Sympathetics in dentistry, TMJ MRI & CBCT interpretation, T-Scan usage, Joint Vibration Analysis, Digital Jaw Tracking, Laser Dentistry, PRF usage & more! dental practitioner who has been heavily involved in treating confounding bite and TMJ/D patients for the past 10 years. I penned a chapter in a new, 1st edition dental textbook that was released in January 2015, "Handbook of Research on Compute
rized Occlusal Analysis Technology Applications in Dental Medicine". IGI Global is the publisher, Dr. Robert Kerstein is the editor. I recently updated the chapter in the 2nd edition of this textbook in 2020, and have been involved as a co-author in several other related publications over the past several years as well. In July of 2016, I created the Center for Neural Occlusion (CNO), a teaching organization designed to help health care professionals diagnose and potentially treat patients with confounding occlusal and TMD issues based upon objective and reproducible measured metrics, using digitally objective equipment such as MRI, CBCT, EMG, Jaw Tracking, Mastication Analysis, and T-Scan digital occlusal (bite) analysis technologies. We are training doctors how to measure parameters objectively, and treat accordingly. The CNO is creating a curriculum to help patients identify practitioners who are adept at Neural Occlusion screening protocols and Disclusion Time Reduction "bite alignment" therapy. This list may be seen on our website, CNOTMJ.com. The CNO website is morphing into a teaching website for dental professionals, and many of the novel CNO levels may be streamed via prerecorded webinar format on the site. I have been treating TMD patients quite successfully for many years now, employing "Neural Occlusion" screening principles. I could write for hours on this topic, but won't. I'm going to hit highlights and refer the group to videos that my practice has posted on YouTube. We have posted in excess of 400 confounding bite and "TMJ" patient testimonial videos (as of September 2020) on the drnickdds homepage of YouTube over the past 8 years. Many of these patients have traveled internationally to Arkansas, U.S.A. from as far away as Indonesia and Australia. We have particularly high success rates when the patient is found to have primarily muscular TMJ/D issues and possesses a pair of relatively stable and adapted TM joints. These joints are not necessarily in perfect shape (most aren't), but they need not be unstable and acutely inflamed (per objective metric usage). We use the rarely inaccurate objective digital modality known as Joint Vibration Analysis (JVA) coupled with highly accurate and objective 3D MRI and cone beam (CBCT) imaging + history and exam to identify those joints that are stable and adapted, and patients are given what's known as a Piper Classification. If that given Piper rating is amenable to our assorted treatments, our success rate is very favorable, and usually accomplished in a single visit. The treatments do not involve splints and are objectively guided by using objective digital metrics.. We identify appropriate patients via detailed screening questionnaires and something as simple as an ice water swish. I know that sounds ludicrous, but it is a documented fact in the scientific literature that muscular TMD patients tend to have hypersensitive teeth. If you are a patient who cannot drink cold, and you happen to lack exposed dentin, there is an excellent chance that you have hyperactive muscles of mastication since the muscular load upon your dentition may cause what's known as torsional flexure and subsequent Frictional Dental Hypersensitvity (FDH). FDH is one of the topics in my chapters in the two textbooks that I have published in, and is a novel (new) descriptor. I actually conducted a pilot study on 32 TMD patients and posted statistical proof that FDH exists and is typically present in most muscular TMD patients. In November of 2016, I was first author on another paper relating to FDH, whereby we showed statistically that 100 patients had a reduced FDH score after undergoing the ICAGD precise occlusal adjustment procedure. In other words, their tooth sensitivity went away when their muscles of mastication were made more efficient resultant of a digitally directed "bite" adjustment procedure. Many in the scientific literature claim that the bite has nothing to do w/ TMD issues, yet the only joint in the human body that has a hard tissue stop are the 2 TMJ's...? There exist millions of exquisitely sensitive tiny ligaments that hold the roots of teeth into the bone known as periodontal ligaments (PDL's). Dr. Kerstein's research since the early 1990's has shown that excessive compression of the PDL's leads to hyperactive muscles of mastication (angry chewing muscles). So, if one overworks a muscle, what happens? One gets sore... We generate excessive lactic acid because we have kicked through the amount of ATP (energy) available via aerobic metabolic pathways, and kick into anaerobic pathways. The byproduct of the former pathway is carbon dioxide (CO2). The byproduct of the latter anaerobic pathway is lactic acid. Lactic acid in excess quantities is toxic to every mammal on the planet! In 2008, Japanese researchers found that there exists a special nerve fiber within the dental pulp known as an A-beta fiber, and tracked this to the somatosensory cortex in the brain in humans (Kubo et.al, 2008). The somatosensory cortex is that part of the brain that "feels" things, like touch, rub, friction, etc. When someone touches you, your somatosensory cortex alerts you to that fact. Well, the A-beta fibers are confined to the inside of your teeth, surrounded by not only the hardest substance in the human body, enamel, but dentin and cementum as well. So, though encased in a hard place, the pulp (nerve) can feel things like touch, friction and rubbing. How does the pulp/nerve feel within the hard tooth? It does, due to flexing resultant of muscular output. Muscle "bends" the tooth, activating the A-beta fibers. "Bend" it too much for too long and brain cranks up the muscle more, due to excessive compression of the PDL's AND the A-beta nerve fibers. This is part of the reason the bite can stimulate bite and muscular TMD problems. We study and manipulate this fact to great effect everyday in our "Neural occlusion" and MAGD/DTR therapy treatments. Control what the Central Nervous System "feels" through the "sensory organs" that are the teeth in force and time (dependent upon MUSCLE), and we can neurologically control the muscles of mastication. So, based upon objective modalities, one can SHUT THE HYPERACTIVE MUSCLES DOWN, thereby decreasing the excessive lactic acid production, typically leading to at least a partial resolution of TMD myalgic symptoms. Some bullets:
-85% of symptomatic TMD is muscular in nature based upon the literature
-bite splints do not effect a permanent physiological change, as they are removable
-bite splints also remove the bodies ability to adapt the teeth to the status of the damaged TMJ's via muscular output from the Central Nervous System
-the CNO believes that splints are only indicated when there exists objectively confirmed, acutely inflamed, and unstable or maladapted set of joints, and that these splints should only be constructed after gleaning the condition of the TMJ's per objective MRI and CBCT imaging.
-controlling the timing and efficiency of how our teeth interact can control or even eliminate symptoms of muscular TMD
-what moves the mandible? We will upload information and videos that will help the TMD patient find answers that are not available anywhere else. These treatments are validated in the scientific literature and are not subjective conjecture. We three use these principles in everyday practice to great effect and want the rest of the world to learn about, use, and apply these principles. The principles of Neural Occlusion diagnostic screening will greatly benefit confounding occlusal/bite and TMJ/D patients! The human bite can be intricately related to TMD issues contrary to popular opinion! None of these video case studies could have been accomplished with such a high success rate if this statement were not true for the human organism! Measured Matters when it comes to confounding bite problems and TMJ/D! Dr. Nick Yiannios
September 2020
