Monthly Archives: April 2009

Primum non nocere (“First, do no harm”) Part 6

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 CO Rt  TMJ Orthoticrt

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

  TMJ COLt   TMJ OrthoticLt

  10ro

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

 

  10o   10orthotic

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

Primum non nocere (“First, do no harm”) Part 5

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:

  Close   IMG_7819ed

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. 

2 wk progress front 

 2 wk progress back