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TruDenta Concepts & Terminology

Read the Wikipedia.org page on DMSD, here.

The TruDenta system has arisen as an evolutionary and revolutionary system for dentists to utilize in patient treatment.

This program is built upon the common concepts of occlusion, dental anatomy, mastication physiology, oral sensorimotor function, and the musculoskeletal anatomy and function of the head and neck. Also, the program has elements of the applied neurology of the afferent and efferent pathways, which are involved with sensation, proprioceptive, pain, reflex motor control, and compensatory adaptations and engrams of function and para function.

For far too long, the well understood anatomy and physiology of the head and neck has been only loosely associated with the dental treatment of patients. For many reasons the dentist has isolated the teeth and the pathology of dentition from the functional and para functional physiology that can cause wear, damage, fracture, abfractions, failure of restorations, and pain. These traumas and degenerations are merely the signs and symptoms of an underlying problem. While we would like to offer patients the opportunity for the best possible outcome, that would require us to get to the foundational cause of these manifestations of disease, dysfunction and, too often, despair.

It is the premise of the TruDenta system, that we simply redirect the focus of the examination processes and the initial care sequences to address the underlying functional physiology. Patients can then be offered the opportunity to deal with their symptoms and problems in a way that will assure them of a pathway to long-term predictable health and dental stability. In addition, by addressing the problems at the level of the causation, we will be able to expand our care to include excellent results for many of our patients with intractable, late or end stage disorders. These include severe dental disease, as well as head and neck pain, range of motion disabilities, and accelerated aging, which is related to dysfunction and poorly healed injuries.

The nexus of tooth related problems, along with musculoskeletal and neurological physiology is at the point where the effects of muscle related forces are applied to the teeth or a bolus of food in a way that develops and determines the patterns of muscle activity through the sensorimotor neurology via the brainstem. When the neurology is abnormal, as in chronic pain, the forces between the teeth are altered via the musculature. This can also occur when the muscle patterns are driven by central nervous system requirements, as in para function during sleep disturbances, or when the proprioceptive of the teeth is altered, as in sensitization or dental changes. The way in which these forces are managed, sensed, and adapted to is the essence of force related dental disease.

The vast majority of dental related disease can be categorized to only three primary issues:

  1. Bacterial / host response disease (especially periodontitis)
  2. Acid breakdown of tooth enamel 
    • Caries
    • Acidic biofilm
    • Gastric acid (reflux)
    • Dietary acid
  3. Force overload
    • Frictional
    • Compressive
    • Shear
    • Bending (abfraction)

Most restorative treatment on adults in dentistry today, is a direct result of force related problems. Also, aside from external trauma, the abnormal forces are applied to the teeth by the patient’s muscles. The forces that cause the breakdown of the teeth also cause the acceleration of periodontal breakdown and the early breakdown of previous restorative attempts.

Whether we observe open margins, fractures, wedge defects (abfractions), wear, sensitivity, mobility, or failed restorations, there is reliably an underlying force problem at play. We call this “Stress in the system.”

Today we can truly redefine the term “malocclusion” to mean: “Abnormal forces between some or all of the teeth, that results in damage to the integrity of the tooth anatomy or the periodontal interface, or resulting in pain to the patient. Malocclusion related pain can manifest as hypersensitivity, deep tooth pain, jaw pain, or pain in the head and neck region served via the trigeminal cervical nucleus.”

This definition does not necessarily exclude other definitions, which refer to the interdigitation of the teeth, or the location of centric stops on the teeth. Rather, this definition allows a perspective on occlusion that addresses the direct relationship of functional physiology to the disease and degeneration that we observe and treat.

There must then be a force related definition of a normal or healthy occlusion. I would suggest the following definition,

“Force Balanced Occlusion - a system of interdental forces that are well distributed around the arch with an unhindered path to closure and to mastication. The interdental forces should be distributed down the long axis of the posterior teeth, with the total forces balanced in a 50/50, right/left ratio during a full closure to interdigitation.”

Additionally, the closure muscles should function with symmetry and synergy during a full closure to interdigitation. There should be musculoskeletal stability and symmetry of the temporomandibular condyles with the discs normally interposed at full closure. The patient is comfortable in rest and full closure and the mandibular range of motion is within normal limits.

Many other conditions may also be present to demonstrate normal health, including but not limited to:

  • Patient comfort at rest and in function
  • No acute or chronic pain
  • Normal cervical range of motion
  • Normal posture
  • Normal work abilities
  • Normal tooth anatomy and mobility
  • No dentin showing
  • No dietary restrictions due to dental function

As we explore further into the realm of “force balanced occlusion”, we will encounter many other issues that can disrupt the normal function of the musculature. We will see that as patients develop pathology or have dentistry done, there will be changes to the balance and function of the mandible. The patient’s proprioceptive system will constantly adapt to changes. This is true whether the problem is as simple as a sore or sensitive tooth after restoration, or as complex as the creation of an adapted interdigitation to avoid extreme forces. This can result in malpositioned or dislocated condyles during mastication, clenching, early disc movement that can precede disc displacement, or patterns of self-equilibration to “grind in” the original force balance through self-mutilation.

Occasionally, these adaptive changes will result in the conversion of acute pain to chronic pain. This then will cause the patient to undergo many neurochemical adaptations, as well as compensatory muscle activity that can limit range of motion, either mandibular or cervical. It can also result in trigger point muscle spasms.

The signs and symptoms of a “malocclusion” can be manifest in the teeth, muscles, or joints. This triad of anatomy is referred to as the “dental foundation.”

The dental foundation is considered to be out of balance when any of the following conditions exist:

  • Accelerated aging or degeneration of the temporomandibular condyles
  • Temporomandibular joint vibrations indicative of disc movement, disc derangement, or inflammation
  • Tooth damage or degeneration related to abnormal forces
  • Limited range of motion of the mandible or the cervical spine
  • Presence of sore or painful muscles of the head and neck especially the presence of “trigger points”
  • Symptoms of pain that emanate from the structures connected via and controlled by the trigeminal cervical nucleus, especially headache.
  • Any lifestyle disability related to the teeth, muscles or joints of the head and neck
  • Abnormal forces are detected in the dentition by examination
  • Injuries have occurred that affect any of the above structures or activities.

Generally speaking, any time a patient’s symptoms, connected to the dental foundation need to be addressed, it would always be in the patient’s best interest to have the foundation stabilized and balanced prior to, or as a part of, any treatment for the problem. In other words, if any treatment is needed for the patient, the best possible outcome will reside in the approach that builds a balanced foundation as the first step to care.

Creating a balanced foundation involves more than just balancing forces. It requires proceeding down a path that will allow for the most symmetry of the muscles and joints as the initial focal point for care. This is what we call the "Pathway to Care."

This Pathway to Care refers to the development of an appropriate sequence to rehabilitate the musculature and the joints while treating the patient’s symptoms. Much like an orthopedist must balance the rehabilitation of a patient’s muscles, ligaments and joints with the development of a planned prosthesis, we must approach the most adaptable tissues, the muscles, first. Then we proceed to joint rehabilitation. Then we can finalize the dental treatment of the teeth.

This rehabilitation approach gives the appropriate time process to each patient, depending on the extent of the injury and degree to which the condition has become chronic. A patient who has an acute problem can certainly go through a quick rehab assessment and move quickly to dental restoration. However, a patient with limited range of motion in the mandible or cervical spine will need more time to rehabilitate the musculature and reduce pain and disability prior to dental restoration.

In either case, rehabilitation and the appropriate Pathway to Care is the way to cure dental foundation problems.

As a patient approaches their rehabilitation, we will often discuss “balancing of the foundation” and the “balancing of the bite.” Balancing of the bite is the only aspect of the rehabilitation process that can only be done by a dentist. This means that, for the best chances of success, a knowledgeable dentist must be the one treating a patient with a problem residing in the teeth, muscles or joints or in the trigeminal cervical nucleus. Other medical professionals, who treat some of these “foundation” problems, can only achieve short-term success, because they cannot control the afferent signals from the teeth to the trigeminal cervical nucleus.

This brain stem pathway, or column, carries all the information regarding headache, head and face pain, and neck pain to the patient’s thalamus and on to the cortex. Approximately 40% of the afferent control into this column comes from the area around the teeth and jaws. In other words, this is the domain of the dentist. The dentists have the systems to ultimately stabilize the rehabilitation that is necessary for this part of the body.

As the dentist begins to “balance the bite,” they will balance the forces applied to the teeth around the dental arch, through both additive and subtractive procedures. The process of “balancing the bite” is not a therapeutic end unto itself. It must be developed, along with the symmetry and normalization of all aspects of the dental foundation, including the joints and the muscles. This will create and develop a balanced foundation.

Although many problems with the dental foundation have a chicken or the egg etiology, all therapy for dental foundation imbalance or bite imbalance must be approached comprehensively, and it must involve all foundational elements to achieve success. Understanding that the “stress in the system” must be managed through comprehensive rehabilitation of the dental foundation is of utmost importance.

When all the elements of teeth, muscles, joints, neurology, pain, and force balance are addressed, the patient will have the best chance for an excellent outcome. This rehabilitation approach is the crux of a medical dental synergy that is TruDenta.

 

Resources and Suggested Reading:

www.TruDenta.com - Information for patients about symptoms, examination and treatments with TruDenta. 

Understanding, Assessing & Treating Dentomandibular Sensorimotor Dysfunction - by Mark W. Montgomery, DMD and Richard Amy, DC

Manual of Temporomandibular Disorders - Edward F. Wright, November 10, 2009; Edition: 2

 

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Assessment & Treatment
  • Assessment Process
  • Treatment Process
  • Only Dental Professionals
  • Assessing DMSD
  • Bite Force Analysis
  • Mandibular Range of Motion
  • Cervical Range of Motion

Only Dental Professionals

In many cases, only dental professionals can help the estimated 80 million Americans suffering from the painful symptoms caused by improper dental forces, called dentomandibular sensorimotor dysfunction (DMSD).

READ MORE "...it is imperative to include the training for orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues.” JADA Cover Story, 10/2015, Vol. 146, Issue 10, Pg. 721-728

Assessing DMSD

20% of your existing patients suffer from DMSD, as do 20% of all Americans. Your team members quickly assess patients for "red flags" (which indicate DMSD), utilizing TruDenta's patented technologies.

The National Institutes of Health estimate that over 80 million Americans suffer from one or more of the symptoms of DMSD, including:
• Chronic Headache
• Migraine
• Tinnitus
• TMJ/D
• Vertigo
READ MORE

Bite Force Analysis

TruDenta uses digital force measurement technology, powered by Tekscan®, for evaluating the amount of bite force that is present during closure, at closure, and while chewing. The technology is so advanced that it actually calculates the bite force and motion on a tooth-by-tooth basis. This digital exam literally shows a movie of the bite force in action revealing abnormal forces in the nerves, muscles and ligaments that are often the cause of symptoms.

Bite balance is also calculated to identify potential issues within the overall chewing system. READ MORE

Mandibular Range of Motion

A normal opening for an adult is 53 mm to 57 mm. Limited or restricted range of motion (less than 40 mm) is a reduction in an individual’s ability for normal range of movement. Along with opening movement, an individual should be able to slide their jaw to the left and to the right at least 25 percent of their total mouth opening in a symmetrical fashion.

When restricted movement exists, an imbalance in the system is present, and breakdown of the system is likely to occur. READ MORE

Cervical Range of Motion

The TruDentaROM is a system of hardware and software that digitally measures cervical range of motion (ROM) impairment based upon AMA guidelines. This directly affects the proprioceptive feedback system of the dental occlusion, TMJ, and the muscles of mastication.

ROM impairment is another “red flag” which assists doctors in accurately diagnosing symptoms that are often dental force related. This data enhances medical insurance collections and the collaboration with referring medical doctors. READ MORE

  • Doctor Chair Time
  • Therapeutic Ultrasound
  • Microcurrent Stimulation
  • Low-Level Cold Laser

Less Than One Hour Doctor Chair Time

A typical case requires less than one hour of doctor time in the diagnosis and minor occlusal adjustments during the rehabilitation period.

Treatments are performed by a trained team member once per week, in less than one hour. The most severe cases require 12 treatments. Therapies are spa-like, non-invasive and require no drugs or needles. Most patients report dramatic results after the very fist treatment. Note: The majority of patients utilize an orthotic only during the treatment period, up to a maximum of 12 weeks. READ MORE

Therapeutic Ultrasound

The goal of therapeutic ultrasound treatment is to return circulation to sore, strained muscles through increased blood flow and heat. Another goal is to break up scar tissue and deep adhesions through sound waves.

Therapeutic exposure to ultrasound reduces trigger point sensitivity and has been indicated as a useful clinical tool for managing myofacial pain. Additionally, ultrasound also has been shown to evoke antinociceptive effects on trigger points. READ MORE

Microcurrent Stimulation

Sub-threshold microcurrent stimula¬tion reduces muscle spasm and referral pain through low electrical signal. It also decreases lactic acid build-up and encourages healthy nerve stimulation. In particular, microcurrent electrotherapy has been shown to help increase mouth opening significantly.

• Reduces muscle spasm and referral pain through low electrical signal
• Decreases lactic acid build-up
• Encourages healthy nerve stimulation
• Increases mouth opening significantly
READ MORE

Low-Level Cold Laser

Low level laser/light therapy is one of the most widely used treatments in sports medicine to provide pain relief and rehabilitation of injuries. Over 200 randomized clinical trials have been published on low level laser therapy, half of which are on pain.

Low level laser/light therapy decreases pain and inflammation, accelerates healing of muscle and joint tissue 25 to 35 percent faster than without treatment, and reconnects neurological pathways of nerves to the brain stem, thereby inhibiting pain. READ MORE

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