Abstract
Adding technology to clinical diagnosis improves patient care, because objective measurements enhance the patient's report of symptoms and the observations made during an examination. The combination of multiple tests has universally been acknowledged to improve diagnostic sensitivity and specificity, as well as add value to treatment effectiveness monitoring and treatment outcomes. This chapter discusses four dental technologies that objectively measure differing masticatory functions: Surface Electromyography, Magnet-Based 3-Dimensional Electrognathography, Temporomandibular Joint Vibration Analysis, and T-Scan Computerized Occlusal Analysis. Each technology is presented with examples of its output data recorded from both an asymptomatic patient and one demonstrating masticatory system dysfunction. An included case report illustrates how combining these technologies can therapeutically improve a symptomatic Occluso-Muscle Disorder patient's diagnosis and treatment. Finally, recommendations are made that Dental Medicine accept these technologies as an indispensable part of modern clinical practice, so that resistance to their implementation will no longer inhibit their use.
TopIntroduction
There are three types of data collection methods used in healthcare to gather information for research, for diagnostic purposes, or to monitor treatment outcomes. They are:
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Self Report (Patient History).
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Type of data: Subjective
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Observation (Clinical Examination).
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Bio-Physiologic Measurement (BPM).
Of the above three methods, Biophysiologic Measurement is the most quantifiable (e.g. blood pressure, heart rate, range of motion), since it incorporates modern measurement equipment, and currently takes full advantage of the latest advances in computer technology. Despite the advantages of incorporating digital technology in dental practice, resistance within the dental community discounts the application of technology to dental diagnosis and treatment monitoring (Reid and Greene, 2013; Greene, Klasser & Epstein, 2010; Greene, 2010a; Greene, 2010b). In the 21st century, this resistance is surprising especially considering that there exists a myriad of evidence -based information, published studies, and extensive dental literature, that demonstrate the efficacy of various technologies for specific dental applications.
However, a closer inspection of some published literature that appeared in1969, proposed a psychosocial and stress-related theoretical epidemiology of what was termed “Myofascial Pain Dysfunction Syndrome” (MPDS), that to date, has long fueled the debate as to the need, or lack thereof, to employ measurement technology when diagnosing Temporomandibular Disorders (TMD) (Greene, Lerman, Sutcher & Laskin, 1969). The biopsychosocial etiology minimizes the role that the breakdown of masticatory structures plays in the appearance of Temporomandibular Disorder symptoms, thereby eliminating the need to measure physical and structural function. This stress-related epidemiologic theory was further perpetuated into the early 1990s, when the so-called “Research Diagnostic Criteria” was first postulated as a valid method to diagnose TMD (Dworkin & LeResche, 1992). The ongoing belief within the dental profession that TMD is caused by emotional stress, explains why some clinicians and authors still resist using any bio-physiological measurements in clinical diagnosis. The “biopsychosocial” theorists’ rejection of virtually all physical diagnostic measurement, is based in their (incorrect) assumption that TMD has no causative physical structural basis. It is interesting to note that resistance to technology-aided TMD diagnosis is maintained philosophically, despite there being a complete lack of reproducible physical data to support these biopsychosocial theories. Alternatively, the dental literature does contain many studies that detail the benefits that technology offers to patients who present with Temporomandibular Disorders, some of which will be described within this chapter. While scientific honesty requires acknowledging conflicting or competing theories, it can be a difficult pill to swallow.
Key Terms in this Chapter
Myofascial Pain Dysfunction Syndrome (MPDS): A term coined in 1970 under the theory that painful conditions of the masticatory system are primarily due to emotional stresses rather than physiologic causes.
Electromyograph: A device for measuring the electrical activity associated with skeletal muscle contractions. The unit of measure is the microvolt, one millionth of a volt.
Electrognathograph: A magnet-based incisor-point jaw movement recording technology. It records in 3-Dimensions (frontal, coronal and sagittal planes), the path and speed of the lower incisors during various mandibular movements.
Research Diagnostic Criteria: A scheme designed to diagnose all TMD conditions as if they were somatized pain conditions irrespective of actual etiology. Introduced in 1992 and extensively studied, it has never been successfully validated.
Dysthymia: A neurotic, chronic depression. A mood disorder with the same cognitive and physical symptoms as depression, but less severe with longer-lasting symptoms.
Bio-Physiologic Measurement: The measurement of any physiologic processes, usually for the purpose of evaluating its function. Also referred to as, Biometrics.
Joint Vibration Analysis System: A device for recording and analyzing vibrations emanating from the Temporomandibular joints during movements. The recorded vibrations are described by a unit of pressure, equivalent to loudness known as the Pascal, which is defined as 101.97 grams of force, spread over a one meter area.
Temporomandibular Disorders (TMD or TMJD): An umbrella term referring to one or more of at least, 38 distinct pathologic conditions within the head and neck area. It is always a plural term and never represents a diagnosis.
Average Chewing Pattern (ACP): The mean frontal, coronal and sagittal patterns of a patient’s chewing movements, calculated from a complete mastication sequence.
Irritable Bowel Syndrome (IBS): A condition of unknown etiology causing disruption of lower intestinal function and discomfort, but without evidence of inflammation.
Immediate Complete Anterior Guidance Development: A method of coronoplasty utilizing the T-Scan, to detect and remove excursive friction present in all excursive movements.