NORTH COAST 2017 INTERDISCIPLINARY OROFACIAL PAIN SYMPOSIUM OROFACIAL PAIN: A SYSTEMATIC METHOD OF

Transcription

1 NORTH COAST 2017 INTERDISCIPLINARY OROFACIAL PAIN SYMPOSIUM OROFACIAL PAIN: A SYSTEMATIC METHOD OF EVALUATION, DIAGNOSIS, AND TREATMENT... AS A PART OF COMPLETE DENTISTRY Karl E. Hegyi DDS FAGD North Royalton, Ohio kehegyi@gmail.com

2 Presenter s Disclosure: Although Dr. Hegyi is the creator and owner of the DATA Appliance discussed in this course, he does not profit from its fabrication or use. He does however utilize it in his private practice and teaches additional courses regarding its use.

3 Orofacial Pain - Site: A general term covering any pain which is felt in the mouth, jaws and the face.

4 Orofacial Pain - Origin: - Odontogenic (pulpal or periodontal tissue) origin - Masticatory system non-odontogenic origin - Non-masticatory system (e.g. cervical) origin

5 Chronic Orofacial Pain - Type: Musculoskeletal - Nociceptive pain resulting from damaged musculoskeletal tissues - usually sharp, aching, or throbbing Vascular - Nociceptive Pain resulting from damaged or altered vascular tissues - e.g. Migrane HA s, Temporal Arteritis Neuropathic - Pain resulting from damaged or over sensitized nerves - usually shooting, burning, stabbing, tingling, or numbness - Pain that continues after what initially caused it has healed or is gone - usually neuropathic

6 This Presentation s Pain: Musculoskeletal Orofacial pain of non-odontogenic masticatory system origin (plus head and neck pain)

7 V. What medication do you take or have you previously taken for your pain? MEDICATION DOSE FREQUENCY f1 Vveckci_ 7 a- ti\iz -0,-eic (,( 0,3 ao P 04 teafe l -(. k.-u 0 (Nar-) a 0 - Ni'l Please do not write in this space. VI. Does it hurt to move your N Does it hurt tp chew? Any discomfort upon chewing hard foods like carrots? Do your jaw muscles get tired from chewing? Y N Does it hurt to open wide? Y N Which side of your jaw makes a popping sound? Which side of your jaw makes a clicking noise? Which side of your jaw makes other noises? What Noises? When did you first notice the noises? Viks.\-- vi.,2-k--t.a..q.,ka._ \Avve,.tiao i\ wvv-i-e- VII. Have you ever not been able to open your jaw all the way? Y )( Have you ever had to wiggle your jaw to get it open? (2/7 Has your jaw ever been stuck open and you could not close it? 'SL When did this first happen? When did this last happen? R 6 Nrni,i-ti.3 a_so f' N N L VIII. Have you noticed a change in the sg3 N way your teeth come together? Have you noticed your teeth shifting? Has the shape of your face changed? Has your chin shifted to one side of your face? When did you notice any of the above changes? k. Cc., 62,iyet1,0 IX Do you get headaches? () N How often? InivtAltue How long do they last? Where does it ache? V\eCk.- \ --'\,ka-aa/1) -, 1 \-c--.:.,,,,),.,,-,,, z.. i.?, j,...:., nh il...,-- 16' PI Sode -CAr. vvvs. 2 V9sAckaak 'Jaw. Rve,Lua t rea, 6,1(16Leo

8 XVIII. Describe the problem (s) in your own words: \14-ker,1, 4 \f\\, \, ' \ArAre_- Wc-k-(4. \o,k- ccc AAL3 eals \Akkt-. Lk L9 oat 16 u1/4..) tr4- -Mese. 03\kkit,z-wiLce-- kaa A T 4-6A vr\aa/3 kittl Y N 6.(/ a 1 1,./ e \if jd (4.1.S' U t 06 g eav / 1"), Saci 5 RI- XIX. How have these problems affected your life? Does it keep you from doing anything that you want to do? (work, play, chores, eating, talking) CA.( \Akecii- 07\-, We.. karapc.. What would you like to accomplish with treatment here? / VVVAALAAA.A...0a, 1)- aliut;i3 40\\c, AN) We.tre_ 5

9 Orofacial Pain without restorative/aesthetic wants or needs Pre-RedAddibration

10 Post-RedAddibration

11 Significant History

12 Significant History

13 Orofacial Pain with restorative/aesthetic wants or needs

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16 I needed to save my teeth that were suffering from occlusal disease and unhealthy TMJ's. My experiences during treatment included not only a relief from pain but also an education in complete dentistry. I will always be in debt to Dr. Hegyi s commitment to thoroughly diagnosing my problems and delivering not only super function but also an aesthetically pleasing smile. Dr. Larry Bucher

17 Key Presentation Points 1. Musculoskeletal pain of non-odontogenic masticatory system origin is the most common type of orofacial pain in adults. (with the possible exception of odontogenic pain).

18 Key Presentation Points 2. In most cases, the most conservative, predictable, and cost effective means of definitively resolving this type of pain involves the alteration of tooth form (or position).

19 Key Presentation Points 3. When altering tooth form (or position) to resolve orofacial pain, patient restorative and esthetic wants and needs should also be considered.

20 THE PHYSIOLOGICALLY GUIDED TREATMENT SYSTEM P TS G Function Esthetics Restoration A guide to safe, predictable treatment when altering tooth form (or position) for functional or esthetic change

21 THE PHYSIOLOGICALLY GUIDED TREATMENT SYSTEM With unique methods of: Evaluation/diagnosis, Treatment planning/design, and Treatment... utilizing

22 THE PHYSIOLOGICALLY GUIDED TREATMENT SYSTEM 1. The DATA Appliance - involved in evaluating, planning and treating 2. Verified & Validated Mounted Casts - the starting point for planning 3. A Stable Biomechanical Foundation - the foundation of functionally sound treatment

23 THE TOOLS ICS TMJ Stability Functional Occlusion Parafunctional Activity S T R U C T U R E S B F E S T H E T I C S F U N C T I O N 1. The Integrated Classification System (ICS) 2. The DATA Appliance 3. A Stable Biomechanical Foundation (SBF)

24 DATA Appliance Evaluates each Biomechanical Element of the Integrated Classification System (Diagnosis), And when indicated, Assists in delivering definitive occlusal therapy to establish a Stable Biomechanical Foundation (Treatment) TM-Joint Stability Type Functional Occlusion Type Parafunctional Activity Type DATA I Applications: Most DATA Appliance applications where there is adequate interocclusal space distal to the most posterior maxillary teeth to place the C- Clasp wire without interference to the opposing mandibular tooth during closure. This is the most comfortable and esthetic DATA Appliance. DATA II Application: Those DATA Appliance applications where there is not adequate interocclusal space distal to the most posterior maxillary teeth to place a Labial Bow wire or posterior C-Clasp without interference to the opposing mandibular tooth during closure DATA III Application: DATA Appliance applications where there is adequate interocclusal space distal to the most posterior maxillary teeth to place the Labial Bow wire, and where control of upper anterior tooth position is critical (e.g. post orthodontics), where control of anterior tooth movement with loading is critical (e.g. flared or periodontally involved upper incisors), or where easier removal of the appliance is desired. DATA IV Applications: Those DATA Appliance applications for patients with Angle s Class III anterior dental relationships DATA I-A (not shown) Applications: DATA Appliance applications where control of tooth position or prevention of potential tooth eruption is critical. Most typically, the DATA I-A is used on post-orthodontic patients and on patients where the DATA Appliance is used more than eight hours a day for more than four weeks

25 The DATA Appliance IF YOU FREE THEM, THEY WILL GO HOME.

26 The DATA Appliance Allows the patient s Masticatory Muscles, TMJ s, and Teeth to go where they want to go and do what they want to do - without mechanoreceptive interference

27 Mechanoreception? What is it? Mechanoreception is the unconscious sensing or conscious perception of touch or displacement caused by mechanical stimuli such as tension, pressure, and vibration. Jay Harris Levy, DDS Proprioception: The unconscious perception of movement and spatial orientation arising from stimuli within the body itself.

28 Key Points To understand Mechanoreception is to understand the trigger of most TMD and non-odontogenic Orofacial pain. To understand the impact of interocclusal relationships on Mechanoreception is to understand the cause of most TMD and non-odontogenic Orofacial pain.

29 Key Point Aberrant mechanoreceptive input is the trigger for harmful muscle and joint activity. This is responsible for most TMD and non-odontogenic Orofacial pain (as well as other occlusal disease signs and symptoms). Pathologic functional occlusal interactions are the cause of this aberrant mechanoreceptive input.

30 Key Points Pathologic functional occlusal interactions are the primary cause of aberrant mechanoreceptive input. Aberrant mechanoreceptive input is the primary cause of harmful muscle and joint activity. Harmful muscle and joint activity are the primary cause of most TMD and non-odontogenic Orofacial pain (as well as other occlusal disease signs and symptoms).