How do we KNOW that there is improvement with our therapy?  Of course, subjective reports are important.  But how do we know that it is simply not the case of a patient desperately hoping for an improvement that overstates the change?

Objective measures confirm or invalidate the subjective findings.

 TMJ CT sagittal view Pre-OP
With Orthotic…confirming decompression

emg - muscle activity at rest on the left half and at light occlusion- gently touching teeth on right half

Muscle Activity while lightly touching on natural teeth Vs on orthotic shows much calmer muscles.

This is the continuation of Sue’s story.

Once the diagnostic tests revealed where the mandible SHOULD align, the next step is to make that change in a reversible way.  Remember!  Primum non nocere (”First, do no harm”).  IF for some reason the patient does not get better, we need to make her no worse.  That means reversibility to the condition when she presented at our office.

Fixed LVI orthotic was placed on the mandible and fine tuned with the K7 instrumentation.  The progress is measured 3 ways:

a. Subjective reports

b. Objective tests - K7 scans of emg and mandibular movements and CT scans of the joints and cervical spine

c. Objective / Subjective:  Palpations of jaw and neck muscles and TM joints.  The pressure of palapation is consistent and objective.  But the patient’s response is subjective.

The images of the orthotic are below:

This is her report two weeks later.  Immediately after delivery Sue had gone on a long planned vacation and just returned for this follow up visit. 

Sue suffered with these symptoms (listed below) for over 6 months. She had seen a family physician and a neurologist who had tried various medications, as is the norm.  Nothing helped.  She finally heeded the advice of a friend who was treated with NM orthotic.  So very skeptically, Sue came for an evaluation.

  This was her baseline form.  We choose to use a “comfort scale” instead of the usual “Pain scale”.  So a Zero is the worst.  Her pain when chewing and pain the TM joints were Zero - meaning constant, severe pain.  All her other symptoms were in the “Severe” range, as can be seen above.

I will describe the treatment in the next post - Part 4

This is a story of a nice lady that sought our help recently. 

Sue is a 40 something woman who wanted to improve her smile.  So her dentist provided aesthetic all ceramic crowns for the upper front teeth.   

She also had tooth colored crowns to restore some    of the back teeth with large amalgams.  

Sue had several bite adjustments to these restorations since it did not feel right.  The symptoms gradually progressed to the point of “debilitating”.  She loved her work caring for mentally challenged people.  But she simply could not carry on, when she had constant pain that had worn her down.  The list of symptoms is long and they were present constantly. 

I will talk about these symptoms and what was done….in the next post:  Part 3

Primum non nocere is a Latin phrase that means “First, do no harm.”

While this is often erroneously attributed to Hippocrates, this maxim has nevertheless been a foundational principle of medical ethics for many years.  I believe that it equally applies to the practice of dentistry as well.

Cosmetic dentistry and orthodontics provide tangible benefits to patients.  A confident smile and improved self esteem greatly improve the quality of life of many.  But if the principles of physiology and function are violated there could be more harm caused than no treatment at all.  “First, do no harm.”

This is by no means an indictment of all cosmetic or orthodontic services.  But it is a call for prudence and careful consideration of the patients that trust us as their dentist.

I will describe a case to illustrate this point in Part 2.