Critical Member Chewing System Orthopedic Team:

1) TMD is joint muscle complex

2) Being joint/muscle, Chewing System Orthopedist coaches team

3) Physical Therapy specializes joint muscle inflammation

4) TMD: can't get better without Physical Therapy

5) TMD: requires team of professional

Reducing inflammation in muscles-joints-ligaments of chewing system & cervical system

1. Most PT are gifted at neck and shoulders a) joints-TMD & neck b) chew muscles c) ligaments
2. Additional education in chewing system
3. Additional education in chronic pain
4. Orthopedics of TMD is team sport
5. Intergration: TMD-hyoid-cervical systems
6. Joint hypermobility requires advance training
7. Requires intraoral & extroral manual therapy
8. Requires iontophoresis on badly damaged TMD
9. Other tools: dry needle, ultrasound, tens, hot pak, cold laser, tr pt tx, jt mobilization, scar tissue tx

Of the 250 physical therapists in triangle area, only about 25 physical therapists have adequate training to integrate of chewing system with cervical system.  In some larger towns in NC, we may have 25 PT but only 1 PT trained in TMD.

Insurance control over Physical Therapy: 1) Decreased time allowed for each patient 2) Eliminated paying for certain tools 3) Forced increase delegation to PT assistants 4) Cause individual into larger clinics

Physical therapist manages dysfunctional joint-ligament-muscle system to ensure healing of joint muscle complex. With their hands and various tools, they still do outstanding job of removing inflammation from TMD & neck system.

ORTHOPEDIC TEAM: 1) Physcial therapy sucks inflammation out joint muscle complex 2) Biofeedback disallows inflammation from coming back 3) Chewing system orthopedist manages orthotic & other tools to reduce inflammation in TMD 4) Patient responsible for changes health habits to increase proper healing 5) As a team, we can be successful at even a complex joint and complex pain

Tools for reducing inflammation

• Inflammation Control . Postural Therapy
• Patient Education . Exercise Physiology
• Trigger Point Therapy . Computer posture
• Ultrasound . Chronic Pain Control
• Mobilization . Range of Motion
• Iontophoresis . Trans Elect Stimulation
• Dry Needling . Cold Laser
• Postural therapy . Manual therapy
• Postural training . Joint stabilization

The influence of posture and stress on muscle contraction of jaw and neck is a primary etiologic factor in TMD.  Jeff Mannheimer, PhD (renowned PT) Dental Clinics 1991

Ionotophoresis: 

1. By passes gut
2. Apply anti-inflammatory directly to jaw joint
3. Glorified topical
4. Charges particles to pentratrate skin
5. Applied to joints near skin like TMD

Muscle damage from over stimulation by 1) Enlargement of muscle mass 2 ) Trigger Points

Trigger Points:

1. Trigger points are damage muscle spindles
2. Over contraction causes muscle damage 
3. Over recruitment muscles by different sources
4. Muscle stimulation is over long periods
5. Top recruiters: a) Parafunction, b) Tension in Muscles, c) Trauma, d) neck pain
6. Reduced- trigger pointt injection or dry needling

Manual therapy:

1. Muscle manipulation muscles
2. Press lactic acid out muscle
3. Required inside and outside mouth
4. PT schools do not trained at intraoral manipulation
5. Reduce trigger points by all tools PT utilizes

Ultrasound:

1. Providing heat to deep tissues
2. Improve circulation to muscle/ligaments
3. More nutrients and removal lactic acid

Dry Needling:

1. Used on trigger points (Tr Pt)
2. Disrupts damaged muscle spindle
3. Promotes enhanced healing
4. Best used after reduction in size & number Tr Pt
5. Best used in conjunction biofeedback
6. Best used in conjunction w/ orthotic
7. Best used after reduction anxiety
8. Best used shortly after early use other PT tools
9. Highly effective tool, use after several PT visits

Chewing system orthopedic Team

1. Biofeedback use EMG testing to teach tools decrease tension in muscles
2. Physical therapy removes muscle & joint inflammation in JT/Mus complexes
   a) Neck system b) Hyoid system c) chewing system
3. Orthotic reduces clench/grind inflammation
4. Orofacial pain: a) grind/clench 11 tools b) tension muscle tools c) Trigger point therapy d) Assist at manage anxiety e) Co-ordinate care team
5. Patient: change health habits, postural re-training, passion health/pain management, anxiety management, reduction negative thinking loops, integration team, passionate implementation, trust in science, counseling emotional hyjacking

Talents of Physical Therapist (PT):

1. Reduction in inflammation from muscle, joint, ligament, & disc.
2. Reduced pull on lateral ligament of disc in TMD.
3. Reduced pull on zap joint ligaments of neck.
4. Reduction cervical parafunctional activity (shrugging-FHP-FSP-phone/shoulder).
5. Reduce reciprocal activation on TMD-hyoid-neck
6. Reduce clenching/grinding
7. Postural retraining (muscle bracing)
8. Team: PT cannot manage chronic pain w/o team
   a) Biofeedback utlitizaiton
   b) Orthotic
   c) Patient practicing exercises b) Patient changing health habits d) Orofacial Pain Specialist coaching

No one on team is more effective at chronic pain or chewing system orthopedics than the other. It is not unusual for each patient accentuate one area over another, but is not consistently. One patient will say physical therapy or biofeedback works best forth, but all understand it was team effort.

Warning: If you see someone is advertising that treat TMD by themselves, run, don’t walk from that office. That is an “ego” talking, not orthopedic science.

ORTHOPEDIC TEAM VS construction team: 1) Construction team: 1) plumber 2) electrician 3) carpenter 2) Each team member has tool box 3) Each tool box has assortment tools 4) You need finest professionals to ensure tools properly applied 5) Construction foreman oversees house builders interest

New areas for physical therapy: 1) Therapies: a )dry needling b) hypermobility c) airway constriction. d) trigger point 2) Co-ordination care: a) Massage b) Exercise physiology c) Yoga d) Chiropractic care 2) Joint stabilization for hypermobility 3) Hyoid dysfunction 4) Computer posture 5) Parafunction in chew & neck system

Physcial therapist must have extra training to manage the chewing system. They are gifted at most joint muscle systems, but they left TMD out dental school, ENT school, medical school, and all dental specialities. The first to treat TMD was dentist with limited nightguards acting like "Lone Ranger" (old black & white cowboy show on early TV). We finally grew up or science finally revealed the "TMD" was a joint muscle problem requiring orthopedic team to manage complex joint muscle system.