course number: 166 dental treatment of headache and force-related problems · 2017-10-18 · dental...

Continuing Education

Dental Treatment ofHeadache and Force-Related

ProblemsAuthored by

Robert L. Harrell, DDS

Course Number: 166

Upon successful completion of this CE activity 2 CE credit hours may be awarded

A Peer-Reviewed CE Activity by

Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of

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LEARNING OBJECTIVESAfter participating in this CE activity, the individual will learn: • To describe how force related dental disease affects thehead, orofacial, and dentomandibular areas.

• To identify the assessment and treatment modalities in asystematic approach to treating dental headache pain.

ABOUT THE AUTHORDr. Harrell is a practicing dentist inCharlotte, NC. His practice focuses ontreating advanced restorative and TMDcases with the latest digital technologies. He has also pioneered the concept of thedental-based headache center for treat-

ment of patients with chronic head aches, TMD, and facial pain.He can be reached at [email protected].

Disclosure: Dr. Harrell is a paid consultant for DentalResource Systems, Inc.

INTRODUCTIONDentomandibular sensorimotor dysfunction (DMSD) isassociated with such conditions as chronic head aches,migraines, temporomandibular joint (TMJ) disorders, andnumerous other symp toms. When no definitive pathologyexists, more emphasis has been devoted to the mas ticatorymuscles, soft tissues in the head and neck area, andaltered central ner vous system pain processing in thetrigeminal area. Dentists are trained and experts inassessing and treating the an atomical areas affected bythese conditions and can provide patients with dentalheadache care, pain resolution, and treatment of forcerelated problems.

This article reviews the need for providing care topatients with chronic and unresolved headache pain. It alsodemonstrates the typical use of a complete, proprietary

system (TruDenta [Dental Resource Sys tems]) for providingcomprehensive assessment, treatment, and managementprotocol to achieve consistent, long-lasting, and effectiverelief from pain and dental foundation rehabilitation.

For millions of Americans affected by DMSD, pain ispart of their daily lives. Dentomandibular sensorimotordysfunction—a disorder of the head and neck, TMJs, jawfunction, dental forces, and neurology of these structuresand functions resulting from imbalanced or improperforces—lies at the root of many conditions. These include,but are not limited to: chronic headaches, migraines, TMJdisorders, and numerous other symptoms, such as TMJsounds or vibrations (eg, clicking and popping of the jaw),and pain in the head, neck, face, or jaw.1,2

The scope and negative impact of these conditions aresignificant. According to the National Headache Foundation,an estimated 90% of the population suffers from headaches,with migrane sufferers losing more than 157 million work andschool days a year because of heachace pain.3 More than 29million Americans suffer from migra ines.4 Additionally, theNational Institute of Dental and Craniofacial Researchindicates that anywhere from 10 to 45 million Amer icanssuffer from some type of TMJ issue.5

Finding little or no relief from over-the-countermedications or nonpharmacological techniques, thousandsof patients look to different healthcare professionals fortreatment solutions to their often debilitating pain. Dentists,trained and knowledgeable in assessing and treating theanatomical areas affected by these conditions, are uniquelysuited to offer such patients dental headache care, painresolution, and treatment of force-related problems.6-8

ASSESSMENT TOOLS AND TREATMENTS FROMOTHER DISCIPLINESDentistry has applied many technological and materialscience innovations to assess and treat oral-basedproblems. High-strength ceramics or in-office CAD/CAMsystems address the need to restoratively correct thedestructive effects of wear, bruxism, and tooth decay.9,10

The development of such enhanced materials has beenbased on clinical and research knowledge of the effects ofthe oral environment on restoration longevity, natural teeth


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Dental Treatment of Headacheand Force-Related ProblemsEffective Date: 10/1/2013 Expiration Date: 10/1/2016

opposition, and the masticatory system.11

Cervical range of motion (CROM) de vices or occlusalanalysis equipment (T-Scan) have helped shed light onpossible functional and physiological issues influencing thedentomandibular area and/or contributing to related healthproblems.12-16 Dentists have applied these technologies toimplant procedures and restorative rehabilitations centering onocclusal adjustments. For instance, electronic axiographictracers are used to resolve the movements of the condyles,magnetic resonance tomography imaging can be utilized toanalyze the anatomical relation of joint surfaces to the disc,14

and pressure sensitive foils in conjunction with time resolutionenable an accurate analysis of masticatory forces.11-13

These assessment and restorative ap proaches havecontributed to greater comprehension of the interrelationshipbe tween force overload and disease/dysfunction within theoral environment and the masticatory system. In restorativedentistry, awareness of the symptoms of malocclusion hasbeen key to offering predic table, consistent, and durabledental treatments.11,17

When malocclusion (ie, abnormal for ces between someor all of the dentition resulting in pain and/or damage to thetooth anatomy or periodontal interface) is present,alterations and adaptations may occur to the masticatorymusculature, the TMJ, and the function of the condyle.18-22

These adaptations sometimes may contribute to acute orchronic pain in the head and neck region served by thetrigeminal cervical nucleus. Subsequently, this can lead toadditional neurochemical adaptations and compensatorymuscle activity that can limit range of motion (eg, cervicalor mandibular) and/or result in trigger point musclespasms.20,21,23-25

When the occlusion is force balanced, a person iscomfortable at rest and in full closure exhibits mandibularrange of motion within normal limits, and is free from acuteor chronic pain. The person demonstrates normal toothanatomy and mobility, normal posture and work abilities,and has no dietary restrictions due to dental functionlimitations.11,26-29

Practical measuring instruments have successfullyidentified occlusal interferences and heavier forces, as wellas muscle responses and pain symptoms duringmasticatory function.26-28 Technology has helped to

accurately show significant discrepancies in jaw positionand muscle function that contribute to chronic dailyheadaches.30 Such objective data concerning pain stimuli,in conjunction with masticatory function combined withresearch on TMJ, orofacial, headache, and other systemicpain responses related to muscle forces, have shifted howdentistry deals with patients experiencing debilitatingdiscomfort issues.

When there is no definitive tissue pathology, moreemphasis has been devoted to understanding that pain insome patients may arise from altered central nervous systempain processing, especially in the masticatory muscles andsoft tissues in the head and neck area.31 Heightened muscletension and force—as related to parafunctional habits andstress—signal the likelihood of jaw and facial pain.32 Manytypes of headaches are now understood to be referred painfrom myofacial trigger points in the posterior cervical, head,and shoulder muscles.33

Reversing parafunctional habits (eg, bruxing, clenching,and grinding) through behavior modification has proveneffective in minimizing pain from TMJ disorders andmyofacial issues.34,35 Deprogrammers have played a rolein “retraining” the masticatory muscles, recognizing themuscles’ role in the forces contributing to pain, as well asthe fact that controlling the perpetuating factors (ie, force)can help control, reduce, or eliminate pain.35,36

For years, sports medicine technologies (eg, low-levellaser therapy, therapeutic ultrasound, and micro currentnerve stimulation) have been used successfully to enhance,accelerate, and improve athletes’ recovery frommusculoskeletal and force related injuries.37 Suchtreatment methods—when combined with neuroscienceand systematic and objective assessment/monitoring—noware be ing increasingly applied in dental practices.38-42

A COMPREHENSIVE AND INNOVATIVE SYSTEM The availability of a patented, proprietary system(TruDenta) enables dentists to provide comprehensiveassessment, treatment, and management protocol toachieve consistent, long-lasting, and effective relief frompain and dental foundation rehabilitation for patientssuffering from the symptoms of DMSD. The systemincorporates proven combinations of sports medicine


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Dental Treatment of Headache and Force-Related Problems

rehabilitation and advanced dentistry techniques, as well aswell-developed and tested equipment, technology,software, and therapeutic protocols (Figure 1). These havebeen cleared by the US FDA. They also have been shownto objectively measure and visually illustrate the cause ofpatient symptoms relating to DMSDs, as well as contributeto predictable outcomes when combined with conservativecare.38-45

The system uses T-Scan technology (TruDentaScandigital force measurement) for evaluating the amount andbalance of forces at closure and while chewing, and acomputerized ROM assessment tool (TruDenta ROM), whichmeasures the CROM as ex pressed in the patient’s headmovements. A CROM disability can be correlated withmandibular ROM disability and/or an imbalance in thedental foundation. The system’s rehabilitation technologyfeatures therapeutic ultrasound, transcutaneous electricalstimulation (ie, subthreshold micro current), low-level lasertherapy, and intraoral orthotics.

The following case demonstrates the typical TruDentaassessment and treatment protocol for individualspresenting with chronic headache pain and otherdiscomfort resulting from DMSD.

CASE REPORTDiagnosis and Treatment PlanningA 36-year-old woman presented, complaining of varioussymptoms of DMSD. As with any assessment and clinicaltreatment protocol, the first step was determining thecondition(s) that may be amenable to treatment. Therefore,the patient completed—and the dentist reviewed—comprehensive head health, medical, and headache history.A review of the patient’s pharmacological treatments alsowas undertaken prior to the clinical evaluation. Dental,periodontal, airway, orthodontic, and occlusal ex aminationsalso were undertaken. Additionally, a computed tomographyscan had been done recently by her neurologist to rule outthe existence of any underlying organic condition.

The patient showed symptoms of bilateral frontalheadaches. She experienced occipital and temporal headpain, jaw pain bilaterally with opening and closing, andlimited mandibular ROM with limited vertical opening. Inaddition to frequently experiencing jaw pain when chewing,

talking, and at rest, she noted jaw clicking, teeth clenching,and grinding, as well as recurring eye pain, pressure behindthe eyes, and shoulder pain and stiffness.

The patient was allergic to codeine and reported takingover-the-counter pain medications (eg, Tylenol [McNeilConsumer Healthcare]; Advil [Wyeth]; and Aleve [Bayer]),which did not provide relief. She also reported taking aprescription antihistamine medication (Allegra [Perrigo]) forseasonal allergies. Addi tionally, she reported seeking the careof an oral surgeon after awakening one morning with a lockedjaw. The oral surgeon had recommended joint surgery.

Upon muscle palpation examination, the patient showedtenderness of the anterior and middle bands of the temporalismuscle. In addition, bilaterally, the masseter, occipital, andtrapezius neck/shoulder area, pterygoids, andsternocleidomastoid (SCM) were severely sensitive. Thepatient rated the pain a 10 on a pain scale of one to 10, with10 being the worst. Severe tenderness also was detected uponpalpation of the posterior and lateral capsules of the TMJ. In


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Figure 1. View of thecomplete TruDentaSystem (DentalResource Systems) thatcan be used to assessand treat dental forcerelated problemsassociated withdentomandibularsensorimotor dysfunction.

brief, all of the muscles of mastication, TMJ ligaments, and thejaw position produced stark myalgia, which negatively alteredher normal daily living and social habits.

Crucial to establishing the severity of sensorimotordysfunction, any abnormal, excessive, or imbalanced for -ces were identified objectively using mandibular ROMdisability, cervical range of motion disability (digitally), anddigital force analysis (TruDentaScan). These technologieswere combined with panoramic radiographs. It is importantto note that the ROM portion of the diagnostic processprovides objective data conforming to AMA guidelines.

The patient’s T-Scan testing showed that 38.5% of thepressure from her bite was localized to the left side of hermouth; the right side of her mouth received 61.5% of bitingpressure (Figure 2). This demonstrated an imbalance ofthe stomatognathic system, which adversely im pacted thepatient’s overall well-being.

Clinical examination re vealed bilateral crepitus uponopening and closing. Cervical ROM measurements showedpain on extension and limited extension. The patientpresented with forward head posture, a back sleepingposition, and a sitting and standing work position. A digitalROM study revealed extension of the neck limited to 50°(60° is the normal ROM). The patient’s left lateral rotationwas at 37° (45° is the normal neck stretch) (Figure 3).These findings were thought to likely account for the severepain at the occipital, trapezius, and SCM muscles.

Based on assessment codes that are in agreement withthe AMA insurance codes, it was determined that thepatient suffered from the following: atypical face pain,cervicalgia, eye pain/pressure, headache, limitedmandibular ROM, TMJ pain, muscle spasms, and myalgia.

Treatment ProtocolTreatment was directed toward conservative therapy in anattempt to avoid surgery, establish orthopedic realignmentof the mandible, im prove myalgia, reduce inflammation,strengthen the musculoskeletal system, and alleviateheadaches as well as pain, pressure, and sensitivity in theeyes. First steps in the treatment process would involveassessment conforming to AMA insurance codes, wouldinclude manual muscle testing, TMJ ultrasound, and ROMtesting. Then, an individualized treatment plan would

involve therapeutic in-office appointments consisting ofapplied electrical stimulation, manual muscle therapy, coldlaser therapy, and therapeutic ultrasound. Addition alcomponents of the weeks-long therapy to be incorporatedwould be therapeutic exercises, an occlusal orthopedicdevice, and self-care home management training, based onperiodic occlusal analysis.

Stabilization goals were directed toward maintainingmuscle comfort, joint stability, and orthopedic stabilizationof the mandible. This normal function restoration wasachieved through an occlusal orthopedic de vice orrehabilitation orthotic. The rehabilitation orthotic helps tobalance, stabilize, and support the man dible. At the timeshe presented, the patient experienced symptoms from aninjured TMJ from excessive clenching and grinding, andlongstanding occlusal force imbalances. This overusetypically results in spasms and pain/sensitivity in themuscles of mastication.


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Figure 2. Theassessment T-Scanshowed that 38.5% ofthe pressure from thepatient’s bite waslocalized to the left side of her mouth; the right side of hermouth received 61.5%of biting pressure.

Figure 3. Digitalcervical range of motion(ROM) measurementsrevealed extension ofthe patient’s necklimited to 50º (60º is the normal ROM). Thepatient’s left lateralrotation was at 37º (45º is the normal neck stretch).

It was important to ensure that the orthotic wasfabricated in a manner that stabilized the jaw position to ahealthy placement to minimize muscle activity and thepatient’s pain and symptoms. The patient was taughttherapeutic exercises by the dental team. These exercisesfirst were done in-office, and then continued by the patientat home. The importance of continuing the regimen at homewas emphasized to the patient. If treatment did not continueafter the patient left the office, she would not progress in hercare. By purchasing—and correctly and regularly using—the home care kit, including the Alpha-Stim AID(Electromedical Products), the patient learned andbenefited from the proper preventative measures andmethods to stabilize and maintain her jaw health.

Treatment OutcomeThe patient underwent in-office therapeutic rehabilitation aspreviously described for 6 weeks. In addition to fabricatinga custom rehabilitation orthotic for the mouth, 3 sequentialocclusal equilibrations, or bite adjustments, were performedto correct bite imbalances.

At 6 weeks, the patient’s health and stability wereconfirmed with a digital ROM test. Range of motion valueswere found to be equal to or above physiologic norms(Figures 4 and 5). Dental bite force balance also wasconfirmed with the T-Scan analysis, which revealed left/rightbalance at 52%/48%, well within physiologic norms andtooth force readings at normal levels (Figure 6).

CONCLUSIONDentists can create a pathway of care that offerspredictable, reliable, and long-lasting relief from pain andrestored function to patients suffering from the symptoms ofDMSD. These include chronic headaches and force-relateddental conditions. Using a systematic approach toassessing and treating these conditions that incorporatestechnologies used for years in sports medicine (TruDenta),they can confidently provide much needed care toindividuals who haven’t yet found the relief they’ve beenseeking. Additionally, as in the case presented here,restoring balance, function, and overall well-being to thelives of long-suffering patients provides dentists and theirteams with pride and professional satisfaction.


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Figure 4. Following 6weeks of treatment, thepatient’s health andstability were confirmedwith a digital ROM test.

Figure 5. The digitalROM test at 6 weeksshowed the patient’sROM to be equal to orabove physiologicnorms.

Figure 6. At 6 weeks, aT-Scan analysisrevealed the patient’sdental bite force balance had alsoimproved to well withinphysiologic norms andtooth force readings atnormal levels, withleft/right balance at52%/48%.

REFERENCES1. Junge D. Oral Sensorimotor Function. New Haven,

MO: Medico Dental Media International; 1998.2. Okeson JP. Management of Temporomandibular

Disorders and Occlusion. 6th ed. St. Louis, MO:Mosby Elsevier; 2008.

3. National Headache Foundation. Migraine.headaches.org/education/Headache_Topic_Sheets/Migraine. Accessed July 10, 2013.

4. Sessle BJ. Mechanisms of oral somatosensory andmotor functions and their clinical correlates. J OralRehabil. 2006;33:243-261.

5. US News and World Report. Headache. 2006.health.usnews.com/health-conditions/brain-health/headache. Accessed July 10, 2013.

6. American Dental Association. Dentists: doctors of oralhealth. ada.org/4504.aspx. Accessed July 10, 2013.

7. Kerstein RB. Reducing chronic masseter andtemporalis muscular hyperactivity with computer-guided occlusal adjustments. Compend Contin EducDent. 2010;31:530-538.

8. Bogduk N. The neck and headaches. Neurol Clin.2004;22:151-171, vii.

9. Tysowsky GW. The science behind lithium disilicate: ametal-free alternative. Dent Today. 2009;28:112-113.

10. Strub JR, Rekow ED, Witkowski S. Computer-aideddesign and fabrication of dental restorations: currentsystems and future possibilities. J Am Dent Assoc.2006;137:1289-1296.

11. Kugel G. Materials continue to expand dentistry’soptions. Compend Contin Educ Dent. 2012;33:80.

12. Dawson PE. Functional Occlusion: From TMJ to SmileDesign. St. Louis, MO: Mosby Elsevier; 2007.

13. Ogince M, Hall T, Robinson K, et al. The diagnosticvalidity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther.2007;12:256-262.

14. Garg AK. Analyzing dental occlusion for implants:Tekscan’s TScan III. Dent Implantol Update.2007;18:65-70.

15. Koos B, Godt A, Schille C, et al. Precision of aninstrumentation-based method of analyzing occlusionand its resulting distribution of forces in the dentalarch. J Orofac Orthop. 2010;71:403-410.

16. Koos B, Höller J, Schille C, et al. Time-dependentanalysis and representation of force distribution andocclusion contact in the masticatory cycle. J OrofacOrthop. 2012;73:204-214.

17. Francisconi LF, Graeff MS, Martins Lde M, et al. Theeffects of occlusal loading on the margins of cervicalrestorations. J Am Dent Assoc. 2009;140:1275-1282.

18. Hess LA. The relevance of occlusion in the goldenage of esthetics. Inside Dentistry. 2008;4:38-44.

19. McNeill C. Occlusion: what it is and what it is not. J Calif Dent Assoc. 2000;28:748-758.

20. Mackie A, Lyons K. The role of occlusion intemporomandibular disorders—a review of theliterature. N Z Dent J. 2008;104:54-59.

21. Frisardi G, Chessa G, Sau G, et al. Trigeminalelectrophysiology: a 2 x 2 matrix model for differentialdiagnosis between temporomandibular disorders andorofacial pain. BMC Musculoskelet Disord.2010;11:141.

22. Hegarty AM, Zakrzewska JM. Differential diagnosis fororofacial pain, including sinusitis, TMD, trigeminalneuralgia. Dent Update. 2011;38:396-406.

23. Kampe T. Function and dysfunction of the masticatorysystem in individuals with intact and restoreddentitions. A clinical, psychological and physiologicalstudy. Swed Dent J Suppl. 1987;42:1-68.

24. Lodetti G, Mapelli A, Musto F, et al. EMG spectralcharacteristics of masticatory muscles and uppertrapezius during maximum voluntary teeth clenching.J Electromyogr Kinesiol. 2012;22:103-109.

25. Ohrbach R, Fillingim RB, Mulkey F, et al. Clinicalfindings and pain symptoms as potential risk factorsfor chronic TMD: descriptive data and empiricallyidentified domains from the OPPERA case-controlstudy. J Pain. 2011;12(suppl 11):T27-T45.

26. Velly AM, Look JO, Carlson C, et al. The effect ofcatastrophizing and depression on chronic pain—aprospective cohort study of temporomandibular muscleand joint pain disorders. Pain. 2011;152:2377-2383.

27. Ackerman JL, Ackerman MB, Kean MR. APhiladelphia fable: how ideal occlusion became thephilosopher’s stone of orthodontics. Angle Orthod.2007;77:192-194.

28. Maness WL. Force movie. A time and force view ofocclusion. Compend Contin Educ Dent. 1989;10:404-408.

29. Kerstein RB. Treatment of myofascial pain dysfunctionsyndrome with occlusal therapy to reduce lengthydisclusion time—a recall evaluation. Cranio.1995;13:105-115.

30. Wright EF. Manual of Temporomandibular Disorders.2nd ed. Ames, IA: Wiley-Blackwell; 2009.

31. Didier H, Marchetti C, Borromeo G, et al. Chronic


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daily headache: suggestion for the neuromuscular oraltherapy. Neurol Sci. 2011;32(suppl 1):S161-S164.

32. Cairns BE. Pathophysiology of TMD pain—basicmechanisms and their implications forpharmacotherapy. J Oral Rehabil. 2010;37:391-410.

33. Glaros AG, Williams K, Lausten L. The role ofparafunctions, emotions and stress in predicting facialpain. J Am Dent Assoc. 2005;136:451-458.

34. Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielson L, et al. Myofascial trigger points andsensitization: an updated pain model for tension-typeheadache. Cephalalgia. 2007;27:383-393.

35. Glaros AG. Temporomandibular disorders and facialpain: a psychophysiological perspective. ApplPsychophysiol Biofeedback. 2008;33:161-171.

36. Okeson JP, de Leeuw R. Differential diagnosis oftemporomandibular disorders and other orofacial paindisorders. Dent Clin North Am. 2011;55:105-120.

37. Cameron MH. Physical Agents in Rehabilitation: FromResearch to Practice. 3rd ed. St. Louis, MO: SaundersElsevier; 2009.

38. Öz S, Gökçen-Röhlig B, Saruhanoglu A, et al.Management of myofascial pain: low-level lasertherapy versus occlusal splints. J Craniofac Surg.2010;21:1722-1728.

39. Marini I, Gatto MR, Bonetti GA. Effects of superpulsedlow-level laser therapy on temporomandibular jointpain. Clin J Pain. 2010;26: 611-616.

40. Srbely JZ, Dickey JP. Randomized controlled study ofthe antinociceptive effect of ultrasound on trigger pointsensitivity: novel applications in myofascial therapy?Clin Rehabil. 2007;21:411-417.

41. Aguilera FJ, Martín DP, Masanet RA, et al. Immediateeffect of ultrasound and ischemic compressiontechniques for the treatment of trapezius latentmyofascial trigger points in healthy subjects: arandomized controlled study. J Manipulative PhysiolTher. 2009;32:515-520.

42. Zuim PR, Garcia AR, Turcio KH, et al. Evaluation ofmicrocurrent electrical nerve stimulation (MENS)effectiveness on muscle pain in temporomandibulardisorders patients. J Appl Oral Sci. 2006;14: 61-66.

43. Morphett AL, Crawford CM, Lee D. The use ofelectromagnetic tracking technology for measurementof passive cervical range of motion: a pilot study. JManipulative Physiol Ther. 2003;26:152-159.

44. Kerstein RB. Combining technologies: a computerizedocclusal analysis system synchronized with acomputerized electromyography system. Cranio.2004;22:96-109.

45. Kerstein RB. Current applications of computerizedocclusal analysis in dental medicine. Gen Dent.2001;49:521-530.

SUPPLEMENTAL READING LISTDiMatteo AM, Montgomery MW. Understanding,Assessing & Treating Dentomandibular Sen sor imotorDysfunction. Fort Lauderdale, FL: Dental Re sourceSystems; 2012.

Forssell H, Kirveskari P, Kangasniemi P. Effect of occlusaladjustment on mandibular dysfunction. A double-blindstudy. Acta Odontol Scand. 1986;44:63-69.

Karppinen K, Eklund S, Suoninen E, et al. Adjustment ofdental occlusion in treatment of chronic cervicobrachialpain and headache. J Oral Rehabil. 1999;26:715-721.

Silverman MM. Headache from pathology-producingocclusion of the teeth. Headache. 1971;11:35-46.


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POST EXAMINATION QUESTIONS

1. Dentomandibular sensorimotor dysfunction (DMSD)is associated with which of the following?

a. Chronic headaches.

b. Temporomandibular joint disorders (TMJ).

c. Migraines.

d. All of the above.

2. Technologies that provide insight into possiblefunctional and physiological influences thatcontribute to health problems are which of thefollowing?

a. In-office CAD/CAM systems.

b. Cervical range of motion devices (CROM).

c. Occlusal analysis equipment.

d. Both b and c.

3. Pain and headache pain in some patients may arisefrom which of the following?

a. Altered central nervous system pain processing.

b. Heightened muscle tension and force.

c. Myofacial trigger points.


4. Which technology can be used to evaluate theamount and balance of dental forces at closure andwhile chewing?

a. TruDenta Scan/T-Scan.

b. Computerized ROM assessment tool.

c. Transcutaneous electrical stimulation.


5. What can a cervical range of motion disability becorrelated with?

a. Mandibular ROM disability.

b. Imbalance in the dental foundation.

c. Both a and b.

d. None of the above.

6. Objectively identifying abnormal, excessive, orimbalanced forces is crucial to determining what?

a. The severity of sensorimotor dysfunction.

b. Tenderness of the anterior temporalis bands.

c. Sensitivity of the pterygoids.


7. Rehabilitation for DMSD includes which of thefollowing technologies?

a. Therapeutic ultrasound.

b. Transcutaneous electrical stimulation.

c. Low-level laser therapy.



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8. Symptoms of DMSD that can be assessed andtreated with a proprietary system include which ofthe following?

a. Chronic headaches.

b. Force-related dental conditions.

c. Both a and b.


9. What may be achieved through the use of anocclusal orthopedic device or rehabilitation orthotic?

a. Restoration of normal function.

b. Stabilization and balancing of the mandible.

c. Both a and b.


10. How are bite imbalances corrected?

a. Fabrication of a custom rehabilitation orthotic for themouth alone.

b. Sequential occlusal equilibrations or bite adjustmentsalone.

c. Low-level laser, ultrasound, and low-level electricalstimulation therapy alone.

d. A combination of low-level laser, ultrasound, low-levelelectrical stimulation therapy, orthotic wear, and biteadjustments.


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Approved PACE Program ProviderFAGD/MAGD Credit Approval doesnot imply acceptance by a state orprovincial board of dentistry or AGDendorsement. June 1, 2012 to May 31, 2015 AGD PACE approvalnumber: 309062

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course number: 166 dental treatment of headache and force-related problems · 2017-10-18 · dental...

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