Is there scientific evidence to prove cause or solution to TMD?

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There is plenty of research on TMD, but the problem with this TMD research is many professionals can’t seem to agree on whether TMD is a psychosocial (stress, tension or emotional upset) issue or whether it is a muscular issue based on a perspective on muscle balance.  Some have examined pain patterns from trigger points and tight muscles lead to altered TMJ mechanics in the joints and occlusion and or whether it is a malocclusion issue with a focus on the cause of premature contact due to trigger points in the muscles, relieving muscles before splinting, prolonged dental work, stress or trauma (malocclusion can perpetuate trigger point activity) and proprioception/muscle disturbance can cause malocclusion and altered TMJ mechanics.

Research within the dental profession has been done extensively on all these various 3 main areas relating to TMD. The problem is with our profession not agreeing which of these 3 areas lends the greatest credance to TMD as a problem.  I can tell you that a mass majority of research has not focused their investigations on the “physiologic” and objective measurement responses of what is an optimal mandibular positioning relative to the maxilla and the associated musculature before and after muscle relaxation therapy.
Very little objective scientific data has been acknowledged by these theorist, thus a lot of drawn conclusions about TMD with very little awareness as to how occlusion/ the teeth, the muscles and joints effect the CNS and their responses after relaxation therapy as it relates to mandibular positioning before and after muscle relaxation. Only those within the neuromuscular NM and GNM community have even considered using scientific ADA and FDA approved technologies in their offices to measure these responses. Other TMD and occlusal oriented philosophies have not used these computer aided technologies such as low frequency TENS and Jaw Tracking devices to begin to measure mandibular jaw positioning changes before and after TENSing (muscle relaxation) before, during and after.
Since the psychosocial orofacial community are typically antii instrumentation and more pro pharma and stress related they have concluded with their traditional biases about what TMD is about. Those who recognized malocclusion as a possible valid TMD theory also have bantered against the use of objective measuring instrumentation but are just now barely getting on board with the use of EMG measuring and or measuring joint sounds (JVA), but once again they have not yet gotten on board with accurately measuring mandibular POSITIONing of their patients mandibles relative to the maxilla before and after muscle relaxation techniques, so they really haven’t accurately quantified their occlusal results…so we get a diverse group of opinions of success responses with non reported TMD occlusal failures as reported on these TMD forums.
What is wrong with using objective measuring tools that are ADA and FDA recognized to do research?
NM and GNM are doing our best to stay cutting edge to better understand these issues by using TENS to relax muscles, measuring muscle activity before and after any occlusal treatment with EMGs and even more importantly use accurate and precise computerized mandibular scanning (jaw Tracking) to measure our patients mandibular location, positionings and functional abilities before, mid and after any occlusal interventions. That is how we do our research objectively.
The GNM dentist doesn’t just use TENS to relax muscles only, neither do they just use EMGs to measure muscle activity and balance only but used a combined approach using all 4 modalities of TENS, EMGS, ESG (joint analysis – electrosonography) as well as CMS – computerized mandibular scanning/ jaw tracking to objectively measure and quantify our patients resting and functional status of where our patient’s mandibles function whether their bites are on the right healthy functional path mandibular closure or whether the patients bites are functioning on some other abnormal functioning path that may be pathologic. 0.1-0.3 mm difference whether the mandible is closing on an optimal path of off an optimal path of closure makes a difference to those of us who measure and and realizes these micron differences do matter to how the body functions and responds to postural issues.
How else can anyone (any clinician) within this profession or outside this profession adequately do objective reliable research without proper measuring tools to logically and scientifically arrive at the cause and or solutions to these multifaceted problems involving teeth/occlusion, muscles, and joints?
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Is there scientific evidence to prove cause or solution to TMD?

OC IS THE LEADING GNM/NM TRAINING CENTER

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OC IS THE LEADING GNM/NM TRAINING CENTER

I want to let you know that OC and all our K7 doctors are committed to Myotronics and the neuromuscular approach.  OC no doubt in my mind is the leading training entity, center and place where those who are seeking advancement in their NM understanding and clinically abilities can come to learn how to apply the principles at an advanced level –  beyond what is being presently offered anywhere in this world.

We believe in building long term commitment dentists who value the NM principles that Dr. Jankelson and Jim Garry advocated years ago.  We see the importance of creating dedicated clinicians who understand the clinical issues as well as help instill a deep seated value for our K7 and J5’s.  We believe in effective clinical interpretation of all the K7 scans (not a watered down version of pseudo NM interpretations) according to GNM principles that have been proven and clinically effective.  OC raises the bar on all neuromuscular K7 dentists who treat TMD, orthodontics and complex occlusal problems with insights and depth that surpasses standard classical NM teachings of the past 10 years.

Please encourage any and all NM colleagues who have a desire to advance their continuing education in these concepts to come to OC for their GNM training.  OC is the true believes in Neuromuscular Occlusion.

OC has proven to many NM K7 trained dentists that we have advanced teachings that fills in the missing gaps of the present day NM teachings.  As you know we are passionate and are definitely on track in helping many regain back a vision,  focus, commitment and return back to a balanced perspective of why we own and operate our K7’s at advanced levels.  We are not those who understand a watered down NM political perspective, but rather are the committed elite who know what the differences are about.

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OC IS THE LEADING GNM/NM TRAINING CENTER

How Many Practicing Dentist are Expert Dentists?

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According to the U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, there are 151,500 Practicing Dentists in the United States. I believe conservatively speaking 80% are involved with the following:
* Preventative care – Restore, reconstruct, replace, redo, alter, extract, maintaining.
* Limited understanding of the importance of the bio- physiology of occlusion/ practice management of their practice.
* They have very little to no understanding of TMD issues.

Approximately 22,725 Dentist in the U.S. (15% at best, again a conservative number, giving them a benefit of doubt) are involved with the following More Advanced forms of dentistry such as:
* Recognize some of the musculoskeletal occlusal signs & symptoms.
* Masticatory dysfunctions disorders.
* Joint derangement problems
* Temporomandibular pain problems.

Now this leaves a remaining 5% approximately 7,575 Dentists in the United States who may consider themselves as “expert” dentists (again a very conservative and generous number for the benefit of any to doubt…these expert dentists should be able to do the following:
* The ability, skills to treat, recognize and see the occlusal/TMD problems.
* Able to treat the masticatory dysfunction, pain and TM Joint derangements effectively.
* Ability and knowledge to address the cervical dysfunctional TMD problems
* Ability and knowledge to address the TMJ primary problems, Class II division 2 retruding jaw problems and or retruded maxillary problems.
* Ability, skills and knowledge to treat the anterior open bite TMD pain problem cases
* Address the CNS – autonomic (parasympathetic and sympathetic) responses of the TMD patient.

Question: Where are these 7,575 Expert Dentists in the United States, let alone in this world where our TMJ/TMD discussion group of patients can go to access these doctors? I want to know…where are they if they exist in this country.

Consider this…<1% of the total number of dentists in the United States is the remaining number of 1, 515 Dentists possibly available at best to address this list of problems I mentioned above (these are the concerns that most of these internet TMD layfolks on these forums have as their concerns). I don’t think what I have stated was over exaggerated or out of line at all. How else can one explain the predicament that many here are on in?

[A TMJ/TMD Discussion forum member] stated his interpretation and posted his opinion above as: “The arrogance of stating that only 1%, of health care providers agree with the current #TMD #CNS model. Then stating that 99% are wrong, is in addition outrageous.”

I don’t think what I stated was wrong neither outrageous…..I actually stated the following: “This is where we see 99% of the profession fall short from their lack of understanding the GNM issues.”

What I posted above in this thread was based on this type of data and information. You can all decide base on state data…not on some biased opinion.

There are no more than 230-250 dentists who have actually come to get trained in GNM here in Las Vegas at Occlusion Connections. Not all have gone through the Levels 1-7 and ortho/orthopedic training in total. You all can do further the math!

GNM is such a small entity in the bigger picture of things, yet for some reason it has become a significant focus of attention around the world for some odd reason amongst many TMJ and TMD forum groups. GNM dentists are just dentist trying to do what is right and do good things for our TMD patients. Is that a bad or outrageous thing to do?

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

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How Many Practicing Dentist are Expert Dentists?

Fabricating an Appliance: A Word from the Wise

Dr. Clayton Chan…..views on fabricating an appliance
Wise words…..

Here is the problem:

Some folks don’t realize that there are a number of things that should be considered to make a so called “NM orthotic” or whatever appliance/ GNM Orthotic to be effective. It’s not just the look of the appliance, its not just the shape of the appliance, its not the color of the appliance that makes an Orthotic successful! Its how the doctor, yes the doctor manages it. It is how he/she the dentist finds the mandibular position of the patient. It’s not some kind of willy nilly open the VDO (vertical dimension of occlusion) and snap the orthotic in your mouth and away you go! NO. It’s so much more than that. It’s more than collecting some fee and saying now you are done. NO its more than that….Its not about doing a 5-10 min adjustment and says everything looks good and now you are done (that is NM??? – You are kidding?!!%^&). NO, it should be more than that! Its about the doctor taking his/her time to do it right! Yes, that is right it takes time to make an orthotic or a so called NM orthotic fit well in the mouth, feel and function properly in your mouth. If it ain’t feeling right in your mouth it ain’t going to help you get better faster…It will just take more time like all the other splints and quickie band aid appliances so called NM orthotics out there.

Sure there is a particular way we design the orthotics amongst the OC doctors, but again, that doesn’ t guarantee anything…its the doctors know how, the training and the time he/she spends to apply the principles and the techniques “properly” that are necessary to make that orthotic feel like is is suppose to fit not just on the top of the teeth but between the teeth when you talk, chew and sleep. It takes time!

Again, if the appliance is not feeling right in you mouth, of course you will not want to wear it…because the bite is not fitting correctly, or the position of the appliance that it is causing your jaw to go to some other position (pathologic), it may not be right and or a number of other factors. So, lets be clear on what is not working! It’s not just the look or color or shape of “one of those”. It’s how it is done to fit the mouth and bite that makes it effective…It is not the clear thing that is the secret to TMD resolution!

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

To Read More:

 

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Fabricating an Appliance: A Word from the Wise

Where are your studies to back your talk up Chan?

Nick Yiannios Where are your studies to back your talk up Chan? We are still waiting… You’re sounding like a salesman for Myotronics.

Clayton A. Chan

Clayton A. Chan Nick, where have you been all these years? 15 years ago and even earlier in the early 1970’s this NM battle was ragged (read: http://nmdfacts-battles.blogspot.com/) among our profession regarding occlusion and the neuromuscular concepts validity to which I practice. Scientific facts rather than opinions was Dr. Bernard Jankelson basis for his further investigative studies as a trained prosthodontist who practiced in the state of Washington. Let me take a moment to update you on some past history. (if you have time to carefully read).

“In 1986, the American Dental Association Council on Scientific Affairs recognized Myotronic’s neuromuscular instrumentation. [To keep the record straight I am not a paid a salesment by Myotronics nor have any financial interest with them like some others…I am just an end user who realizes its value and sophistication very well].

In July 1995 House Commerce Oversight Subcommittee on allegations of FDA retaliation that the FDA’s Office of Internal Affairs found Roland Jankelson’s testimony so compelling, the credibility of then FDA Commissioner David Kessler’s testimony to the Committee regarding the Myotronic’s issues so lacking and the evidence of FDA cover up so powerful that the criminal investigation was transferred to the Inspector General, Department of Health and Human Services. The two year investigation concluded “In 1994 the Dental Products Advisory Panel of the Center for Devices and Radiologic Health (CDRH) assessing a Myotronics Inc. dental measuring device was indeed rigged.” The probed resulted in discipline and dismissal of certain FDA employees, including the author of the 1988 ADA Draft Status Report.

(I do not believe your Bio colleagues had the guts or stamina to stand up to such scrutiny and convictions…even to this day….if so where have they been during those early pioneering years and even after during those years when many criticized NM instrumentation, its validity and its concepts, where have they been when it was needed to stand up, voice their belief’s, convictions in order for you to enjoy the things you are professing today?). Where have they been? Hiding? Just watching on the sidelines to see who is the winner?…without putting any conviction of thought or effort into really find the truths about how the masticatory system works physiologically, or are they just selling equipment to the dentists with no occlusal philosophical belief.

Dr. James Garry, past President of ICCMO, Dr. Barry Cooper, President of ICCMO, Dr. Larry Tilley, President of the TMD Alliance, Robert and Roland Jankelson (son’s of Bernard Jankelson) who possessed the courage and tenacity of Dr. Bernard Jankelson (father of Neuromuscular Dentistry) along with countless others gave their time and energies to overcome seemingly insurmountable adversaries who were skeptical about the validity. Yet, time after time the disciples of Dr. J have prevailed and the pigeons of Zeus retreat, only to reappear. Their venues change, but their agendas remain the same. The neuromuscular devices, principles and protocols have the ADA Seal of Acceptance and recognition of the FDA. The neuromuscular devices I and many of my GNM colleagues use clinically have the lowest priority classification as per the Advisory Council, which have been granted in 1994, and are recognized as safe and effective by the FDA.

An overwhelming amount of scientific evidence was produced to both the ADA and FDA’s scrutinizing councils years ago so to produce that here would be unproductive. But if you want you can do your own research as I have done years ago to read up and find those supportive papers as I have done in times past giving you reference link for your perusal on your own time. (see above and the related links in those links).

Through the years since the early 1970’s there has been a resistance of anti-instrumentation critics when the present methodologies were challenged with scientific credibility. Although the CR concepts has been the gold standard for years it has been unsupported with scientific evidence. In 1988 the political battlefield shifted from occlusion to TMD. A small group identified with the gnathological occlusal paradigm joined a small group from the American Association of Orofacial Pain (AAOP), to exert political pressure upon the ADA to rescind the Scientific Council Seal of Recognition for neuromuscular measuring devices. As time evolved the K7 users across this continent and internationally (university research departments, etc) also see: http://occlusionconnections.com/…/k7-system-used-in…/, advanced protocols and techniques have been developed beyond the classical NM teachings over these past 15 years at OC. Testing these protocols and ideas has been done amongst many astute and very clinicians of at least 10-21 years of clinical experience regarding EMG fatigue analysis and various clinical studies regarding efficacy of occlusal outcomes. GNM teachings sprouted out from the foundations of NM to further advance the concepts and teachings beyond the classical NM teachings.

Interestingly the Bio folks including you and your colleagues are riding on the good will of dedicated hard work of others you seem to fail to acknowledge the often unrecognized NM predecessors who pioneered and developed the foundation of CMS, EMG, ESG and TENS technologies to which you are privy to know in limited forms (whether more advanced than K7 is to be questioned clinically and philosophically).

Dr. Norman Mohl was retained by the ADA to review the scientific safety and efficacy of these devices as aids in diagnosis and treatment of TMD. The draft Report concluded that “Expert for devices have been developed for electromyographic biofeedback, none of the other devices intended for treatment of TMD have the scientific evidence required for their recommendations.”

Ultimately it could not hold back the tide of scientific evidence that exposed the Mohl Report as a adhominem politial diatribe, not a reasoned scientific document. Myotronics submitted a voluminous review of the scientific literature supporting the efficacy of surface EMG, jaw tracking and low frequency TENS for diagnosis and treatment of TMD to the ADA Council on Scientific Affairs. After unprecedented scientific scrutiny these devices were ultimately awarded the ADA Council on Scientific Affairs Seal of Acceptance.

“Manuscripts submitted to scientific journals are reviewed for validity in the same way as granted requests. And who is better qualified to judge an article than those same eminent experts with their laurels to guard?”

It is based on this science and the work of many of my colleagues, our studies, clinical experience from years of practice and analysis from various perspectives and philosophies being in the trenches of dentistry and using our K7’s properly and completely and prudently both nationally and internationally that we at Occlusion Connections follow and implement the physiologic occlusal and neuromuscular principles we call GNM at an advanced objective level.

I am not sure if you have time to study these objective measuring concepts to the depth that many of us OC doctors have studied over these 15 years, since we too are a group of analytical and skeptical clinician’s who are very interested in TMD and occlusion, etc., desiring to positively assist in understanding the demises of TMD issues and effective remedies. That is why we ask you the questions and will continue to do so to encourage a rational debate of clinical and treatment effectiveness for the sake of our TMD lay folk members understanding.

 
NMDFACTS-BATTLES.BLOGSPOT.COM

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

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Where are your studies to back your talk up Chan?

Understanding Principles: More than Technology

An Emphasis of IMPORTANCE – PRINCIPLES over Technologies

What all dentist need to learn and understand are the PRINCIPLES of what this type of technology is discovering and unveiling. If they understand the principles the dentist can then modify their traditional occlusal and TMD philosphies as well as modify their clinical methodologies to fit and be in better align with the biophysologic science. It doesn’t mean they all have to have these kind of technologies but they do need to learn what these technologies are unveiling…the technology definitely does not support a mechanical occlusal philosophy like centric relation methods when recording bite registrations, as example…. the technology shows that the bio physiologic neuromuscular concept is the right direction to go.

That is what all TMD treating clinicians need to realize…and from this kind of data and information adapt their protocols to better fit the neuromuscular bio-physiologic protocols that better helps patients. It is simple as that. Who says every dentist has to have K7 and J5 TENS. Learn the principles!

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

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Understanding Principles: More than Technology

Here is My Story…

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

Here is my short story…

I have been practicing routine general dentistry for years in California…it was good dentistry. After some years I realized some of my patients were having TMD problems…but I couldn’t seem to help them resolve the issues…and it really bothered me. I tried many ways but they were not working for them or me…. I almost decided to quit dentistry because things were not working like it was taught in dental school. After feeling frustrated for some time as a dentist not getting the results I knew were possible….I decided to do something about it. I wanted a change…. so I decided to look for answers…I had a lot of questions about dentistry and the way it was being done that had to be answered. So I started to search…

I took continuing education courses across the country…listening and gathering ideas, information, searching for ways that made the most sense…. over time I started to formulate ideas and eventually got some answers that made sense…but not without disrupting audiences, lectures and programs…oh yes,..I am noted for doing such and asking the difficult tough questions to the profession…why? Because I am a dentist and I got tired of doing the same routine of drill and bill dentistry. I wanted answers that made sense and answers that were practical.

Well, here is the “pitch”…. there is another way dentist can do things if they really want to….if they pride themselves in the work they do… or are they just dental technicians doing piece meal work (doing fillings, crowns, extractions, root canals, dentures, implants)…or do they really care about getting patients healthy…looking at the bigger picture being physicians of the masticatory system?

I decided to slow my dental practice way down…purposely over the years…I got tired of cattle herding folks in out of my operatories with large number of employees to perpetuate the typical dental process, doing it fast, and quick and short visits… but over time I realized a dentist has to make choices….do routine care or he/she can do quality healthcare both are needed but only one way will meet the needs of the 20%ers who are in greater need.

As I got older and experienced in my career I decided quality of care to me was valuable then the quantity of care. Quality of heath is valued to me more than the quantity of care. Quality of function is valued more than dysfunction and bodily impairments…

So I continue to search for that fine balance in life as a dentist…to help those I can…dentist who understand this plea, tired of the rat race of dentistry and patients desiring a different way.

This is the journey for us all. Change is necessary for some of us… or we put up with the status quo. I chose to change and do what I can to help make that change in my life with purpose. It is all possible…if there is a will there is a way.

Last thought… I believe in Prayer! When things look impossible and bleak….offer a sincere pray to our Heavenly Father we don’t see…but He listens to all his crying children on earth. That is what I do when I have difficult challenges in life. Prayer is amazing. It’s free and no strings attached.

 

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Here is My Story…