What is NORMAL When Gathering Diagnostic DATA?

“Dear TMD patient, based on the multiple MRI’s, CBCT imaging radiographs, doppler, muscle palpation examination, blood work up, diagnostic cast articulated model mountings, EMG, ESG and jaw tracking tests everything appears within normal limits (“Normal”)….”

REALLY?  BUT I DON’T FEEL NORMAL!

The problem with all gathered data is that a majority of clinicians don’t know how to interpret the data whether it is as good, bad or is it of any value as it relates to their treatment considerations. So often data will appear normal to them based on their paradigm, but in reality when sizing up all the objective and subjective info doctors may see and observe things and think certain anatomical forms and relationships are “normal” but maybe they are not really “normal”. Feelings of discomfort, pain and tension and aberrant postural problems doesn’t always correlate with a doctors report and interpretation of the MRI’s, or what the EMG data is indicating.

Normal? Really? Impossible. What this tells me is that they assume many things and may be leading folks and themselves to conclude wrongly.

Because they many not be seeing the complete picture of the problem from a “Physiologic healthy” standard. As dentists we only see what we are focused on. Data (which is actual physical evidence) are great indicators that help point the investigator to the problem. The investigator has to understand how to put the pieces of information (both physical, biologic and physiologic) together in a manner that makes sense. They can’t have a bias or opinion about what is occurring in front of them (structural and physical) without a greater appreciation of the unseen world of bio-physiology beneath the skin and bones. Their own occlusal or TMD philosophy should not over ride the clinical realities of what the patient reports as their true experience.

A physician of the mouth should understand how various musculoskeletal signs and symptoms relate to the specific occlusal/TMD and CNS problem. But in fact we know that is not the case. Most clinicians who do a muscle palpation examination, or request MRI’s or take EMGs or jaw tracking data or do a doppler, don’t always understand how to interpret the data to the occlusal issues, so they may believe a certain condylar position with the observed discal tissue is normal. Low EMG patterns to many may be normal, or if the myo-trajectory after TENS looks like it is opening and closing on the path coincident with the habitual trajectory path they may say that it is normal…when in fact the TMD patient says,….”I don’t care doctor what your K7 is saying or I don’t care what the MRI or your muscle palpation indicated, but I don’t feel normal!”….But the doctor says, but that is what the data and report says…, etc.

You see, the doctors are interpreting these kind of objective pieces of information based on their learned interpretations which obviously can’t be totally correct. How can the data say it is normal when the patient says they don’t feel normal (headaches, neck pain, cervical problems, tingling in hands fingers, shoulder pain), yet the mouths can open wide with seemingly no restrictions, they have symptoms, they have dysfunctions, that he clinician just didn’t fully understand according to their understanding. That is a problem!

MRI - Normal Pathology - Clayton A. Chan, DDS

MRI radiology report indicates:  “on the closed- mouth views, the articular disc is “Normal” in position on both left and right TMJs.  Open- mouth views demonstrate “normal” translation of the disc and mandibular condyle with respect to the articular eminence.

EMG and CMS - Normal Pathology - Clayton A. Chan, DDS

Some K7 clinicians would also indicate that this data is “Normal” (within normal limits) of resting muscle activity (EMGs) and mandibular jaw function relative to CO.  But patient complains of symptoms tenderness, headaches and joint pains.  Is this really normal?

Normal Pathologic Occlusion - Clayton A. Chan, D.D.S.

After functional ortho and fixed orthodontics patient has presented with musculoskeletal symptoms for the past 2 years.  Has been evaluated by 52 health care providers with no resolution of pains and dysfunction.  Is this normal?

Electrosonography - Abnormal Joint Sounds - Clayton A. Chan, DDS

Electrosonograhic data appears “normal” – but the patient indicates joint tenderness on opening.  How can this be normal?  Are the dental investigators interpreting the data correctly?

Where did the doctors get their training to learn what they did to conclude that things appear “normal” when in fact we know they are not? Or are these complains “psychosomatic” . If doctors are not monitoring cervical EMG activity how will they know if things are normal or not? If they are not monitoring temporalis, masseter muscles etc how will they know if the patients jaw and occlusion is functioning correctly. Well, that requires some understanding how to relate various muscle EMG patterns with occlusal issues. it is more than just high or low EMG patterns or muscle palpation evaluation or centric model cast mountings on articulators.

Doctors are not always reducing the joints during the bite registration process, even if they are using TENS how will we know if joints are normal or not for a correct and optimal model cast mounting to see the problems?

If doctors are hoping that TENS relaxes muscles and EMGs go up after TENS how does one know if the occlusion is right or not? How do we know if MRI’s are interpreted correctly, and or model cast mountings are physiologically correct or not? All this great high tech data is based on WHAT as their reference? What is the dental investigators reference for optimal health? A CO bite registration? A centric relation bite registration? A neuromuscular bite registration?

– Clayton A. Chan, D.D.S. – Las Vegas, NV

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What is NORMAL When Gathering Diagnostic DATA?