR candidates may be quite low, but many cases do merit coordination with other orofacial pain disciplines—especially with respect for medical diagnostics. Macrotraumas and medical triage (e.g., neuroma, edema, arthritis, fibromyalgia, avascularity, ICR, developmental/anatomical asymmetries, dysautonomias, POTS, CRPS, CCI/AAI, etc.) are important considerations in diagnosis and treatment planning. Repeatable data acquisition is imperative for bite calibration—if a medical condition hinders our ability to reliably measure malocclusion, a multidisciplinary treatment plan becomes appropriate.
Dynamic TMJ diagnosis is a fundamental part of all TMD treatment plans. Joint Vibration Analysis ('JVA') uses a sonograph of your TMJs to objectively diagnose the status of your articular discs throughout your entire mandibular range of motion, and it documents potentially significant correlation to the tone and balance of your mandibular musculatures during movement.
Cone beam computerized tomography ('CBCT') and magnetic resonance imaging ('MRI') are static 3D X-ray visualizations for patients whose treatment plan should start with joint repair rather than occlusal therapy. CBCT/MRI are typically taken at a specialist's office or an imaging center.
DTR THERAPY
first session is 2 hours & has the biggest impact
please arrange transportation ahead of time
a 72-hour personal journal is requested
during the initial window of muscle response
refinement sessions are typically one hour each
travelers need at least ~48-72hrs between sessions
feedback is encouraged throughout the process
follow-up after each session is imperative
goal is measured occlusion improvement
typically, symptoms subside over 3 to 6 months
long-term follow-up is always appreciated
T-SCAN bite pressure mapping synchronized with EMG sensors definitively identifies micro-malocclusion contact points into, during, and out of your bite alongside corresponding masseter and temporalis activity. Data-driven, specifically targeted micro-adjustments to your bite can provide potential relief from head and neck muscle hypertonia symptoms like clenching, grinding, headaches, tinnitus, vertigo, nerve compression, airway constriction, and related TMD diagnoses.
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, when the wrong contacts are either removed or introduced (even inadvertently), resultant consequences can affect not only the tooth in question but also the muscles responsible for controlling jaw movement, the TMJs, 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 even 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.
VIRTUAL/PHYSICAL MODELS
Full-color 3D digital visualization
plus physical hand-articulated stone models
for diagnosis, planning, and communication.
T-SCAN BITE SENSOR
Full-arch relative force measurement
of occlusion and disclusion patterns
during all mandibular movements.
VIBRATION SONOGRAPHY
Audio recording of TMJs as your mouth opens and closes for objective joint vibration analysis ('JVA') of your articular discs during motion.
ELECTROMYOGRAPHY
Measurement of your muscle activity (temporalis, masseter) during mandibular movements.
COMPUTED TOMOGRAPHY
Static cone beam imaging the hard tissue
of your TMJs, with special attention paid to the health of the condyles and ramus.
MAGNETIC RESONANCE
Static imaging the soft tissue of your TMJs,
with special attention paid to the articular discs
in several mandibular positions.