where there was none before
To train health care professionals in TMD diagnosis, 3D Imaging, and Measured Anterior Guidance/DTR Therapy concepts so that they can in turn provide hope and direction for many patients with bite issues, tension and temporal headaches, and TMD.
We believe in measuring “TMJ” problems whenever possible. Many times the TIMING of your bite is out of alignment and that IS the root cause of your “TMJ” problems. Sometimes though, things are more complex than just your bite being off… Neural Occlusion screening greatly aids a practitioner in identifying the root cause(s) of your confounding “TMJ” and orofacial pain troubles, as they relate to your bite, muscles, ligaments, cartilage, bone and the neurology within your chewing complex.
CNO protocols assist in objectively finding a proper diagnosis (or diagnoses), followed by predictable treatment protocols, to address the root of your orofacial issues. TMJ issues are rarely psychological, though they ARE “in your head”; ligaments, muscles, cartilage, the timing and force between your teeth, bone, inflammation, and much, much more - all located within your head and neck!
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What is "TMJ?"
TMJ is just anatomy. TMD is an umbrella term that involves orthopedic, muscular, neurological, and/or dentally related issues.
CNO Founder’s Letter
Dr. Nick Yiannios
Orofacial and TMD pain has long demanded the attention of medical and dental professionals. When a physician or dentist becomes involved in this field, he or she begins to appreciate the fact that the purviews involved cross the manmade boundaries, since essentially, everything in the human body is connected in some way, shape or form…Continue Reading
How Neural Occlusion Screening Works
Neural Occlusion screening involves a combination of hi-tech objective technologies and knowledge to ascertain whether or not a patient possesses a proper bite and stable and adapted TMJ's, and/or if their problem(s) arise from other sources.
We believe in measuring “TMJ” problems whenever possible. Many times the TIMING of your bite is out of alignment and that IS the root cause of your “TMJ” problems.
What We Measure
This device called a T-Scan reads the force and timing of your bite. Placing this into the patient’s mouth it is possible to objectively record and measure the bite.
Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles in microvoltages. CNO uses the EMG.
Allows us to look inside your teeth. Sometimes your past dental work is responsible for your TMD issues, or at least a contributing layer.
Frictional Dental Hypersensitivity (FDH) can occur when the patients muscles are overworking due to a misaligned bite. The patient with a TMD issue solely due to overactive muscles from a bite issue will typically have hypersensitive teeth that shows up when they are challenged with the ice water swish. Once the bite alignment is corrected, the sensitivity will typically go away. There are neurological reasons for this that are not fully understood, which may relate to the overactivity of the sympathetic branch of the autonomic nervous system.
Joint Vibration Analysis is a screening tool of the TMJ cartilage. JVA is based on simple principles of motion and friction: When smooth surfaces rub together, little friction is created…and little vibration. If these surfaces become rough, as would be the case when the TMJ cartilage is damaged relative to the bone in one or both joints, then the friction and vibration that is created when these surfaces articulate would show up as an aberration in the JVA readings.
CBCT scan, also called X-ray cone beam computed tomography, is a low-radiation way of studying the bony jaw bone and the skull, objectively elucidating spacing between these bones as well as growth and development issues. It is also very effective at identifying degenerative and arthritic changes that might be taking place within the TMJ’s as well.
Magnetic Resonance imaging uses magnetic pulses rather than ionizing radiation to study cartilage, fluid, and fat content within both TMJ’s. An extremely useful tool, MRI often identifies problems that would go completely unnoticed otherwise.
After all scans and measurements are complete, patients are then categorized.
Stable Adapted Joints
Objectively Confirmed Healthy TMJ's
No Organic Issues
Other MD's, Neurologists, and Chiropractors Have Ruled Out Other Systemic Issues
The bite is off
Dental Work, Tipped Teeth or Braces Caused This TMD Problem
- This case is very likely to respond to DTR bite alignment therapy
- Very Treatable
- High Percentage of Success
Relatively Stable & Adapted Joints
Alignment of the Bite Can Help
People Are Unaware, But It Is Common
Minor Bone Wear
Usually Due to Damaged Cartilage in the TMJ
- There Is Hope
- Usually At Least Partially Treatable with DTR Bite Alignment Therapy
- Good Percentage Of Success
Unstable Maladapted Joints
Acute Inflammation & Effusion
- Help is at Hand
- Bite Alignment Treatment Should Not Be Attempted
- May Need to be Referred for Workup by a TMJ Surgeon
Digitally Directed “Alignment”, IF Indicated
Disclusion Time Reduction (DTR) therapy is a bite/occlusal adjustment procedure used in patients that possess stable and adapted temporomandibular joints (TMJ’s). Objective confirmation of stable & adapted TMJ's leads to predictable outcomes regarding restorative dentistry &/or TMD therapy!
When back teeth contact/touch too long in TIME during function, research has shown repeatedly for decades that this neurologically overstimulates muscular contraction within the chewing complex. Many of these muscles, when overworked, become very fatigued and painful, resulting in unexplained headaches and tension within the head and neck. In a practical sense, muscles that overwork chronically can lead to not only broken teeth, but failing dental work as well!
A precise and objective, digitally directed “alignment” of the way the teeth relate to one another over TIME, can reduce this overstimulation of the muscles, leading to not only a reduction in painful symptoms, but the likelihood that dental work will not fail over time as well!
Based upon three decades of evidence-based research by Dr. Robert Kerstein and others, DTR therapy does not involve the usage of splints, medications, injections, lasers, chiropractic therapy or other temporary adjuncts. DTR addresses the genesis of the problem that causes the chewing muscles to overwork, excess contact of posterior teeth, in TIME.
What others are saying
Neural Occlusion screening is revolutionizing TMD diagnosis and treatment, and improving the likliehood of successful dental treatment outcomes! Check out what patients and doctors are saying about it!
“Because the measured linkage of force and muscle activity in DTR is a critical component of treating occluso-muscular disorders, I was happy to be able to take the Certification exam to ratify that the learning I had undertaken would enable me to serve my patients' best interests.”
– Peter Barnett, DMD, FCNOPlano, TX
"The motto says it all: "Measured Matters". Dentistry has wandered thru the wilderness of solving oro-facial pain for our patients, and the DTR/CNO concepts are a huge step forward in our ability to help the people we serve. It is an exciting time for dentistry!"
– Rick Coker DDS, FCNOTyler, TX
"Hello from Calgary, Alberta! It's been a few weeks since my DTR treatment, and I have to tell you that you've changed my life! It took a few days for my jaw to settle out, but since then, I haven't had any jaw pain. I continue to sleep without my splint, and although I had a couple of pressure points early on, my teeth do not hurt at all. My muscles still seem tight when I wake up (I might still be clenching at night), but my joints do not cause me any pain. This is very different from before DTR, when a sore jaw was a daily and significant occurrence. Also, I have again tried the dreaded "ice water test," and while I was still an 8/10 in your office right after the treatment, I would now put my pain at a 0/10. It feels cold, certainly, but not at all painful. When I first tested it out last week I couldn't believe it, and had to keep swishing to see if it was true! So amazing. So needless to say, I am incredibly happy with the results of my DTR treatment. I can't believe the difference you have made in my life, and I can't possibly thank you enough." Her case study: https://youtu.be/8Vx58frPGqc
– Vikki-a DTR patientCalgary, Alberta
“Nobody in my area, not one dentist, could get my bite right. Every time I had dental work done, the bite was shifting all over to the point that I had teeth banging from my front teeth to my back teeth. Jaw pain, headaches in the back of my head, neck and shoulder pain; all of that has improved since getting my bite balanced to the way it was supposed to be!” Her case study: https://youtu.be/rJEN8CoqGTA
– Darleen-a DTR patientMichigan, U.S.A.
"Before doing DTR my mouth was telling my brain that things weren’t right, but I didn’t know what to do about it. Several months after having done DTR, I have nothing bad to say about it! If things keep going the way they are, I’m going to be a very happy person! The things that I’ve done w/ this disability… imagine what I’m going to do without it! I’m going to take over!" His case study: https://youtu.be/AWv-1-_JhKQ
– Taner-a DTR patientIstanbul, Turkey
DOCTORS - Get CNO Certified.
Positively Change Lives.
As a CNO trained health professional, you will be well-suited to identify, diagnose, and address many confounding bite and TMD problems. The higher your level, the better suited you will be to consistently diagnose and treat many TMD conditions, resulting not only in a more rewarding experience for you and your patients, but also an ethical, practical, and ubiquitously needed skill set which will set your practice apart from the rest!
Practitioners who have passed the various certification levels and who possess an active CNO annual membership will be listed in the CNO "find a doctor" database, used by patients to find a CNO trained practitioner.
Included w/ $695 Annual Membership
All health care providers
- Learn how unmeasured dental and orthodontic work can actually cause muscular TMD problems, headaches, and pain.
- Learn how neurologic, orthopedic, and timing issues within the bite can profoundly influence a TMD patients condition.
- Become more proficient at diagnosing occlusal (bite) and TMD conditions
- Why analog bite ribbon is so prone to error, yet most every dentist uses it exclusively.
- Learn why "Measured Matters" for bite & TMD.
- Maintain an active CNO membership to be listed in our CNO Doctors database as a CNO Foundation level provider (upon CNO F didactic exam completion).
CNO Level 1
Dental practitioners & all health care providers
- Gain a thorough understanding of both Joint Based Occlusal and Measured Anterior Guidance concepts as they pertain to both occlusal and Temporomandibular Dysfunction.
- Why ICAGD is completely different from occlusal equilibration.
- The importance of midcourse corrections.
- Instructed via live lecture by Dr. Yiannios, and/or other CNO Board members either on the road or at CNO headquarters in Rogers, Arkansas.
- In-depth instruction on use of tools such as the T-Scan, BioEMG III, JVA, and other objective measurement tools as they relate to TMD diagnosis and treatment.
- Maintain an active CNO membership to be listed in our CNO Doctors database (upon CNO 1 didactic exam completion).
CNO Level 2
- A CNO instructor will travel to your office and observe as you perform DTR therapy on 3+ appropriately selected TMD patients.
- Prove to the instructor that the practitioner knows how to properly identify patient type and assess whether or their chosen patients are appropriate candidates for DTR therapy.
- Prove to the instructor that the practitioner is capable of proficient use and proper operation of all tools relevant to DTR Therapy & Measured Anterior guidance concepts.
- Maintain an active CNO membership to be listed in our CNO Doctors database (upon CNO 2 clinical one on one training completion).
CNO Level 3
- 3D imaging introduction including CBCT hard tissue imaging and MRI soft tissue imaging of the TMJ.
- Didactic and practical clinical instruction regarding both image-based Measured Anterior Guidance and DTR concepts conducted at the CNO headquarters in Rogers, Arkansas and/or at the Piper Education & Research Center (PERC) in St. Petersburg, Florida.
- How to objectively determine if a patients has stable and adapted TMJ’s
- Maintain an active CNO membership to be listed in our CNO Doctors database (upon didactic & oral exam completion).