The Right Tool for TMD

April 14, 2014
I want a magical machine that tells me exactly what is wrong with my patients, so at least I can understand where to start.

By Neal Patel, DDS


Also by Dr. Patel: The Right Laser | The iChiropro from Bien-Air


It's time for me to be honest! As you read this, it's time for you to be honest to yourself! How many of us really know what we are doing when we evaluate and treat our patients with TMD? To me, it's a big mystery. I, for one, have not gained the experience to evaluate TMD patients by traditional methods. In addition, sometimes the piece of plastic I give them does not provide the relief it is intended to provide.

Sometimes we have to be honest with ourselves so that we can make appropriate changes within our practice to have a better understanding of our patients' needs and feel equally confident in providing a solution to their needs. After having struggled with treating a few patients who presented with TMD, I reached out for advice and guidance from a few colleagues that have experience in TMJ therapy. I came to realize that each colleague had a different approach and protocol. I am sure that each one of these colleagues has great success with their methods, but I needed something in my practice that would allow me to leapfrog the seemingly years of experience needed to successfully manage TMD. I want a magical machine that tells me exactly what is wrong with my patients, so at least I can understand where to start.

The same machine should spit out a diagnosis, so I don't fumble in front of the patients with words that don't make sense to the average patient. After all, patients believe computers more often than their own health-care providers! In my search to find this magical machine, I met an amazing company called Bio-Research Associates, Inc., a group of passionate individuals who develop and produce highly innovative and advanced products for the evaluation of the stomatognathic system. I hope to one day introduce you to the complete BioPak, but let's start with the entry point for their comprehensive diagnostic testing equipment.

Bio-Research Associates is the sole manufacturer of the BioJVA (Joint Vibration Analysis) System, which provides a unique capability to quickly, inexpensively, and noninvasively evaluate temporomandibular-joint injuries, internal derangements, and degenerative conditions.

Let's face it; the TMJ is the most complex joint system with the most delicate nerves. It's a system that patients are acutely aware of when it's not working. Our ability to assess and document the joint varies from clinician to clinician. Far too often, our diagnosis is subjective. We blame our patients for breaking our porcelain and keep telling ourselves that the porcelain manufacturers need to come out with stronger and "better" materials.

Today, we have a massive problem of providing the same restorations, built into the same occlusion, but using a virtually indestructible material (zirconium oxide) to help compensate for our lack of understanding. I may be young and naïve, but I sure am dreading 15 years from now when these restorations need to be replaced! I think I would rather pull the tooth than try to cut one of these things off! All joking aside, I think we are doing more damage than we know. Even in being meticulous with the treatment of the stomatognathic system, the last thing I want is to have patients complain of pain after routine restorative care and blame me for a preexisting condition.

I decided to take the guesswork out of traditional approaches such as palpation, the stethoscope, the Doppler, or sonography. Such subjective measurements are no longer state-of-the-art in my opinion. We need to be as progressive as our physicians and utilize progressive diagnostic tools to help treat patients.

The Joint Vibration Analysis instrument provides objective testing that determines a baseline for the patient and provides for accurate and reproducible tests prior to, during, and after treatment. I highly recommend implementation of the JVA into general dental practices as a screening device, as well as an objective measurement tool in both diagnosis and treatment.

Joint Vibration Analysis is based on simple principles of motion and friction. Normally functioning joints are smooth, have lubrication, and little to no friction. However, friction is created when rough surfaces rub together and vibration results. Degenerative changes to the joint, tears in the soft tissues, and displacements of the disk cause surface changes, thus creating friction and vibration. Different disorders produce different wear patterns and these result in different and distinctive vibration patterns or "signatures." BioJVA, a computer-assisted technique that uses vibration transducers in headphones placed over the TMJs, helps identify these signatures and distinguish various TM disorders.

I realize that the TMJ is the cornerstone of everything we as dentists treat. Regardless of your philosophy of occlusion and treatment modalities, whether you treat some TMD or refer, the BioJVA is a useful screening tool that provides the dentist the ability to effectively provide documentation for all patients. The BioJVA clearly identifies the presence and nature of vibrations, the range of motion of the joint, and the presence or absence of significant deviations or deflections within a computer-graphical interface. It really impresses patients in that it looks similar to an ECG graph that can be recorded on follow-up or even routine exam – just like in medicine!

BioJVA offers specific information about the TMJ that simply cannot be obtained with traditional approaches. It is unique in that it can obtain simultaneous recordings of both TM joints during movement. In addition, it allows the clinician to quickly determine whether the patient has any signs of degenerative changes in the joints. Involving the patient early in a comprehensive diagnosis of their entire stomatognathic system at the very least creates a conversation about comprehensive care. Planting the seeds of comprehensive care begin with having the ability to show patients their needs.

Incorporating BioJVA into the examination of patients requires little disruption of the existing procedure times in the appointment schedule. It can be easily integrated because it takes the average clinician or team member only 30 seconds to administer the test. When a patient is positively identified with joint pathology, informed decisions can be made regarding the treatment options. It's a win-win!

The return on investment for the JVA is multifold. What I mean is clinicians will feel more confident with their diagnosis, treatment decisions, and sleep better at night with regard to TMD patients. There will be direct revenue streams from exams and appliance therapy and indirect revenue streams from creating an environment where the entire team feels confident in the dentistry provided by their leader, you! Get on board with JVA and take the mystery out of diagnosing and treating TMD!

Neal Patel, DDS, created a completely digital practice where he utilizes digital technology throughout (all-digital planning, fabrication of splints, surgical guides, and prosthetics), bypassing traditional analog methods. Widely published, he is best known as an international educator on 3D digital imaging, treatment planning, and computer-guided implant surgery. He can be reached via email at [email protected].

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