TMJCHICAGO.COM

A WEBSITE ABOUT HEADACHES,
"TMJ" AND FACIAL PAIN

ALLEN J. MOSES, DDS

OBJECTIVE MEASUREMENT

Scientific equipment is now available to aid in documenting the physiologic status of patients, advancing dentists' understanding of pain involving masticatory dysfunction and guiding doctors toward better patient care. Using painless, non-invasive electronic measurement tools such as electromyography, electrosonography, and electrokinetic range of motion tracings, doctors are now able to confirm the status of many orofacial pain patients before, during and after treatment. Dentists can accurately evaluate the results of treatment. The methodology for such clinical study and treatment is scientifically sound, logical, safe, and well established in the dental literature.

In 1998, at an FDA meeting in which the panel recommended approval and classification of these objective measurement devices as aids in the diagnosis and treatment of Temporomandibular Disorders, one speaker criticized these measurements for not being validated by double-blind controlled studies. He contended that evidence based care should be the standard of medical science, and that the highest form of evidence should be double-blind controlled studies. A member of the audience then related a story. His wife had been hospitalized, and her physician had recommended a certain steroid drug. The husband asked if his wife couldn't first be tested to see if she was allergic or if the drug might be toxic to her. Her medical specialist explained that according to journal articles based on double-blind controlled studies, the medication was safe in well over 85 percent of all cases. No test for toxicity or allergy had nearly that level of reliability, so testing was not indicated. The medication was administered, the wife had an adverse reaction and died. The point is that no patient should ever be treated as a statistic. No one is the "average patient." Double-blind controlled studies provide inference, not evidence. It predicts statistically what the results would be on the average patient.

When patients consult with a doctor regarding orofacial pain, they are really asking, "Doctor, based on your expertise, can you repeat your most successful results from previous patients on me?" In order to do so, doctors must know what they did to get these results. They need to know what the condition of the patient was when he or she first came in, what specific characteristics constitute any diagnosis and what treatment was administered to achieve the result.

Dentists availing themselves of such measurement devices have objective documentation to establish defined parameters for many conditions manifesting masticatory dysfunction (TMJs and TMDs). These devices are FDA- and ADA-approved for safety and efficacy. Doctors who utilize such non-invasive, painless electronic measurement devices can document what they did to get their results. This is truly evidence-based care. Doctors who do not have the benefit of this information can only treat pain and non-specific symptoms based on subjective judgment.

In the words of U.S. Supreme Court Justice Benjamin Cardozo, "If something has been measured, it is a fact. If not measured, it is merely an opinion."

Devices used as diagnostic aids:
  •  Computerized Electrokinetic Jaw Tracking
  •  Electromyography
  •  Electrosonography
  •  Ultra-low-frequency neural stimulator

Computerized Electrokinetic Jaw Tracking

Electrokinetic Jaw Tracking is accomplished by placing a tiny magnet with adhesive, non-intrusively, within the lower lip vestibule beneath the teeth when they are in occlusion. A sensor array is anchored around the face by an ear and nose frame that is secured behind the head by velcro bands. The sensor array records incisor point movement in three dimensions by measuring the magnetic field. The information is fed to a computer, which digitizes the data into such frames of reference as sagittal, frontal, anterior, posterior, vertical, lateral, and velocity of movement. Functional activities such as opening, closing, chewing, swallowing, and rest position can be analyzed. Neuromuscular status such as degree of relaxation or dysfunction can be recorded, documented, analyzed and saved for future comparison.
        



Electromyography

Electromyography for analyzing masticatory function utilizes self-adhesive disposable silver chloride skin electrodes. They are usually placed bilaterally on the skin overlying the mid-masseter, anterior temporalis, posterior temporalis and anterior digastric muscles. Muscle activity is analyzed in both rest and function, at baseline initial readings and after relaxation therapy by ultra-low-frequency neural stimulation.

Surface electrodes are preferred over needle or wire electrodes because they are painless and non-invasive and they record the broad range of activity of the entire muscle. (Needle electrodes, in contrast, cause pain, which initially alters muscle function, and they only record the activity of the few sarcomeres or cells with which they are in direct contact. Measurement of electrical energy using needle electrodes does not accurately characterize the combined activity of the entire muscle).

Electrosonography

Electrosonography utilizes a pair of vibration transducers held in place over the temporomandibular joints by a very lightweight headset. Vibrations from each joint during opening and closing of the lower jaw are monitored by the transducers, amplified, and input to a computer for processing, display and analysis. Joint sounds can be examined for loudness, duration, and frequencies present. The condition of the jaw joints can be objectively documented over extended periods of time and their status accurately evaluated.

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