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Dentomandibular Sensorimotor Dysfunction is a medical condition involving the mandible (lower jaw), upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas. There is a concentrated nerve center in this area called the trigeminal nucleus.This major pathway of nerves controls pain signals from the teeth, face, head, and neck, and carries them to the brain. Dentomandibular sensorimotor dysfunction refers to a condition in which an individual experiences chronic pain or stiffness from these nerve inputs as a result of dental force imbalances.
1 Dental Foundation
3 Assessment Protocol
3.1 Digital Portion
3.1.1 TruDenta Scan (T-Scan)
3.1.2 Range of Motion (ROM) Assessment
4.1 Therapeutic Ultrasound
4.2 Transcutaneous Electrical Stimulation
4.3 Low Level Laser (light) Therapy
4.4 Manual Muscle/Trigger Point Therapy
4.5 Table 1: Levels of Dental Force Imbalance and Dental Headache Care
5 References Dental Foundation
The dental foundation consists of teeth, muscles, and joints in the dentofacial (head and neck) area. The dental foundation is considered to be out of balance when one or more of the following conditions apply:
Advanced aging or disability of the muscles which open the jaw.
Movement or noises in the jaw joints which indicate the disks in the neck are moving, deformed, or swollen.
Tooth wear or breakage.
Limited range of motion in the jaw and cervical (neck) spine.
Painful or sore head and/or neck muscles with very sensitive spots referred to as “trigger points.” Pain that stems from the trigeminal cervical nucleus.
Any lifestyle limitation related to the teeth, muscles, or joints of the head and neck.
There are many symptoms associated with DMSD conditions. The most commonly reported are:
Chronic daily headaches
Temporomandibular joint (TMJ) disorders
Poor airway control
Changes in brain chemistry and neurotransmitter balance
Unstable dental arch form
Restricted range of motion and postural adaptations
Clenching with or without torus formation
Abnormal tooth wear patterns
Degenerative joint disease
This condition affects all ages and both genders. However, females are more likely to suffer from DMSD. Individuals who have experienced chronic headaches and/or migraines without finding lasting relief through traditional medicine can be assessed for DMSD through a combination of objective tests, evaluations, and a comprehensive discussion of their symptoms, medical history, headache history, pharmacological background, and head health. Research used in sports medicine and rehabilitation allows dentists to address the population with DMSD symptoms.
The TruDenta System is a complete software and technology system that combines—and applies to treatment—neuroscience and systematic, objective assessment and monitoring. The physical examination is supported by findings from the mandibular range of motion (ROM) disability, cervical range of motion (digitally), and dental force analysis (TruDenta Scan).
A physical examination with head health, headache, pharmacological and complete medical histories. Additionally,dental, periodontal, occlusal, orthodontic, and airway examinations are encouraged as part of the initial screening process.
Next, a panoramic radiograph (also called a curved surface tomograph) is used to identify or confirm dental conditions which may contribute to painful DMSD symptoms. Computed tomography(CT scans) can also be utilized at this point for further aid in assessment and treatment planning.
Muscle palpationis used to evaluate where the individual is experiencing “trigger points”. These are areas of high sensitivity in the facial, head, and neck muscles. When these areas are pressed, it causes pain either in that muscle (localized pain), or in another area(referred pain). A muscle palpation examination is performed to aid in the discovery of “latent trigger points”, or trigger points which cause no pain unless direct pressure is applied.
TruDenta Scan (T-Scan)
This tool is used for digital force analysis to measure the presence and amount of imbalance at closing of the mouth, during closure, and during mastication (chewing). The computer displays the results of how the forces in the mouth spread along the arch, the center of force, the center of force trajectory, and the left/right force balance. This means the dentist can show patients which teeth are generating the most force, and facilitates the dentist’s knowledge of what adjustments need to be made to teeth and soft tissue to create a stable dental foundation.
Range of Motion (ROM) Assessment
This test digitally measures an individual’s cervical range of motion from a standing position and displays the results in terms of flexion and extension, left and right lateral flexion, and left and right rotation. Limited cervical range of motion is a disability, and being able to understand what is normal—and where their own mouth, head and neck are during the examination—helps people see how this disability is affecting their condition.
This is also when the amount a person can open their mouth is measured. Along with normal opening movement, the jaw should slide symmetrically from left to right at least 25% of the total mouth opening distance.
Finally, during the range of motion assessment, a record of jaw joint vibrations and sounds are made. Normal jaw joints glide without noise or vibrations.
Depending on the assessment findings, patients are classified as needing 1 of 4 levels of care (see Table 1: Levels of Dental Headache Care) to treat and manage their pain and balance their dental foundation. Every level has a regimented therapy protocol designed to provide the most effective, long-lasting care for each individual.
Once the type of headache pain and extent of dental foundation imbalance is determined, treatment options are discussed. Historically, the treatments for headache pain included one or a combination of herbal remedies, stress-reduction exercises, massage, acupuncture, non-steroidal anti-inflammatory drugs (NSAID), narcotic pain relievers,anti-seizure medications, chiropractic adjustments, anti-depressants or sedatives.
The combination of advanced dentistry techniques and sports rehabilitation-derived therapies used in treating dental force imbalances in dental headache care has resulted in a dentist reported 93% success rate in providing patients with real, lasting relief from their DMSD symptoms. The methods used control muscle force and force balance, restore proper function and range of motion, and change the way the brain perceives stimuli, so pain levels, dysfunction, and improper muscle activity return to normal. By balancing the muscles, joints, and teeth, and controlling the way the body feels pain in the head and neck areas, long lasting pain relief can be achieved.
Once the individual has had the proper dental adjustments to restore normalcy to the dental foundation, and has been prescribed and fitted for their at-home orthotic (worn in the mouth for the short term, typically only during the 4 to 12 week rehabilitation period) for muscle re-training, the sports rehabilitation-derived components of therapy begin.
The goal of therapeutic ultrasound treatment is to restore circulation to sore, strained muscles through increased blood flow and heat. Another objective is to break up scar tissue and deep adhesions (areas where connective tissue fibers have formed over muscle) through sound waves. Therapeutic exposure to ultrasound reduces trigger point sensitivity and is considered a useful clinical tool for managing myofascial pain. Moreover, the ultrasound has also been shown to lessen the stiffness and discomfort of trigger points.
Transcutaneous Electrical Stimulation
Sub-threshold micro-current stimulation reduces muscle spasms and referral pain through a low electrical signal that decreases lactic acid build-up and encourages healthy nerve stimulation. Micro-current electrotherapy is known to significantly aid in increasing mouth opening.
Low Level Laser (light) Therapy
Low Level Laser (light) Therapy decreases pain and inflammation, accelerates the healing of muscle and joint tissues by 25%-35%, and reconnects the brain stem’s neurological pathways, effectively inhibiting pain. Low-level laser therapy combined with electrical stimulation improves mouth opening in patients diagnosed with TMJ/D. The musculoskeletal system's natural healing ability decreases pain and promotes TMJ stability.
Manual Muscle/Trigger Point Therapy
Manual Trigger Point Therapy decreases and eliminates pain and tension in the trigger points by breaking up muscle knots and increasing blood flow. This decreases inflammation and pain in the muscles.
As part of their in-office treatment,a dentist monitored homecare system/deprogrammer and intraoral orthotic device is given to patients for their own personal use, on their own time.
Table 1: Levels of Dental Force Imbalance and Dental Headache care
1. Patients will typically need a rehabilitation orthotic and some occusal adjustments
2. Patients will typically need a few in-office treatments, a rehabilitation orthotic, and some occlusal adjustments
3. Patients will typically need more in-office treatments, rehabilitation orthotic, a basic at-home care kit, and occlusal adjustments
4. Patients will typically need a greater number of in-office treatments, a rehabilitation orthotic, a basic at-home care kit, a micro-currenrt stimulation kit, and occlusal adjustments.
^ Sessle BJ. Mechanisms of oral somatosensory and motor functions and their clinical correlates. J Oral Rehab2006;33:243-61. ^ Koolstra JH. Dynamics of the human masticatory system. Crit Rev Oral Biol Med.2002;13(4):366-76. ^ Junge D. Oral sensorimotor function. Medico Dental Media International, Inc.:1998. ^ Srbely JZ, Dickey JP, Lowerison M, et al. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study.Pain.2008;139(2):260-66. ^ Dijkstra PU, Kalk WW, Roodenburg JL. Trismus in head and neck oncology: a systematic review. Oral Oncol.2004;40(9):879-89. ^ Fikackova H, Dostalova T, Vosicka R, et al. Arthralgia of the temporomandibular joint and low-level laser therapy.Photomed Laser Surg.2006;24(4):522-27. ^ Quinn C, Chandler C, Moraska A. Massage therapy and the frequency of chronic tension headache.American journal of Public Health2002;92(10):1657-61. ^ DiMatteo AM, Mongomery MW. Understanding Assessing and Treating Dentomandibular Sensorimotor Dysfunction. Fort Lauderdale, Florida: Dental Resource Systems, Inc.:2012.
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
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
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
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
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
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
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
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
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