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The Profitable Dentist Magazine

Profiting by Providing a Pathway to Care 

How technology for treating dentomandibular sensorimotor dysfunction can boost productivity.

by Dr. Charles W. Martin

November, 2012

Providing patients with the most comprehensive andmodern treatments distinguishes progressive dentists from other practices and enables the entire dental team to derive personal satisfaction. Diagnosing and treating patients suffering from the symptoms of dentomandibular sensorimotor dysfunction further differentiates innovative and complete care dentists from those who merely provide dental restorations. It also affords dentists and their practices with opportunities for enhanced profitability.

Dentomandibular sensorimotor dysfunction is a disorder of the head and neck, temporomandibular joints, jaw function, dental forces and the common neurology of these structures and functions. It is at the root of many symptomatic and asymptomatic conditions, including abfractions, tooth wear, bruxism, TMJ disorders, repeatedly fracturing restorations, chronic headaches, migraines, and a host of other symptoms.1-3

According to the National Headache Foundation, more than 29 million Americans suffer from migraines. The causes include such trigger factors such as dietary factors, hormonal variations, sleep disorders and others that excite brain cells and ultimately trigger a reaction in the trigeminal nerve that results in pain.4 People suffering with migraines lose more than 157 million work and school days each year due to pain.5 In addition to migraine sufferers, an estimated 90 percent of the population suffers from headaches.5

Additionally, dentists themselves are all too aware of the increasingly staggering numbers of patients suffering with TMJ disorders. The National Institute of Dental and Craniofacial Research (NIDCR) has estimated that more than 10 million Americans suffer from TMJ disorders, but the number could actually fall between 15 and 45 million patients with some type of TMJ issue.6

Although chronic headaches, migraines and TMJ disorders have been treated by many different health care providers, dentists are appropriately trained and knowledgeable to diagnose and treat these conditions.7 And, by incorporating new programs, systems and technologies designed to establish normal function and relieve symptoms of theses condition, dentists can provide a long-term solution and pathway to complete care based on a framework of healing their patients. In the process, they can simultaneously increase their profitability and productivity.

Innovative Technology for Patient Care

A complete system of patented, proprietary diagnostic and treatment hardware and software is now available for dental practices that enables the team to identify, screen, evaluate, diagnose and treat force related dental disorders (TruDenta, Dental Resource Systems, Ft. Lauderdale, FL). Using the TruDenta system, dentists can deliver an objective, visually engaging diagnosis and offer scientifically proven, systematic and predictable treatments for patients suffering from the symptoms of dentomandibular sensorimotor dysfunction.

All therapy for the dental foundation or bite imbalance is approached comprehensively and addresses all foundational elements based on a simple and effective diagnosis and assessment of the functional elements of the head, neck and oral cavity. The examination and diagnostic devices objectively measure and visually illustrate the cause of symptoms.

For example, the TruDenta ROM is a computerized measurement of the cervical range of motions as expressed in the patient’s head movement, which is directly connected to jaw movement and affects the proprioceptive feedback system of the dental occlusion, the temporomandibular joints and the muscles of mastication. The T-Scan, on the other hand, is used to evaluate imbalances in the dental foundation (i.e., teeth, joints and muscles) both prior to and during rehabilitation. Using objective data instruments to augment and validate the diagnostic opinion is a powerful tool in developing a treatment plan and garnering the patient’s acceptance of the treatment plan.

The examination and evaluation process also includes a head health, medical, and headache history, as well as a pharmacological assessment. These findings are combined with a standard of care panoramic radiographic examination. Thorough dental, periodontal, airway, orthodontic and occlusal examinations are also recommended and encouraged.

Once diagnosed, patients receive a series of treatment therapies using a proprietary combination of low level laser therapy, therapeutic ultrasound, and microcurrents, among other therapies, to control muscle forces and force balance, rehabilitate and restore normal function and range of motion, and reset engram patterns of pain, dysfunction and muscle activity. Normal function and a stable foundation are achieved by balancing the muscles, joints, and teeth and controlling the proprioceptive feedback loops.

All of the diagnostic and therapeutic equipment meets stringent FDA requirements, where applicable and have been well documented for their effectiveness for their respective use. The multiple TruDenta treatment modalities are a proven combination of sports medicine rehabilitation and advanced dentistry techniques that have been shown to speed the healing of joints and force related traumas.8-13 The TMJ responds to therapies in a similar manner as ankles, knees, shoulders and other joints typically treated in sports medicine. Additionally, all of the devices are approved by the Food and Drug Administration (FDA) for their respective applications.

The combination of objective diagnostics and unique therapies enables dentists and their team members to provide solutions to patients that measurably and permanently improve their lives. By restoring the dynamic soft tissue system first and ensuring it performs properly, dentists and their patients can be more confident that any subsequent restorations or tooth adjustments—regardless of the occlusal philosophy that a dentist follows—will achieve the proper, balanced results.

Innovation for Profitability

The truly complete TruDenta system was designed for use by dentists in diagnosing dentomandibular sensorimotor dysfunction, then by the dental team for providing therapy. In fact, because less than 120 minutes of chairtime is required by dentists themselves for typical TruDenta cases, they can work more efficiently and the practice can generate greater revenue.

Dentists and their staff members are trained by doctors at either the University of Nevada Las Vegas or NOVA Southeastern dental schools. The simple hands-on training includes impactful and interactive sessions, the science behind the diagnostic and treatment equipment and techniques, and sessions in a clinical environment. Therefore, while some technologies and treatment innovations are not adopted by everyone in a practice because they are too difficult to learn or understand, the entire dental team can participate in—and discuss their enthusiasm about—providing patients with a comprehensive pathway to care.

And patients will be receptive. Most dentists who have implemented the TruDenta system report an average treatment plan of between $3,500 and $5,000 per patient. When the treatment protocol are followed properly, the system has been shown to be 93% successful in relieving symptoms of pain for properly diagnosed chronic headache and migraine patients.

The potential patient pool—and opportunities for increased profits—is great. According to the practices nationwide that have already incorporated the TruDenta system, at least 50% of their existing patients can benefit from this type of diagnostic and rehabilitation service. Additionally, because the ROM portion of the diagnostic process provides objective data to AMA guidelines, the physician and larger health care community is more likely to refer new patients for whom a drug-free solution to their pain is needed. Since pain relief is not elective, physicians are eager to refer patients to healthcare providers who can diagnose to AMA guidelines, which is something few other dentists can do.

To further enhance profitability, dental practices that incorporate the diagnostic and treatment system benefit from traditional marketing support, including national and local advertising, as well as digital marketing via a customized website and social media. The site is optimized for search terms associated with head, neck, and jaw pain and generates an average of more than 40 patient calls per month. Practices also are assisted in developing referral networks from physicians and other health care professionals.

Nationwide marketing to support TruDenta practices— with an emphasis on direct to consumer advertising and education—is currently underway and expected to continue full force throughout next year. Among these efforts is the functional, informative, and user-friendly patient-focused website: www.TruDenta.com.

Conclusion

The TruDenta system enables dental practices to distinguish themselves as innovators and providers of comprehensive care using a diagnostic and treatment approach the entire dental team can embrace. It provides a systematic pathway to relieve pain and the symptoms associated with dentomandibular sensorimotor dysfunction. It also establishes a stable foundation for any restorative treatments that are subsequently deemed necessary. Concurrently, it represents a new and stateof- the-art profit center to attract new patients.

You can reach Dr. Martin at (804) 320-6800 or cwmdds@gmail.com.

1. Junge D. Oral Sensorimotor Function. Medico Dental Media International, Inc.: 1998.
2. Okeson JP. Management of Temporomandibular Disorders and Occlusion, 6th Edition. Mosby: 2008.
3. Sessle BJ. Mechanisms of oral somatosensory and motor functions and their clinical correlates. J Oral Rehabilitation. 2006; 33:243-261.
4. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_ Sheets/Migraine. Accessed July 3, 2012.
5. Headache. US News and World Report. 2006. http://health.usnews.com/healthconditions/ brain-health/headache. Accessed July 3, 2012.
6. National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/ DataStatistics/ByPopulation/Adults/
7. American Dental Association. Dentists: Doctors of Oral Health. http://www.ada.org/4504. aspx. Accessed July 3, 2012.
8. Cameron MH. Physical Agents in Rehabilitation, 3rd Edition. Saunders: 2009.
9. Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010 Nov; 21 (6): 1722-8.
10. Marini I, Gatto MR, Bonetti GA. Effects of superpulsed low-level laser therapy on temporomandibular joint pain. Clin J Pain. 2010 Sep; 26(7): 611-6.
11. Srbely JZ, Dickey JP. Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy? Clin Rehabil. 2007 May; 21(5): 411-7.
12. Aguilera FJ, Martin DP, Masanet RA, Botella AC, Soler LB, Morell FB. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiolo Ther. 2009 Sep; 32(7): 515-20.
13. Zuim PRJ, Garcia AR, Turcio KHL, Hamata MM. Evaluation of microcurrent electrical nerve stimulation (MENS) effectiveness on muscle pain in temporomandibular disorders patients. J Appl Oral Sci. 2006; 14(1): 61-6.

 

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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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