Evaluation of Gnathic system with attention given to occlusion and Muscle tone.
a. Tooth wear patterns,
b. Jaw opening, how wide? measure. lateral movement during open/close
c. Freedom to move laterally, how far? measure.
d. occlusal plane - steep curve? interupted? missing and/or tipped teeth, uneven marginal ridges.
e. Midline deviation
f. Ortho Class - I, I with *variation, II,II2, III, pseudo III, and note variations
g. Tongue habits retraction during opening** using tongue to brace the mandible during swallowing***, during speech, resting the mandible.(tongue placement for comfort)
h. Appearance of the face, especially eye alignment
i. Neck aligned with body center line
j. Shoulder alignment and evenness
k. Anterior controls and posterior stops ( guiding planes and occlusal stops)
l. discomfort in mandibular maneuvering
m. complaint of head/neck pains or discomfort
n. Any ear noises, photophobia
o. Tap Test mandibular manipulation lower teeth against upper teeth
*Variation It is possible to have different molar relationships side to side in the AP. Check cuspids.
**These people tend to gag easily. The retracted position on opening causes broadening of the tongue and triggers the gag as a result of touching the pillars and simultaneous breath holding.
***As in tongue thrusting. These sometimes show as various degrees of "open bite"
The tongue can be a real pain as we all know. I teach patients to manage their tongue position for the purpose of making life more comfortable for both of us and for the sake of less damage to the dentition. This is very important, especially in full denture cases and the "gagger".
It is physically impossible to gag and breath at the same time. Patients gag for the reason stated above.
You are beginning to get an idea of the complexity of TMD cases. If you are going to take these case you will be rewarded mostly spiritually. :))) I really do go through all of this in each case but I've been doing it for so long that it really does not take a lot of time. Almost all is done by visual observation and questioning. Once you know all of this stuff it gets easier. As I meet people today I find myself evaluating their conditions without ever looking in their mouth. That happened to me at a party my Dc friend was having for his recently graduated DC son. I was introduced to the girlfriend of his older DC son. She was a speech therapist. After a few minutes of discussing her problem cases, I remarked that she compensated very well given her own condition. :)) She became just a little annoyed that I would even suggest that she had a problem for which she needed to compensate. :)). I told her that she had a speech habit of placing her tongue against her front teeth when she said "s" sounds. It gave her a very faint lisp. At that point I suggested that she needs some speech therapy herself. :)) Wrong thing to say to a speech therapist whom you have just met. Long story short, she was in my office two weeks later, after some serious self examination and wanted to know what could be done? Exam revealed that she was using her tongue to brace the mandible during swallowing and had managed to keep all teeth mesial to the third molars out of occlusion. She literally had third molar occlusion, period. I told her that she needed Ortho, and that she was going to lose her third and second molars in very short order due to hyperfunction and clenching and grinding habit, which happened very shortly after this initial exam. That really got her attention. I only used ss brackets ( tried ceramic, too many problems, they were new) so she wanted to be refered to a real orthodontist. She wanted lingual braces for the sake of vanity. She found an Orthododntist that told her that "she did not need braces". She could not wait to tell me of this "opinion". I asked her if she really believed that, after what I had told her and predicted. She said "no", but what else could she do instead of braces. This is what I told her. "if you can keep control of you tongue, keep it away from your teeth, make a super conscious effort, your teeth will all come together within two years, by themselves simply because the tongue will no longer be in the way" That is exactly what happened. No Ortho intervention at all. She is still a patient along with her whole family. I love when that happens.................more later