2nd Patient Describes the TMJ Treatment Experience with Dr. Kerstein

Here are the words of 

LAURA H

a TMJ patient, who has recently undergone the Computerized TMJ Treatment that       Dr. Robert Kerstein offers. 

She has written about her past TMJ History, all the treatments she tried prior to undergoing Computerized Occlusal Therapy,

and how she now lives after experiencing T-Scan III Guided Bite Treatment.

 "I recently contacted Dr. Kerstein to update him on my progress and was asked if I would like to write a blog entry. I am pleased to share my experience with treatment by Dr. Kerstein for my bite problems, guided by computerized occlusal analysis.

 Though I had orthodontics from ages 8 to 13, including headgear, to correct a severe overbite, my bite was never comfortable. Eating was never comfortable. It felt like there were several possible positions for my bite, all of which resulted in discomfort, with jaw pain and headaches after eating. At times, it seemed that the bite problems also caused ear pain.

 I was diagnosed with TMJ and nocturnal tooth grinding at age 29, and fitted for a mouth guard that moved my lower jaw forward to relax the muscles and prevent grinding. This was helpful but when I moved to another state, I could not get a replacement when this appliance became worn. Because of teeth movement from long standing tongue thrust, I was then fitted with retainers for top and bottom teeth. These retainers prevented grinding while sleeping but did not solve the pain problem from eating.

 From 2002 to 2011, my dentist made multiple bite adjustments the traditional way. He was over time able to improve my bite noticeably but far from completely. At times it seemed we were chasing the problem around, as adjusting one side would result in more pressure and discomfort on the other side. I took amitriptyline for a couple of years (a tricyclic antidepressant which often helps in low doses for chronic pain) which helped with the headaches and jaw pain. I also used ibuprofen frequently. But these treatments were for symptom management, not resolution of the problem. I then developed some other health problems that prevented me from taking amitriptyline and ibuprofen. Use of stress management and relaxation techniques helped with coping with the pain, but also did not resolve the underlying bite problem. Professional massage of my jaws and neck also only temporarily decreased the pain.

 After some dental work resulted in my upper retainer no longer fitting, a rigid night guard was made. While this protected my teeth from being worn and chipped, I would still wake up with headaches and jaw aching, and the pain during and after eating increased. I was referred at one point to a TMJ specialist locally who did not think I actually met criteria for TMJ. He suggested that a rigid night guard was exacerbating my symptoms, and suggested that I purchase a different type of night guard. I decided against this because it was quite expensive, and another temporary solution.

 In early 2011, I had some dental work done and further bite adjustment, which I felt only made things worse. I wondered if there was a more high tech solution to adjusting the bite than the “tap tap tap” on the marking paper method. I did a Google search and found that indeed there was! The idea of a computerized bite analysis guiding adjustment of the bite just seemed logical. In my research, I found that Dr. Kerstein was THE expert in this method, and that he was located in Boston. And, I just happened to have a trip planned to Boston in the near future, so I was excited when his office was able to coordinate a consultation and treatment, if appropriate and desired, during that trip!

Pre Teatment Laura H demoinstrated Very Long Right Disclusion Time (Left Pane T-Scan III data =1.7 seconds), and Very High Muscle Activity (Right Pane between C & D in the EMG data)

Pre Teatment Laura H demoinstrated Very Long Left Disclusion Time (Left Pane T-Scan III data =3.547 seconds), and Very High Muscle Activity (Right Pane between C & D in the EMG data)

 I was pleased with the consultation and decided to proceed with treatment, which was divided over 2 days. The first night, I felt my bite was somewhat better but still not quite right. After the 2^nd day of treatment, I was suddenly able to close my teeth together with comfort. That night I enjoyed eating with no jaw discomfort. The next morning I woke up without increased jaw pain and a related headache. I was thrilled!

Post Treatment very short Disclusion Time (.366 seconds) and drastically reduced Muscle Activity (between C & D)

Same Muscle activity lessening Post treatment (below) for the Right Excursion (post treatment Disclusion time .466 seconds)

 It took several weeks for the jaw muscles to recover. Now, I no longer experience jaw pain or related headaches from chewing or upon waking. I can even chew gum without pain! I can close my teeth together and have it feel like there is only one position that is right, natural, and comfortable.

 I got new retainers to keep my teeth straight (no more rigid night guard!), given the tongue thrust. The retainers would prevent most of the tooth grinding, assuming I continue to do that. But when I fall asleep on the couch without the retainers in, I do not wake up with severe jaw pain and a headache as I would prior to the treatment with Dr. Kerstein. The only time I have jaw pain now is if I clench my jaws when I am under a lot of stress (stress management and relaxation techniques are always good skills to know!), or if I have to keep my mouth open a long period of time for dental work.

 I wish I could have had this treatment years ago. It would have spared me much discomfort and tooth damage (wear on teeth, cracked teeth, maybe even a root canal)! If I have dental work done in the future that throws my bite off again, I will definitely return to see Dr. Kerstein for a tune up!"

 -Laura H.

 To see a patient undergo T-Scan III computer-guided Occlusal Treatment for TMJ Disorder go to our new website page:

Dr-Kerstein-Treating-A-TMJ-Patient-Video

TMJ Patient Describes His TMJ Treatment from Dr Robert Kerstein

Here is a letter from a TMJ Patient who recently underwent

Disclusion Time Reduction 

He describes his TMJ treatment experience, where his TMJ Symptoms were recently treated by Dr. Kerstein, using T-Scan guided occlusal treatment.

Dear Dr. Kerstein,                                                                                                          7/30/2011
 
 I just wanted to drop you a note and tell you about the effect my TMJ treatment you performed has had in my life.
   I have been dealing with TMJ now for the past 5 years. Ive had symptoms ranging from jaw clicking, neck pain, jaw pain, difficulty chewing, and bite feeling 'off' everytime i chew.  Ive been to several orthodontists and Dentists alike. Some treatments helped, others have not. Ive tried numerous treatments ranging from splints, nightguards, braces, prolotherapy, and some have said nothing could be done. As you know, Ive had several treatments of Prolotherapy that have made my clicking in the jaws go away. Unfortunately, the treatment had left me with a bite imbalance and I was still getting headaches.
  So I did some research one day on the internet and found your website that stated you treat TMJ by looking at a person's bite by the use of a computer. This treatment had me intrigued, so i packed my bags and headed from Milwaukee to Boston to see if you could help me.
  When I arrived, you checked my bite by using a computer program called the T-scan. You found my bite to be 'off'. By using various instruments you found my jaw muscles were overstimulated as well.  When you did the T-scan bite analysis on me you found that my back teeth were getting in the way of my bite. You filed down the back teeth according to what the T-scan showed.  After the first day of treatment the first thing i noticed was that my bite felt much better and i was able to chew my food much better than i had in a long time.
  Four days later at my second visit, you re-evaluated my bite with the T-scan. It showed I had less muscle activity and that my chewing was much better and that my back teeth were no longer getting in the way.
   It's been about 2 months now and my bite still feels good and Ive started to notice my headaches decreasing in frequency. I look forward to seeing how my bite heals after the treatment you provided. So I just wanted to say thank you for your expertise in fine-tuning my bite.  Should I have any symptoms, i wont hesitate to make another trip back to Boston to see you. 
                                                                                                                   Sincerely, 
                                                                                                                      Dr. Brian Adler

 To see if you are a candidate for Disclusion Time Reduction, Click Below

Boston TMJ Treatment is Effective Without Mouthguards

Dr. Robert Kerstein of Boston MA uses no mouthguards or appliances to treat TMJ problems. He hasn't used them for over 25 years, since he began researching TMJ with the T-Scan III Occlusal Computer in 1984.

This computer-guided TMJ Treatment has been shown in numerous published studies since 1991, to be a much faster, and a more effective, and permanent TMJ Treatment, than any Mouthguard or Appliance-based TMJ Treatment.

Dr. Robert Kerstein's study of the T-Scan occlusal technology has led to him find that:

• Most TMJ patients rarely need Nightguards, Mouthguards, oral appliances, NTIs, or TENS deprogramming to have rapid significant symptom resolution

The computer-guided TMJ treatment has also been shown in many studies to be able to stop nightime tooth grinders from actually grinding their teeth while they sleep. Even these diffiicult TMJ patients don't need to sleep with an appliance once properly treated.

Up until the time of the development of the T-Scan system, Mouthguards were necessary because the Bite Problems that cause TMJ Pain were not known or understood by TMJ Dentists. A Mouthguard works by sitting between teeth to stop them from touching. This often helped TMJ pain, as long as the patients had their Mouthguard or Appliance in place.

However, once the Appliance or Mouthguard is removed from the mouth, the TMJ Pain and Symptoms would re-occur again.  

But with the T-Scan III System, a TMJ Dentist can see minute Time and Force Bite Problems that can’t be seen with Articulating Paper at all….The paper marks are "only ink spots on teeth", and cannot measure a TMJ patients occlusal forces in any way...

Truth be told, Dentists mostly guess at which paper marks to treat because research repeatedly shows that paper mark size, shape and color are all unrelated to Bite Forces 

Properly recorded T-Scan data shows a TMJ Dentist exactly what is wrong with the Bite Timing, the Bite Balance, and the Bite Forces within a TMJ patients’ entire mouth.

By correcting these Bite Problems with T scan computer-guidance, the molar teeth stop firing the jaw muscles so TMJ symptoms go away.

In most patients, many of the TMJ Pain and Symptoms noiticeably decline within the first week after treatment has begun….

• And that’s without wearing a Mouthguard or Appliance!!!

Robert B Kerstein DMD Completes Another TMJ Treatment Study

Dr. Robert Kerstein of Boston, MA and Mr. John Radke of Milwaukee WI, have recently completed a 2-year long study of 45 TMJ patients that have undergone the non-mouthguard, non-appliance based TMJ treatment, known as

• Disclusion Time Reduction

The 2 researchers investigated the statistical liklihood that when a TMJ patient has their Disclusion Time reduced with the ICAGD enameloplasty (which is not Occlusal Equilibration), their hyperactive muscles will be markedly relaxed diring the 1st treatment appointment.

The Abstract of the manuscript, which has been submitted to the Jounal of Craniomandibular Practice, can be seen below:

Purpose – To determine if a statistically significant reduction in muscle activity (p < 0.05) occurs when prolonged Disclusion Time (> 0.4 sec/excursion) is shortened to < 0.4 sec/excursion with the Immediate Complete Anterior Guidance Development (ICAGD) enameloplasty.

Methods – 45 symptomatic fully informed subjects (29F, 16M) had their right and left Disclusion Times recorded with T-Scan III while simultaneously the bilateral masseter and anterior temporalis muscle activity was recorded electromyographically with BioEMG III ( n = 180 muscles).  This recording was done twice, once pre treatment and again post treatment (same day) after undergoing the ICAGD enameloplasty on the same day without changing electrodes. Student’s paired t test was utilized to detect any significant change in the muscle activity levels between the pre and post treatment lateral excursive muscle contractions.

 Results – Highly significant reductions were found in all 4 muscles’ activities after shortening the pretreatment prolonged Disclusion Time to less than 0.4 seconds (p < 0.0014); after Bonferroni correction (p < 0.006). 

 Conclusion - When properly performed, such that the post treatment Disclusion Time is < 0.4 sec per excursion, the ICAGD enameloplasty predictably reduces excursive muscle activity levels in the bilateral anterior temporalis and masseter muscles.

Clinical Implication – Excursive muscle hyperactivity can be a source of lactic acid accumulation, muscular ischemia, and chronic muscular TMD symptoms. The ICAGD enameloplasty significantly reduces excursive muscle contractions within the first ICAGD treatment session.

This study's results agree with the findings of the many previously published studies involving ICAGD and Disclusion Time reduction that Dr. Kerstein has published since 1991. The results indicate that performing ICAGD and creating short Disclusion Time reduces pre treatment elevated levels of excursive masticatory muscle function. The very low p values suggest that hyperactive excursive muscle activity levels, when they exist, can be predictably reduced by using the ICAGD enameloplasty.

The treatment effect of ICAGD and Disclusion Time Reduction can be seen below:

This is an Electromyogram of a TMJ patient who was a subject in the study. The hyperactivity in the muscles can be seen to the right of the vertical thick white line. This high level of electrical activity is what causes muscluar TMJ symptoms like jaw fatigue, chewing tiredness, facial pain, temporal headaches, and clemching and grinding of the teeth.

Below is the post Treatment Electromyogram of the same patient who had th Disclusion Time Reduction perfoirmed with the ICAGD Enameloplasty. Note how the excess muscle contracrtions are removed almost completely (after the vertical white line)….

This removal of the hyperfunction is permanent because the Disclusion Time is changed down to such high-precision tolerances with the T-Scan computer, the muscular TMJ symptoms are readily treated.

• As the new study points out, the muscle activity is lessened during the 1st treatment appointment so symptoms begin to lessen very quickly 

• The statistical findings in the study were so profound, they indicate that a TMJ patient who undergoes the ICAGD procedure to have their Disclusion Time reduced, stands a very high liklihood of having their muscular TMD predictably treated

• And no appliances or mouthguards are required to have the treatment effect take hold

To see a patient undergo the ICAGD procedure Please click on this link below: 

TMJ TREATMENT

Boston Prosthodontist Explains Computer-Guided TMJ Therapy

T Scan III TMJ Treatment successfully eliminates TMJ Dysfunction without Mouthguards 

The cause of Muscular TMJ pain is prolonged molar tooth contact during chewing and clenching and grinding. This painful physilogic mechanism described below: 

Jaw Muscle Pain is actually caused by the amount of time molar teeth engage, which can occur in a well aligned  bite (like one made with Braces) or in a not so well aligned bite, where back teeth can be twisted or tipped into less than ideal alignment.

Well aligned

Poorly Aligned

The T Scan Computerized occlusal Analysis System made it possible to really “see” fractions of seconds of excessive tooth contact that were not possible to see before its development.

Fractions of seconds of molar tooth rubbing contact allow the molars to touch for too long and compress their Tooth socket nerve ending for too longs which activate excess muscle contractions in the jaw muscles. The longer was the tooth rubbing during chewing or grinding, the longer time the socket nerve endings are compressed, and the longer time the Jaw Muscles are made to contract. The patient’s teeth are then a constant source of excess muscle firing which causes excess lactic acid buildup within the Jaw Muscles which lead to the Jaw Muscle Pain.

This published diagram shows the cycle of muscular over firing (hyper contraction) isolated by Dr. Robert Kerstein published in Journal of Craniomandibular Pain 1993;11(2):126 - 140.

Because the T scan can detect these prolonged tooth contacts, a TMJ Dentist can treat the prolonged tooth contact durations by shortening the time the teeth rub down to very small durations (<.4 seconds is ideal) in all chewing movements. This in turn shortens to the tooth socket compressions to the same minute durations that the teeth now rub (<.4 seconds).

This in turn, stops the jaw muscles from being over-fired. The muscle activity goes way down usually in the same appointment and the TMJ pain causing lactic acid buildup is quickly removed through normal muscle physiology.

Without the lactic acid formation no longer taking place, TMJ Pain and symptoms go away within 1 month’s time after Treatment Day 1!!!

Day 1

This muscle paiun treatment can be done without any mouthguard At all....

NO Mouthguards is a great improvement for patient care!

Here is a link to a Video of Dr. Kerstein treating a patient with the T Scan III Computer System

PLEASE VIEW THE T-III IN USE

TMJ Treatment without Mouthguards

Mouthguard Free TMJ Pain Treatment is a major advance in TMJ Pain Treatment over the widely used TMJ Treatment that uses hard plastic Mouthguards and Nightguards.

In published studies documenting this TMJ Pain Treatment approach over the past 20 years, many common TMJ Symptoms can be successfully relieved in 1-3 months without the need for cumbersome and life-interfering plastic mouth appliances.

 Advances in Computer-guided Bite Analysis has brought TMJ Pain Treatment forward to where, now a patient can have successful pain eliminating TMJ treatment without needing Mouthguards, NTIs, or any kind of Appliance.

 The T-Scan III Occlusal Analysis technology, when synchronized with the BioPAK Electromyography Software (muscle firing measuring technology), can isolate and measure the key Bite Factors and muscle problems that are often the primary cause of TMJ Pain.

None of the key Bite Factors, or muscle problems, can be seen with the naked eye, or with dental articulating paper marks on teeth

Those Bite Factors are:

• Excess molar tooth contact during chewing
• Prolonged milling time of all the molar teeth during chewing
• The degree of overall force imbalance in a TMJ Patient’s bite
• Excess muscle contractions resultant from the prolonged milling of the molar teeth

Once these bite and muscle problems are found present in a TMJ patient's occlusion, T-Scan III computer-guided bite treatment can be performed to precisely remove these causative, problematic bite issues that are the primary cause of TMJ Pain.  The muscular improvements can often be seen in the same appointment that treatment is rendered to a TMJ patient.

This computer-based TMJ Pain Treatment has been studied, verified, and deemed highly effective in numerous peer reviewed dental journal publications since the early 1990s.

Go to Dr. Robert Kerstein’s Manuscript page to see the impressive list of publications on “Disclusion Time Reduction”. This TMJ Pain Treatment is so effective patients stop wearing mouthguards from the 1^st day of treatment, even if they have been clenchers and grinders of their teeth.

Disclusion Time Reduction predictably stops the clenching and grinding so common in TMJ patients, so that now…

Many patients can now receive TMJ Pain treatment that eliminates the use of Acrylic Mouthguards and Nightguards, while at the same time, eliminating the TMJ pain from their lives once and for all. 

 Go to http://www.kandfdental.com/Dr-Kerstein-Treating-A-TMJ-Patient-Video

to see a live patient treatment session using the T-Scan III and a Disclusion Time Reduction procedure 

Boston Prosthodontist Treats TMJ Problems without Mouthguards

Mouthguard Free TMJ Pain Treatment is a major advancement in TMJ Pain Treatment over the widely used TMJ Treatment that uses hard plastic Mouthguards and Nightguards. 

A Boston Prosthodontist, Dr. Robert Kerstein Treats TMJ Problems and Nighttime Bruxism

without Mouthguards....

That's right ...

• No Mouthguards
• No NiteGuards
• No NTIs
• No Deprogrammers...

NONE at all...

To see Dr. Robert Kerstein perform this revolutionary TMJ Treatment, Scroll to our NEW PAGE: 

• Dr-Kerstein-Treating-A-TMJ-Patient-Video

The primary cause of TMJ is your bite, and how long in time your teeth rub against eachother. Read on to understand the mechanism oif TMJ Symptom Development

Jaw Muscle Pain is actually caused by the molar teeth, and can occur in a well-aligned bite (like one made with Braces), or in a not so well- aligned bite, where back teeth can be twisted or tipped into less than ideal alignment.

Not until the T Scan Computerized Occlusal Analysis System was developed in the 1980s, could Dentists really “see” the true cause of Jaw Muscle Pain (TMJ Pain). The T Scan detected fractions of seconds of excessive tooth contact that were not possible to see before its' development. These prolonged fractions of seconds of molar tooth rubbing contact allow the molars to touch for too long, and compress their tooth socket nerve ending for too long, which activates excess muscle contractions in the jaw muscles.

The longer was the tooth rubbing during chewing or grinding, the longer time the socket nerve endings are compressed, and the longer time the Jaw Muscles are made to contract.

The patient’s teeth are then a constant source of excess muscle firing which causes excess lactic acid buildup within the Jaw Muscles which lead to the TMJ Pain and Symptoms.

This published diagram shows the cycle of muscular over firing (hyper contraction) isolated by Dr. Robert Kerstein

Because the T Scan can detect these prolonged tooth contacts, a Dentist can also see them, and then treat the prolonged tooth contact durations, by shortening the time the teeth rub down to very small durations (<.4 seconds is ideal) in all chewing movements. This in turn shortens to the tooth socket compressions to the same minute durations that the teeth now rub (<.4 seconds). And, this in turn, stops the jaw muscles from being over-fired. The muscle activity goes way down usually in the same appointment. The lactic acid buildup can now be removed through normal muscle physiology because there is no longer the lactic acid formation to keep building up causing chronic pain.

TMJ Pain and symptoms go away within 1 month’s time once the lactic acid buildup is stopped.

And this TMJ Treatment is succesfully accomplished without mouthguards, appliances, deprogrammers, and/or NTIs

Here is a link to a Youtube Video of a patient who had TMJ pain and used Mouthguard and Appliances for years before having Dr. Kerstein’s T Scan-guided TMJ Treatment

 http://www.youtube.com/tekscaninc#p/c/0A31927968D2F18B/0/3oue1BuvBxQ

And to Learn more about TMJ Pain Treatment Advancement here.

Or, contact us today to schedule a consultation.

Boston TMJ Specialist Dr. Robert Kerstein answers Blog Comments about Occlusal Treatment and TMJ Disorder

 Recently, some of you have commented on the Kerstein Blog about T-Scan III Computer-guided Occlusal Treatment for TMJ Disorder. To possibly reach more of you than only those who commented, Dr. Robert Kerstein will periodically post his answers to these questions about TMJ Disorder.

To see a patient be treated with T-Scan III Computer-guided Occlusal Treatment for TMJ Disorder, go to the below link:

http://www.kandfdental.com/Dr-Kerstein-Treating-A-TMJ-Patient-Video/

and watch a live patient treatment session

Recent Post by “Keith” - Aside from "TENS", is there another natural way of relaxing jaw muscles?  I'd love to know so i can share best practices, too.

Dear Keith:

Thank you very much for commenting on my Blog post "Mouthguards and TENS for TMJ Pain do not Relax Muscles"...

I will try to answer your question:

TENS is NOT a physiologic way to relax your muscles. It is an external method similar to taking medications; the effect only last as long as the TENS is pulsing your muscles (a medication only works for as long as it is in your system)...Then the TENS effect wears off because the true cause of tight muscles has not been properly treated

As described in the Blog post you read...."TENS attempts to non-physiologically relax the muscles, but it can’t totally stop the tooth sockets from creating the excess muscle contractions. So its' effects are usually limited at best, require constant repeated use, and never control what the true problem is…

The TRUE PROBLEM is Prolonged molar tooth contact… which can only be detected and treated accurately with the T-Scan III technology

By using the T scan technology to treat the prolonged molar tooth contact, a TMJ patient experiences internal (from within their own body) natural and physiologic muscle relaxation. The teeth no longer hyperfunction the muscles into a state of tension and tightness, and their muscles are relieved of the excess lactic acid, which relieves the symptoms of TMJ…"

I hope this helps you understand that physiologic relaxation can only occur if your occlusion is treated precisely with computer-guidance... dentists treating occlusion WITHOUT computer-guidance, are basically guessing at what bite issues to treat in a TMJ patient. Its very poor treatment for TMJ patients in light of the fact that computer technology is available that greatly improves the accuracy and precision of occlusal therapy for TMJ...

Please Read some of the other Blog Posts for more information and clarity on T Scan computer-guided precision occlusal treatment for TMJ problems.

I look forward to hearing from you again should you have other questions or comments

Bruxism and TMJ Treatment Results

Boston MA Prosthodontist Robert B. Kerstein DMD has treated TMJ facial pain, bruxism, and headache since 1989, by using occlusal adjustments with T Scan technology. The published research success rates of computer-guided occlusal treatment are extemely high, such that teeth pain, tmj headache, teeth clenching, and mouthguard need, can all be drastically lessened by this revolutionary occlusal treatment

Read for yourself below, the words from Dentists with TMJ problems, that sought out Dr. Kerstein in Boston, for him to perform his specific occlusal adjustment with the T Scan. 

Dr. Gerald Rowe had popping tmj joints and tooth pain on 2 molars prior to treatment:

"Dear Robert,

TMJ Demonstration Video

-Demonstration of TMJ Therapy for Your Viewing

Please follow this link to view an exciting preview of what is in store for you as a successfully treated patient of Dr. Robert Kerstein.