(Joint Vibration Analysis)
(Transcutanious Electrical Neural Stimulation)
Jaw Joint Sounds
TM Joint Vibration Analysis
TM Joint Vibration Analysis is a quick, non-invasive method for your
dentist to examine how your jaw joints function. The vibration from
each patient is like your own personal signature--determined by
loudness, duration and frequency.
Our office uses a new
device called Joint
Vibration Analysis (JVA) to help determine if patients have a
TM joint (jaw joint) problem. Joint Vibration Analysis has the
acceptance of the American Dental Association. The dentist has the
primary responsibility for diagnosing disorders of this particular
joint. Utilizing the JVA procedure aids the dentist in making an
accurate diagnosis and demonstrates the severity level of the
About the TM
Joint--TMJ--consists of bone, cartilage and ligaments. Like most
joints, the TM joint functions best when these parts are in proper
relationship to each other. Just as the shoulder or hip can become
displaced, so can the TM joint.
(left) Normal TM Joint (right) Displaced TM
The TM joint can also
be affected by arthritic changes - like the knee or elbow joints.
Jaw joint disorders may be accompanied by many symptoms including:
pain or soreness
or cracked teeth
or joint sounds
TM joint disorder is
often progressive. A minor joint sound now may mean major pain down
the road, so dental professionals suggest early diagnosis of TM
joint problems. This is where the new test, Joint Vibration
Analysis, enters in.
you open your mouth, the various parts of the TM joint rub together.
When a well-lubricated, healthy joint works normally, this movement
generally produces little friction and hence, little vibration or
sound. However, when there is a joint problem, the parts rub
together in a different way. This motion creates a sound or
vibration you may be able to hear, but some vibrations are outside
our audible range.
of research show that certain TM joint problems can create a
specific type of vibration - almost like a signature. For instance,
the "signature" of a normal TM joint might look like
the picture to the right.
Your "signature" is
analyzed by measuring differences in loudness, duration and frequency.
This provides information to determine:
- if a joint problem is present
- the nature of the problem
The "signature" of
a TM joint with problems or dysfunction might look like this:
a TM disorder does exist, the severity can be checked again at
the next appointment to see if it is stable, worsening or improving.
In fact, your "signature" reading may be redone anytime
as a guide to assess the treatment outcome.
How does this
The test is simple,
takes 3 to 5 minutes and is painless. A headset is placed over your
head (like a stereo headset) with the vibration sensors on the skin
over the TM joint in front of each ear.
You will be asked to
open wide and close all the way 5 or 6 times. That's all there is to
it! Now the computer takes over to provide your specific vibration
signature to be evaluated.
have this test?
Anyone may have a TM
joint problem. Like most medical conditions, if there is evidence of
a TM joint problem, the sooner it is discovered, the better the
chance is for successful and less expensive treatment. Joint
Vibration Analysis is recommended in these cases:
- Any patient who has or recently
had symptoms of TM joint disorder. This includes any pain in
the TM joint or jaw muscle; a "catch" in jaw
movement or a jaw which deviates to the right or left when
opening; a joint sound or sensation; or ringing in the ears.
- Any patient undergoing
orthodontic or major prosthodontic (bridge or dentures)
treatment. It is important to:
- be sure the TM joint is in
good condition before starting an extensive procedure, and
- monitor changes in the joint
function during and after treatment.
Our office is excited
about this procedure and the diagnostic benefits to our patients. If
you have questions about Joint Vibration Analysis that this brochure
has not addressed, please feel free to ask our staff.
An informed patient
is the best patient. Your dental and overall health is important to
many years, dentists have not had an objective way of measuring jaw
movements. Tracking jaw movement is very important, however, to
truly understand whether or not your jaw is functioning properly. If
your were having heart pains, you certainly would not expect a
physician to diagnose your condition by simply feeling your pulse!
Likewise, dentists must use sophisticated medical
instruments to measure jaw dysfunction.
electronics have now made it possible for us to have this diagnostic
capability in our office. We can now track and record tiny jaw
movements with a degree of accuracy far greater than the human eye.
so? A tiny magnet is placed just below your lower front teeth.
The movements of your jaw are tracked through a sensor array,
which you wear like a pair of glasses. This transfers the information
to a computer which then displays it on a screen so that we now
have a "peephole." In other words, we can see exactly
how your jaw is moving whether or not your lips are closed. The
information is also stored and recorded so that it can be referred
to at a later date.
Muscle activity is
measured by using an instrument called an electromyograph
(EMG). Like TENS, electromyography has been used by various medical
specialties for some time. Only recently, however, have dentists
begun to appreciate its clinical application.
By taping EMG
electrodes over particular muscles of the face, head or neck, we can
monitor the amount of tension in these muscles. Muscles operate like
tiny batteries in that they give off small electrical currents. When
tense, they give off a higher electrical charge. The EMG electrodes
pick up this activity and transmit it to an instrument where it is
recorded and displayed. Now we have an objective way of measuring
how much muscle tension you are experiencing.
electromyography in two ways. First, we use it to determine whether
or not your muscles are truly relaxed. Second, we are able to see
how your muscles work together when functioning (i.e. chewing).
Remember that when a malocclusion exists, your muscles must torque
to bring the jaw together. By identifying which muscles are working
harder, we are able to determine where adjustments need to be made
in your bite to relieve these muscles of strain.
We have just
described diagnostic procedures based on the most sophisticated
technology presently available. Not all dentists have access to all
of this instrumentation, but this does not prevent them from
diagnosing and treating MPD effectively.
It is also important
to keep in mind that when making a diagnosis, dentists are trying to
determine the primary source of your pain. Many people with MPD pain
experience related neck and shoulder pain which results from poor
postural habits. When this is the case, physical therapy or
chiropractic work may be required to correct the postural
relationship of your head, neck and shoulders before the bite can be
Muscles are sensitive
to both physical and emotional stress. In some cases identifying and
learning how to deal with emotional stress may be an important part
of the treatment. Do remember, however, that no relaxation technique
or medication will eliminate pain primarily caused by an occlusal/structural
sounds occurring in the jaw joint by themselves do not necessarily
indicate the need for treatment, most doctors feel that they are
important signs when taken together with other information about
you. Studying these sounds can aid the doctor in better
understanding of the status and function of your jaw joint through
sound tracings. Without a computer based sonography device, the
doctor studies the popping and clicking sounds by listening through
a stethoscope. With sonography the popping, clicking and even
grating sounds during opening and closing movements can be detected
and analyzed more thoroughly. This diagram shows how diagnosis of
MPD and other head, neck and facial pain problems has evolved:
by Ear -> Stethoscope -> Sonography
It's easy to see why
the sonograph is an accurate method of capturing and analyzing these
The test takes but a
few minutes and you will wear a headset that looks similar to that
of a small portable radio while you open and close your mouth
several times. The sensors over both of your jaw joints capture the
sound vibrations and they are recorded in the computer for later
When sounds occur as
you open or close your mouth, how loud the sound is, and whether it
is a soft or sharp sound, all have specific meaning to the doctor.
Sonography is not only a diagnostic tool. It may also be used to
monitor the course of treatment.