This issue of Dental Solutions highlights a case study of a patient, who suffered for years from TMJ problems. She went from one dentist to another, from one specialist to another. She had several splints made and two orthonagthic surgeries done. None of these helped her. Why?

If you are like us, TMJ was a big mystery during our dental school years. Then upon graduation and beginning to see “real” patients, we began to understand why this was such a mystery. You see... patients all have different needs. Some patients can alleviate their TMJ symptoms by just using home remedies, but this does not work for all. Others may get results by using a soft mouthguard, or a flat plane splint, or even a CR splint, but these don’t work for all. Different treatments work for different people, and this can be very frustrating to the dentist. There were even some patients that would never get better using any of our old treatments. As professionals, we would think these patients to be “crazy”. The mystery of why some treatments work for some but not for others was unknown to us for many years.

It wasn’t until we began studying neuromuscular dentistry techniques that all these pieces of the puzzle began fitting together. We began to see the human body in a new way. A way that taught us that no man-made technique, no man-made articulator was the answer to all our patients problems. We found that by using the “human articulator” our success rates of treating all patients went up significantly. Neuromuscular Dentistry teaches us that each person is different, each jaw has it’s own physiologic position that is ideal and that no two people are the same.

In neuromuscular dentistry we believe we must always “prove” that the treatment will be successful using reversible procedures before any irreversible treatment is performed.

An informative newsletter by Dr. Brad Durham & Dr. Rod Strickland, to educate and expand your knowledgeDentalSolutions

vol. 1 issue 2 Third Quarter 2009

Brought to you by:

TMJ: Temporo Mandibular Joint Syndrome

If you have a patient that you do not wish to treat at your office, please consider us. Send us your problem patients, even that stubborn denture patient who never seems to be satisfied. Perhaps, we can help.

We enjoy helping others and are generous with the information we have learned. Our observation is that many dentists have been able to treat more complex cases once they have had a few questions answered. Please know that we will be happy to help you in any way that we can.

We have hosted several study club type meetings. If you would be interested in learning more about our practice, increasing your knowledge of neuromuscular dentistry or finding another referral source for your tough patrons; please give us a call or email.

You may e-mail us at office@braddurhamdmd.com or call the office at 912-341-6969. You will get a prompt response. We look forward to hearing from you and will help in any way that we can.

Brad Durham, DMD Rod Strickland, DDS

Rod Strickland DDS Brad Durham DMD

The case we’re highlighting in this issue is about a woman who had suffered from TMJ problems for many years. Her symptoms were many including severe migraine headaches and jaw popping. She had previously sought out treatment from many dentists and specialists, in fact she had 2 orthognathic surgeries performed. None of these treatments helped her. She had given up on the hope that she would one day become pain free.

This patient’s medical history revealed approximately 11 years of migraine headaches, sometimes with a frequency of 3—4 per week and a lifetime of severe popping and clicking of the jaw. Over the past 11 years she had seen her internal medicine physician for this problem. She was referred to and had seen an ENT (resulting in sinus surgery), a neurologist (resulting in an MRI), a dentist (resulting in multiple bite splints), a chiropractor (resulting in spinal adjustments), an orthodontist (resulting in a referral to an oral surgeon), and the oral surgeon (resulting

BEFORE ————————————[Below] Bite over-closed causing the posterior displacement of the mandible.

in two separate jaw surgeries)…. all of these resulted in NO improvement of her headaches or jaw popping.

Neuromuscular treatment always begins in a completely reversible manner. We first want to find the proper physiologic position of the mandible as it hangs in its sling of muscles and ligaments. This was accomplished after a thorough medical and dental history and a K-7 neuromuscular workup. The patient was TENSed which caused the muscles of mastication to go to their physiologic length. This new mandibular position was then captured utilizing the K-7 computer with it’s jaw tracking capabilities. A removable orthotic was placed.

[Right] Jaw displaced too far posterior, cartilage disc not seated on

condyle.

[Top Right] Jaw displaced posterior

[Bottom Right] Neuromuscular

trajectory of jaw is not in line with habitual

trajectory.

Neuromuscular Trajectory

Habitual Trajectory

The purpose of the orthotic is: 1. Position the condyles in the fossa in a more true

anatomical position. 2. Reduce stress to the jaw joint. 3. Increase joint space. 4. Allow remodeling of the condyle. 5. Allow healing of the retrodiscal tissue. 6. Capture the dislocated articular disc. 7. Provide proper alignment of the mandible to the

skull. 8. Reduce myospasm and pain. 9. Maintain the muscles of mastication in proper

physiologic length.

AFTER —————————————[Below] Neuromuscular orthotic, anatomical splint made to physiologic mandibular postion.

[Right] Condyle

properly seated in the fossa,

disc seated on the

condyle.

The Result:Immediately upon insertion of the mandibular orthotic, the patient was surprised that her jaw popping went away. After wearing the orthotic for only a couple of weeks her headaches went away.

So what was learned here? Although she had sinus symptoms, the problem wasn’t the sinus. Although she had chronic headaches, drugs weren’t the answer. Just because previous splints didn’t resolve her pain, didn’t mean that her bite wasn’t to blame. She may have suffered from back pain, but that wasn’t the cure. And finally the jaw surgery that was done in an attempt to give her a better bite STILL wasn’t successful.

This patient emphasizes the fact that unless one can objectively confirm a patients bite (using a K7 bite analysis), they can never be certain of what the bite’s role is in the problem. She may have gone through all this treatment, but if she had stopped just prior to having Neuromuscular Treatment, she would have continued her life in chronic pain.

[Top Left] Increased posterior joint space.

[Left] Habitual trajector and neuromuscular trajectory identical

Neuromuscular Trajectory

Habitual Trajectory

Need back issues or more information? Check out our website at: http://braddurhamdmd.com/pro

An informative newsletter by Dr. Brad Durham & Dr. Rod Strickland, to educate and expand your knowledgeDentalSolutions

vol. 1 issue 2 Third Quarter 2009

An informative newsletter by Dr. Brad Durham & Dr. Rod Strickland, to educate and expand your knowledge DentalSolutions1317 Abercorn StreetSavannah, GA 31401

In future issues:• Phase II Permanent Bite Change– Exploring Porcelain and Orthodontics • Case of the Month– A patient’s testimonialIf you would like to see some other related question addressed in a future issue, please let us know by e-mail, letter or phone.

Lunch & LearnWant to learn more? We offer presentations at your office or at ours and bring lunch too!

Call us at 912-341-6969 to arrange a Lunch & Learn program.

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Need more information? Check out our website at:http://braddurhamdmd.com/pro