Overview
The electronic technology to deal with TMJ problems has been around for over twenty years. The original Myotronics system was displayed on a round cathode ray tube. The patient experiencing pain in TMJ (the joint just in front of the ear opening where the lower jaw meets the bone below the eye) does not need my computer diagnostics to know that he or she has a problem. However, we need to quantify the extent of the problem. We can measure and graph the noise that the joint is making. We can measure and graph the degree of hyperactivity there is in the muscles. We can graph the movements of the lower jaw to see how far out of symmetry that it moves. Then, with all this data, we have a good idea of how much of the problem is because of the misaligned bite. Only then can we determine whether or not changing the bite is going to help.
Diagnosis
The diagnosis almost always starts with the patient coming into the office with TMJ and/or jaw muscles that are painful. X-Rays or other scans can look at the condition of the joint. Electronic tracking can graph the symmetry (or asymmetry) of the lower jaw movement. Our computer displays EMGs that measure the degree of jaw muscle hyperactivity. All of these measurements have "normal" upper limits. The electronic tracking calculates the difference between where bite is now versus where it should be in order for the muscles to remain in a relaxed position. Any existing spinal (back or cervical) problems or leg length issues need to be considered separately. Treatment for these might need the help of an orthopedist or chiropractor. If the TMJ and/or chewing muscle pain is found to have a significant misalignment of the bite component, it makes sense to continue to treat the TMJ issue at least to the point of creating a neutral bite using a clear acrylic orthotic. It is possible that many of the cervical neck issues will be improved by the orthotic, leaving whatever back and leg issues to be dealt with separately.
Creating an Orthotic
We create the perfect bite by using a "tensing" system that is similar to those that orthopedic surgeons use as part of the physical therapy after surgery to maintain the muscle tone. Ours uses a different frequency and serves to place the mandible in a position where the muscles are the most comfortable. We take impressions to capture that position and make a clear orthotic that prevents your jaw from going to the old position that caused the pain and to stay in its new comfort zone. After a few weeks of full-time wear of the orthotic we switch to night time wear only, preserving the advantage of having a reversible therapy at that point.
Knowing It's Working
Reduction of symptoms happens in 95% of patients who have worn the orthotic even for just a couple of weeks. The worse the beginning syptoms are and the electronic readings are the more dramatic will be the relief of pain and the reduction of the muscle electronic measurements. If the X-Rays or other imaging indicate severe damage (common with arthritic damage), the healing will be less predictable, but they can have some of the most dramatic relief from pain.
Long Term Plan
There are two possibilities. One is to stay with the level of comfort provided by the night time wear of the orthotic and to assume that it will retard (hopefully stop) further deterioration. The second answer would be to change the bite by restoring the teeth with crowns creating the same bite that has been successful when wearing the orthotic. There is an interim stage where we can test this approach, placing a type of orthotic that is bonded to the biting surfaces to be worn 24 hours per day. It has the same details that would be used for the final crowns. At this stage this semi-permanent orthotic is reversible but cannot be used for more than a few months. About 80% of patients fit into the first group, 20% needing to move to the second. The patients in the first group are the ones with the least damage and symptoms. Those in the second group are the ones likely to benefit the most by having the perfect bite working for them 24 hours per day (especially while chewing).