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In this Issue
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From the CEO
Hello,
When you mention TMJ Dysfunction (TMJ/D) in any conversation with Dentists, Orthodontists or Otolaryngologists (ENT’s) you never fail to get a reaction. “I don’t treat TMJ, it takes too long. I just refer.” “I find it confusing.” There is always a negative answer. Those who feel they can treat it often have a single treatment for all patients. Some say “I never use splints, I just talk to the patient”. Others will prescribe surgery as the only treatment with assured results, although research proves otherwise.
The vast professional population would describe the broad syndrome called TMJ/D as slightly to completely confusing. The teaching at universities seems to add to this confusion, as there are few who will agree on a definition, diagnosis or treatment.
TMJ/D or CMD (Cranio-Mandibular Disorder) requires an understanding of what is happening before the definitions and diagnosis. Before any treatment starts, the practitioner needs to understand what the impact of a particular treatment will be. Although symptoms vary widely, patterns will emerge if there is a clear understanding what is happening at a muscular, dental an neurological level. The knowledge is contained in the many volumes of literature written on the subject, however putting together an understanding from this knowledge is the difficulty.
Over the past 3 years MRC has started to use 3D animation to enable a visual “walk through” of the jaws, muscles and TMJoint. While depicting the functional relationships between these structures through 3D, suddenly I found my presentations making clear sense of the myofunctional philosophy in the etiology of TMJ/D as well as malocclusion. The creation of these 3D models and sequences was exceptionally time consuming, as there were very few preceding attempts to use this technology for this purpose.
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| 3D animation showing compression of the TMJ. |
Although not everyone will agree on a universal definition, diagnosis or treatment, once seeing the 3D animations, each individual has a much clearer understanding of the structural interaction between the Teeth, Jaw, Muscles and Cervical spine. You can view these animations via the MRC web site and on the TMJ section of the MRC Complete Systems CD-ROM.
MRC is working further on a new generation of 3D models to better describe the varying manifestations of intra-capsular and extra-capsular dysfunction. In the future we expect to provide models showing the wide variations of TMJ/D disorder, which will be of great assistance to both professionals and patients. Hopefully, then, all Dental and Medical professionals will want to treat - not just refer. With this better knowledge, the TMJ System™ from MRC will become better recognised as the treatment of choice, offering simple and effective treatment to every patient.
Regards,
Dr Chris Farrell BDS (Syd Uni)
CEO and Founder
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 Scientifically Speaking
In this issue I will be talking about a very important subject for successful treatment with the TRAINER Appliance - patient compliance. Patient compliance is a big concern among dentists when functional appliances are included in the treatment plan. Literature shows the rates of patient non-compliance ranges from 20% to 90%. A recent research with the TRAINER in Brazil found that patient non-compliance with the functional appliance was around 40%, which is a very good rate compared to the non-compliance rates regarding other functional appliances.
Patient acceptance of a functional appliance may influence compliance and thus contribute to a successful outcome of treatment. More frequent complaints from patients wearing a functional appliance are impaired speech, impaired swallowing and lack of confidence in public, as well as, discomfort and pain to a varying degree. Therefore, it is necessary that dentists highly motivate a patient wearing a functional appliance during treatment and also be able to detect uncooperative patients, particularly those with a defiant attitude toward orthodontic treatment, who are less keen to accept treatment and need higher motivation. Dentists must keep in mind that any appliance produces discomfort when initially introduced, and also, it may be inconvenient in some social events. Thus, acknowledge to your patients that there may be some immediate discomfort or inconvenience associated with the treatment you are providing, but these minor annoyances are justified by the various long-term benifits of improved functions and esthetics.
One of the major difficulties when using a functional appliance to treat myofunctional problems is how a dentist communicates what their intentions are to the patient. Dentists must use an understandable language. Words used to explain treatment must be simple and a clear message must be sent to both the patients and parents so they may be able to follow all instructions. As this is a very interesting topic regarding functional appliances, I elaborated more on this matter in ISSUE 3 of my MRC Newsletter which is available via the Myoresearch website. There, I give some tips on how to communicate and work with the patients to reduce the rates of noncompliance when TRAINERs are used for treating malocclusions and myofunctional problems. I hope you may find it interesting and useful.
Best regards,
Dr. German O. Ramirez-Yañez
Scientific Researcher for MRC
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 MRC Global - A World Perspective
The acceptance of the TRAINER System™ continues to increase right across the world as more and more dental professionals are seeing the TRAINER as an effective way to treat Soft Tissue Dysfunction.
Early Interceptive Treatment in mixed dentition is certainly very popular, as the doctor is not only dealing with the bad oral habits but is also correcting craniofacial growth within the growing child. The number of doctors using the TRAINER to correct bad oral habits in conjunction with brackets and retainers is rising because the combined treatment makes their cases more stable and easier to deal with.
The reason for this ongoing level of acceptance and growth right throughout Asia and North/South America certainly could be attributed to the highly effective educational material provided by MRC, such as the Complete Systems CD-ROM for both doctors and patients, the new All Systems For Every Practice brochure for doctors, the 3 Systems Patient Information and the effective programs run by the company. Having these educational programs and material available in a growing number of languages undoubtedly helps across the planet.
Certainly the most effective practices in these countries are the ones who keep some stock, even if that may be 5 to 10 appliances, so they are ready for the patient when they come. Practices that run a video or show some information on their computer tend to be more effective. Customer brochures or laminated brochures are also inclined to have a positive effect as a minimal information resource. This is of course because those practices are facilitating better patient awareness and education. This is very important. Taking records and regular monthly client visits is vital to get the best overall result in cases within the practice.
Better education for the dental professional and patient is creating an ever increasing awareness of the knowledge of how to better treat bad oral habits more effectively, and certainly when possible to treat bad oral habits earlier too.
Regards,
Damien O'Brien
MRC Global Sales & Training Executive
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Postural Implications of Chronic Mouth-Breathing
Children who are chronic mouth breathers will tend to have a head tilted or pitched backwards. Any head posture where the head is not held level will have an influence on the shape, size and position of all the bones in the cranium.
Change in head posture and dentition in a boy treated only with a TRAINER for one year to establish nasal breathing and improved myofunctional patterns. Note the head is no longer tipped or pitched backwards when nasal breathing is established.
The shape of the cranium in the growing child will be distorted when the cranium is not held level. The adult cranium weighs between 4-5 Kg, the child’s cranium a little less, and it contains largely water. If the head is not held level then there will be an increased mass of cranial contents on the downhill side leading to cranial distortion. The cranium consists of twenty nine different bones separated by sutures. If there is distortion in any bone in the cranium it will be reflected in all bones in the cranium including the upper and lower jaws.
In the mouth breathing child the head is pitched or tilted backwards increasing the mass of cranial contents in the posterior part of the cranium. If the child is able to improve the cranial posture by establishing nasal breathing then the cranium will have the opportunity to grow with a more favourable pattern. This improved pattern will be reflected throughout the cranium including the dental arches.
There is no distortion in one part of the body that is not reflected throughout the body. For a level cranium we need level shoulders, a level pelvis and this requires good foot support.
Sometimes the poor head posture is a result of a pattern that arises lower in the body, for example, a tilted pelvis or pronated feet as the body’s proprioceptors constantly try to rebalance the body. This is called an ascending pattern. Sometimes the poor head posture arises in the cranium, as in chronic mouthbreathing. This is called a descending pattern.
I do not treat the postural patterns but I have learned to recognise them. I work with other health workers who help the patient to improve the posture and foot support.
Regards,
Dr John Flutter
BDS (London) Dental Surgeon.
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"The TRAINER is enjoying great popularity in my clinic.
Thanks to the TRAINER, I've gained more than 570 (pre-)orthodontic patients since I first started using the appliance in July 2001.
It is my great joy and honour to see my patients (children) grow bright and charming without using braces or other orthodontic appliances.
If used properly, the TRAINER almost never fails to prove successful."
Dr Masashi FUKUOKA
Arte Dental Clinic, Japan
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Published by:
Myofunctional Research Co. (MRC)
MRC CEO & Founder:
Dr Chris Farrell (BDS Sydney)
Editor: Jill Steptoe
Webmaster: Aaron Young
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