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Orthodontic Practice • US Magazine

Integrating Technology in Orthodontic Practice for Pain Relief, TMJ/D and Headache

Dr. Sheila Birth uses a systematic therapy approach for life-changing care

Volume 4, Number 4

Orthodontists are, by profession, specialists. We have chosen to narrow our scope of care to those patients requiring additional treatment to perfect their smiles. However, as I quickly learned, practicing a specialty does not limit our ability to provide life-changing care. Rather, broadening the application of relevant treatment technologies that can be used in orthodontic practice can prove beneficial not only to patients, but to practitioners as well.

I am an orthodontist with multiple practices in Texas. Orthodontics is my passion, not just my profession. The greatest reward is transforming the smiles of any child or adult who selects my practice. I know I’m not just improving their smiles, but their self esteem, also.

My practice began in one location in Fort Worth, Texas, but demand subsequently led to expansion to four other locations in Arlington, Burleson, and Keller, Texas. After practicing orthodontics for more than 25 years, I longed to do more for my patients, despite the fact that our practices were thriving and our staff well-trained and extremely efficient. In particular, addressing the needs of patients suffering from temporomandibular joint disorder (TMJ/D) and associated headaches was of interest, but we were unsure and uncomfortable with how to proceed given the level of difficulty these cases often present.

What I felt was needed was an established and integrated technology system with proven results before I would feel ready to begin treating patients with TMJ/D. It wasn’t until 2012, while attending an orthodontics conference, that I discovered the TruDenta system (www.drsdoctor.com). Incorporating this technology-based, systematic approach to assessing and treating dentomandibular sensorimotor dysfunction proved to be the answer we were seeking.

What is TruDenta, and How Does it Work?

TruDenta (TruDenta, Dental Resource Systems, Inc.) is a comprehensive system of education, technology, and training. The assessment technologies include devices to digitally measure cervical range of motion and dynamic as well as static bite forces. The therapeutic technologies (e.g., ultrasound, microcurrent stimulation, low level laser) are designed to resolve dentomandibular sensorimotor dysfunction (DMSMD). This can be a very painful disorder that encompasses the head, neck, temporomandibular joint (TMJ), jaw, and dental forces. Caused by misalignment in the skull and mandible, it can result in problems with bite force, muscles, and joint balance.1,2

Many patients who suffer from these issues display myriad symptoms, including jaw clenching, TMJ/D, clicking and popping of the jaw, tooth damage or fracture, and bruxism. Other symptoms indirectly related to DMSMD include chronic headaches, migraines, tinnitus, vertigo, and sleep disorders.1-3

Sufferers of DMSMD may experience other challenges, particularly in the case of orthodontics. Force distortion can adversely affect the stability and reliability of dental restorations or appliances that patients are using to treat unrelated conditions. Such a distortion could require additional treatment to achieve and retain function and balance.1,2

According to the National Institute of Dental and Craniofacial Research, anywhere from 10 to 45 million individuals may suffer from TMJ/D and similar problems.4 Perhaps more alarming is that nearly 90% of the United States population has headaches, and more than 29 million Americans suffer from migraines.5

The TruDenta system can offer relief to many of these patients. The system’s therapeutic modalities are cleared by the Food and Drug Administration (FDA) and represent a highly conservative but effective solution to managing and treating the causes of DMSMD pain and discomfort.TruDenta enables a customizable treatment plan for each individual to restore motion and function, stabilize the mouth, head, and jaw, and, perhaps most importantly for the patient, treat inflammation and pain.6

Training & Integration

Once I learned about the TruDenta system and how we could use it to care for our patients, I knew that I had to implement the systematic, technology-based assessment and treatment approach into our practice.

Many of our patients were suffering from TMJ/D and associated pain, especially headaches. However, because we weren’t confident treating their pain, more often than not, I had been referring them to physicians. Unfortunately, treatments were usually difficult, painful, and expensive. I wanted to offer a cost-effective, efficient headache and pain treatment alternative that requires no drugs or needles within my own practices.

A company executive worked with us to explain the benefits of the TruDenta system, visited the practice to discuss integrating the system, and spoke with staff members about their questions and concerns. The transition would require a leap of faith, but I was determined to move forward and remove any staff doubts about incorporating this technology and type of care. I was committed to helping them understand it first-hand.

The first TruDenta system was purchased for the Keller practice in October of 2012. Although we were anxious to fully integrate it into the practice, we allowed ourselves ample time to learn the intricacies of the system and participate in the 3-day hands-on training. By March of 2013, everyone felt comfortable with the assessment and therapies, as well as recommending the treatment to patients experiencing painful symptoms. Based on the success and patient response in the Keller practice, I purchased another system for the Burleson office within a month. I’m now considering purchasing a third system to add to one of the other offices, since so many patients have experienced positive results.

Success Realized

Once my team and I began treating patients with TruDenta, that’s when we realized the magnitude of what we are doing in terms of patient care, especially for those who had resigned themselves to lives of chronic, unending pain. Our first patient was a young woman who suffered with severe facial and TMJ pain. Within the course of five treatments, her pain had disappeared. Another patient was a young girl who suffered from weekly migraines who required a melatonin prescription to help her sleep. She is still completing treatment, but her migraine frequency has been significantly reduced, and she no longer requires melatonin.

One of our greatest success stories is the mother-in-law of one of my dental assistants. A lifelong migraine sufferer, the patient tried every treatment available for over 25 years, but to no avail. She estimated having spent more than $45,000 in treatments searching for relief. It wasn’t until she underwent the TruDenta therapies that she finally experienced pain relief. She is now nearing the end of her course of treatment, and her headaches have become much shorter and more tolerable.

Discussion

Although my staff and I began treating only our orthodontic patients, word of our TruDenta treatment success spread, and soon we began treating family members of current patients, as well as new patients who had heard of this effective headache pain therapy and wanted to experience it for themselves. We now treat orthodontic patients, those suffering from DMSMD, and those who need care for both. In fact, we have begun a marketing campaign for headache sufferers, hoping to raise awareness of the type of dental headache pain relief that people can receive from orthodontic practices like ours.

Financially, incorporating this systematic, technology-driven approach to the assessment and treatment of dental force imbalance related pain has proven to be a worthwhile investment for me. It has helped me attract new patients and offer pain relief to current orthodontic patients, also, For example, my orthodontic patients have the option of incorporating a pain management component into their orthodontic treatment.7

For those unsure whether incorporating this type of treatment is right for them, I wholeheartedly recommend exploring it further, and for one simple reason: it works!

Add TruDenta to your Orthodontic Practice and give patients another reason to smile. For more information, call 855-770-4002 or visit drsdoctor.com/ortho.

Sheila Birth, DDS, MS, received her DDS degree from Baylor College of Dentistry and her Master’s Degree in Orthodontics from the University of Oklahoma. Recognized as a Top Doctor in Fort Worth Magazine and a Top Orthodontist in Texas Monthly, Dr. Birth is also an Invisalign® Premier Elite Provider, People-to-People Ambassador, and Fort Worth Star Telegram Reader’s Choice Award Top Orthodontist. A member of several professional associations, including the American Board of Orthodontics, American Association of Orthodontists, and the American Dental Association, she actively participates in ongoing continuing education to remain abreast of the latest advances for successful, efficient, and effective orthodontic treatments.

References

1. Junge D. Oral sensorimotor function. Medico Dental Media International, Inc. 1998. 
2. Sessle BJ. Mechanisms of oral somatosensory and motor functions and their clinical correlates. J Oral Rehabil. 2006;33(4):243-261. 
3. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 6th ed. St. Louis, MO: Mosby; 2008. 
4. National Institute of Dental and Craniofacial Research. Adults. National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/ DataStatistics/ByPopulation/Adults. AccessedDecember 7, 2012. 
5. National Headache Foundation. Migraine. National Headache Foundation. http://www. headaches.org/education/Headache_Topic_ Sheets/Migraine. Accessed July 3, 2012. 
6. DiMatteo A, Montgomery M. Understanding, Assessing and Treating Dentomandibular Sensorimotor Dysfunction. Provo, UT: Dental Resource Systems, Inc.; 2012. 
7. Bicakci AA, Kocoglu-Altan B, Toker H, Mutaf I, Sumer Z. Efficiency of low-level laser therapy in reducing pain induced by orthodontic forces. Photomed Laser Surg. 2012;30(8):460-465.

 

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News Coverage
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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

Additional Content & Resources
Download this eBook on The Hidden Causes of Head Pain
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Download this eBook on The Hidden Causes of Head Pain
Download this eBook on The Hidden Causes of Head Pain
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