As part of a complete joint & muscle exam joint auscultation is necessary. We need to be able to answer the question “Where is the disc relative to the head of the condyle in rotation and translation?”. The answer to this question identifies disc position on both the medial pole and the lateral pole and helps us begin to assess the risks. Ultimately the definitive answer to this question requires an MRI, but auscultation is one early way to get an idea. The following video discusses doppler auscultation as well as demonstrating the technique and creating an opportunity to listen to an observe the sounds.
A critical piece of joint diagnosis is being able to differentiate the sounds we hear using auscultation. Based on the way load is applied in varying positions we know that in a seated condylar position and through rotation the load is on the medial aspect of the condyle/disc assembly. During translation the load moves out to the lateral aspect. By listening to the joint during rotation, which is the first 10mm or so of opening and the condylar movement on the working side during an excursive we can get information about the disc position. Translation occurs when listening on the balancing side during an excursive or during the rest of the opening movement.
In a previous post this year I talked about patients who are at risk of developing a “pop or click” and the importance of identifying this risk. This video clip is a segment of the first session of “Occlusal Diagnosis: Identifying Risk”, a six credit hour online seminar I offer once a year. In this segment I discuss the concept of ligament laxity, the anatomic condition that contributes to it, and the steps in diagnosis.
In Part two I continue the conversation about the relationship between the joint load and the occlusal contacts we create when we design an occlusion. That occlusion can be transitional on an appliance or final, created using an equilibration or restorative dentistry. Joint load is one of three considerations when designing an occlusion for a patient with a history of TMD or wear. We need to think about the relationship of the contacts to the joint load, the muscle engagement and the force across the teeth. An upcoming hands on program
Designing the occlusion for a patient with a history of joint issues can be challenging. Understanding where the disc is in relation to the head on the condyle in intercuspal position and excursions is a critical piece of diagnostic information, as well as inflammation and discomfort in different positions. One of the ways we can stabilize the Temporomandibular joint and minimize or eliminate inflammation and symptoms is by managing joint loading. In this first of two videos I look at the concept of joint loading and how we can use occlusal contacts to alter it. An upcoming hands on program I will be teaching at The Pankey Institute addresses restoring the occlusally compromised patient, whether the compromise is joints, muscles or wear.
Today is the first session of the “Occlusal Diagnosis: Identifying Risk” online seminar and the topic will be joint diagnosis. It can be a challenging situation when a patient suddenly develops a joint “pop” or “click”. Especially if it follows a routine dental visit like hygiene or a buccal pit composite. There are a group of patients we see in that are predisposed to develop a lateral pole disc displacement. We have the ability to determine who some of these patients are and help them understand the underlying condition.
Getting to the bottom of jaw or muscle pain is about putting together the pieces of a puzzle, which is made of the signs, symptoms and diagnostic findings. During a pre-clinical interview with a new patient today he shared that he has pain over his right joint sometimes when eating. Noting this I began to wonder what I might find as I did my exam to narrow down the possible conditions that can cause true jaw pain during function, or muscle pain that is being referred over the lateral pole of the joint. During his comprehensive exam the patient reported a similar discomfort in his right joint when moving to the left.
I’m not sure of the exact percentage of patients that have a “pop” or “click”, but joint noise is a common finding. When working with a patient that has joint noise my primary concern is to assess the stability of the joint. If the situation is unstable or the patient is symptomatic relative to the joint, then together we determine the appropriate treatment to try to establish an asymptomatic, stable condition. Other patients who come to see me with joint sounds are asymptomatic, and from my examination have a stable joint. The next question I ask myself, especially if they have restorative concerns, is “what is the risk of altering that stability”?