Monthly Archives: March 2009

Primum non nocere (“First, do no harm”) Part 4

This is the continuation of Sue’s story.

My challenge was to diagnose very precisely where the jaw fits now (where there are symptoms) and where the jaw SHOULD fit if all the jaw / neck muscles are unstrained AND the jaw joints are in an optimal position as well.

Our Neuromuscular diagnostic protocol includes measuring emg’s before and after these muscles are optimized.  The end result is the mounted casts aligned with the myobite taken at the end of these tests.  We KNOW that the muscles will be unstrained in this position because we measure these muscles when the natural teeth are occluding and when they are occluding on the myobite.  When we see that the muscles are much quieter with the myobite, it confirms the correctness of the bite relation.

FrontCasts View from front showing a larger “gap” on her right side, where recent restorations were done.

  RtCasts  LtCasts

The anterior posterior discrepancy would explain the many adjustments needed on her upper front teeth after veneers were done….and the pain since the mandible had to posteriorize to avoid this area from proprioception.  This explains the joint pain.

In the next post, we would show how this was corrected and the results.

Primum non nocere (“First, do no harm”) Part 3

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.

  BaselineThis 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