New Patient Exam
At your new patient TMJ exam you will need to bring a filled out copy of the patient forms that you can print from our website, a copy of a recent panoramic x-ray, and any orthotic devices you currently have, such as mouth guards or splints. Your appointment will start with one of our knowledgeable Dental Assistants taking you back to our operatory. The assistant will ask to see your Panoramic x-ray if you have one. If you do not have an adequate panoramic x-ray, it will be necessary to have one taken in our office. This is usually covered under insurance for an amount that varies; the x-ray can be taken every 3-5 years depending on insurance.
Our next step will be for the assistant to get as much information about your symptoms and past treatment. Finally, the assistant will take a T-Scan. This is a computerized bite analysis instrument that allows us to obtain a digital reading of your bite or teeth as they come together. After all the information is gathered, the doctor will do a full exam.
During the exam the doctor will examine your teeth and palpate your facial and neck muscles. Often, TMJ sufferers will have muscle triggers in their neck. With the information gathered the doctor will make a diagnosis; however, some patients require more diagnostic information before a diagnosis and treatment plan is given. Also, every patient is unique and will require different treatment plans to help reduce pain and discomfort.
A Deprogrammer is an upper splint that covers the front six teeth. The deprogrammer is used to help with tender jaw joints, constricted airway, muscle tension, headaches, and protects the teeth if the patient clenches or grinds at night. The deprogrammer does not cure all of your symptoms, however it does help to slow them down. The deprogrammer is used as a diagnostic tool to identify where the problem areas are. It is made from a material called triad that starts out as a soft sheet of plastic and is molded to fit the patient’s teeth. It is then cured or hardened with a laser light, and adjusted till it is properly balanced, so that the patient is comfortably resting on it evenly. The deprogrammer is primarily worn at night, and stored in container with a little bit of water when not being worn.
Follow up appointments are necessary to track the progress of the patient, and further treatment that may need to be performed.
Care of a Deprogrammer:
When taken out of the mouth for storing it will need to be brushed with a toothbrush and toothpaste as it will collect bacteria. It will then be placed in a small container provided by us with a small amount of water to cover just the bottom of the container (you may put a splash of mouthwash in the container for taste). Store the deprogrammer out of the sunlight as it will shrink it and the heat will evaporate the water causing the deprogrammer to crack.
If the deprogrammer feels a little tight you can us some warm water to loosen it before putting it in your mouth.
Keep out of reach of pets, they love to chew them.
What is a full bite splint?
A full bite splint is a removable appliance covering some or all the occlusal (chewing) surfaces of the teeth, and can be worn on the maxillary (upper) or mandible (lower) teeth. The splint should provide the patient with a neutral jaw and teeth position, which can cause an immediate relaxation of the muscles. When the lower jaw repositions itself as the muscles become neutral, it is necessary to adjust the splint to maintain even contact. There are several different types of splints and your dentist will determine which one is right for you. The duration and frequency the splint is worn will also be determined by your dentist.
Diagnostic Records Appointment
TMJ Records Appointment
The records appointment is very valuable. We will gather more information and combine it all to determine a correct diagnosis and treatment plan. Here’s a glance of what the appointment will consist of.
At the Diagnostic Records appointment the assistant will begin with a series of digital photographs much like at an Orthodontist office. After the photos are edited and saved, the assistant will take a T-Scan (a computerized bite analysis). The assistant will then proceed by marking the patient’s upper teeth on a bite fork using a fast set impression material. The bite fork is used to take a jaw measurement to show how the upper jaw (maxillary) fits into the cranium. It shows the different angles the jaw may be in and where the asymmetry is primarily. All of the digital information that is gathered will then be assessed by the dentist and he will give a full exam and go over diagnosis and treatment options with the patient.
Balancing a bite with Occlusal Equilibration
Occlusal: The Chewing Surfaces of the teeth
Equilibration: To Balance Equally
What is occlusal equilibration?
Teeth are sacred. Knowing where the asymmetry is located, where the force of the occlusion is travelling during function and having the muscles as neutral as possible is going to give any patient a positive equilibration. Occlusal equilibration, also known as occlusal adjustment, refers to the reshaping of the occlusal surfaces of teeth to create a harmonious contact relationship between the upper and lower teeth. Too much force on the inside or outside of a cusp is going to be trouble down the road. Having cusps hitting point on point is detrimental to the health of a tooth; cracking or breaking, bruising of the bone, swelling of the periodontal ligament, an abscess or even worse, a needed extraction.
After measurements and models have been taken, the proper diagnosis is discussed with the patient. The patients bite is recorded in a digital movie format (T-Scan) on the computer prior to adjusting the occlusion. Bite paper is used, having the patient tap up and down, left to right and forward. The teeth that are hitting the hardest are observed and corrected by using a high speed drill. (The patient isn’t numb for this procedure as we need them to feel the tapping and changes being made to the occlusion.) This process is repeated until a significant change has occurred. A “homerun” adjustment isn’t always the best policy when dealing with occlusion as there is more anatomy involved than just the teeth. Once the adjustment has been made, the patient taps their teeth together in amazement as their teeth actually come together better. (They have more teeth tapping together.)
After each adjustment, the patients are reminded that they may find themselves tapping their teeth throughout the day. This is common as the muscles are looking for their old pattern, or rock in the shoe, that is no longer there. The muscles adapt quickly as they aren’t fatiguing out as fast while chewing or swallowing. And lastly, the patients are made aware that they may bite their cheek or tongue as the teeth come together faster without the restriction they once had, causing the soft tissues to get trapped between the teeth.