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 muscle tension and fatigue, 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 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 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 symptoms commonly diagnosed by medical professionals (e.g. Otolaryngology, Neurology, Chiropractic)
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 disturbance, nerve compression, and compromised airway can occur when parafunctional biomechanical (i.e., "malocclusional") and/or psychosocial stressors impose demands that exceed the adaptive capacity of your head and neck muscles and TMJ anatomy.
Increased and sustained muscle activity causes ischemia (reduced blood flow) and pain. Pain then provokes further tension, as well as emotional stress and frustration. This vicious cycle can trigger neural processes that link pain to emotion, thus highlighting the importance of addressing the original source of atypical hypertension in the first place.
The stomatognathic system provides magnificent witness and creative testament to the wonderful complexity of the human body. Around 14 muscles are associated with mastication, more than 20 involve facial expression, and many more coordinate everyday subliminal motions including swallowing. Although internal muscles (e.g., lateral superior & inferior, medial superficial & deep pterygoids) cannot be measured by EMG, they are significant in TMD diagnosis and treatment outcomes.
Atypical hypertensive muscle contractions have long been observed with orthopedic disease states and joint conditions in medical literature. Recent animal studies consider the coincidence of malocclusion with vertebral alignment and even idiopathic scoliosis, suggesting a 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.
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?
For TMD patients with stable TMJs, occlusal analysis is an important part of a thorough multidisciplinary diagnosis. Digital bite measurement allows dentistry to offer data-driven, precisely targeted occlusal adjustments and potential relief from clenching, grinding, head and neck muscle tension, migraines, tinnitus, vertigo, and related TMD symptoms. Disclusion Time Reduction (DTR) therapy can readily address frictional malocclusion in qualified candidates - usually with no injections, no medications, and no permanent orthotic!
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, neuroma, 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 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 THERAPY candidacy
- T-SCAN calibration of your existing bite guard
- temporary splint fabrication if indicated
- interdisciplinary referral as appropriate
