A Letter From Our Founder, Dr. Nick Yiannios
Occlusal, 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. Nature knows no boundaries. Therefore, no medical professional would disagree that the treatment of occlusal, orofacial and TMD pains often involves a multidisciplinary approach, which may readily cross the boundaries of the various health professions.
The Center for Neural Occlusion, or CNO, will cross these borders, with the intent of disseminating objective, quantifiable and evidence-based diagnostic and treatment protocols to the various professions. The vision intertwines dentists, physicians, chiropractors, naturopaths, physical therapists, researchers and health professionals of all types to come together and realize that there are objective ways to screen for aberrations in how the stomatognathic/masticatory functions, which can readily lead to confounding symptomatology including headaches, limited or irregular mandibular range of motion, trouble chewing, hypersensitive teeth and abstract “TMJ” problems for which there seems to be no definitive diagnosis nor definitive treatment plan. The possibilities include orthopedic, neurologic, inflammatory, vascular, hormonal, and occlusal issues that may all introduce layers into the patient’s perception of pain. Another extremely important parameter which the CNO will proffer that is consistently overlooked involves definitive quantification of the timing involved within the dynamic movements of the mandible, and how aberrations of this timing can adversely effect the health of the stomatognathic system. Additionally, evidence linking inputs from both cervical sensory and autonomic sympahtetic inputs to many types of confounding orofacial pain will be proffered as well. The CNO will strive to set the standard for the objective, quantifiable and reproducible diagnosis of maladies such as these, as well as the definitive treatment protocols necessary to address these issues.
The first introductory level which is included with CNO membership, CNO Foundations (CNOF), is a basic level designed for all health care professionals. Physicians, chiropractors, headache specialists, neurologists, physical therapists, dental laboratory technicians and others will learn to add the timing within the human bite and the condition of the TMJ structures as possible causative factors for the genesis of headaches, orofacial muscular pain, neck and shoulder tension, chronically hypersensitive teeth and other TMD-related symptoms. It will disseminate the fact that these parameters are objectively measurable and potentially treatable via modern, evidence-based digital modalities. This foundational level aims to spread knowledge and hope for health care providers who have looked at every other possible factor for a patients seemingly occlusal, orofacial pain, and/or TMD related issues, other than aberrations in the timing of the bite and how this correlates with painful muscular sequelae .
Primarily for dental professionals, the next level, level 1 (CNO1), will proffer didactic information relating to the tempormandibular joints, the muscles of mastication, the teeth and the occlusion, and the basic neurology behind the dynamic stomatognathic living machine. An extremely appropriate level for all practicing dentists and dental specialists, CNO1 shows a practitioner how to objectively occlusal factors that might adversely affect the initiation of any sort of treatment plan that deals with the occlusion. Core to this level will be the introduction of various diagnostic technologies that actually measure various parameters within the dynamic stomatognathic system, as well as the information necessary to act upon the data gathered. Level 1 will culminate with a written examination, to test the student’s knowledge of what the CNO considers most important relative to occlusal, orofacial pain and TMD diagnosis and treatment. Physicians and other medical professionals are welcome to study this material as well (to compliment CNO Foundations), and will leave armed with new knowledge as to how measurable aberrations within the dynamic occlusion (either naturally or iatrogenically introduced) can readily perpetuate chronic headaches, for instance, and how to treat it.
Level 2 (CNO2) will target dentists specifically, in that it’s primary purpose will be to initiate a practical examination of the student’s prowess at implementation of the Immediate Complete Anterior Guidance Development (ICAGD) occlusal adjustment procedure used to accomplish Disclusion Time Reduction therapy. DTR therapy has been repeatedly shown for decades in evidence-based scientific research to effectively address many muscular TMD issues in patients with objectively confirmed stable and adapted TMJs. A CNO affiliated instructor who possesses at least level 2 status will travel to the dentist applicant who has passed the level 1 process to ensure that the applicant has the clinical prowess necessary to not only appropriately diagnose appropriate candidates (or conversely, eliminate inappropriate candidates) for computer-directed occlusal adjustments, but that the doctor understands how to implement DTR therapy as well. Three patients minimally will be treated in front of the CNO affiliated examiner and competence will be either granted or not depending upon their performance. After passing the level 2 practical exam, the doctor will be listed on the CNO website as a resource that patients possessing occlusal issues and appropriate TMD problems may call upon for computer-directed occlusal adjustment treatments, when indicated. Level 2 serves to help ensure that the doctor has the clinical skills necessary to make effective diagnostic and treatment decisions for the potential usage of irreversible occlusal adjustments.
Level 3 (CNO3) will be open for any dentist who has passed level 2 and is interested in acquiring knowledge about 3D imaging as it relates to orofacial pain and TMD. MRI and CBCT interpretation will be the impetus of this curriculum, as well as an introduction into the world of cervical and sympathetic inputs that are sometimes present in the confounding TMD patient. Importantly, Level 3 doctors will also be most adept at recognizing when DTR therapy is not likely to benefit the TMD patient and what avenues the patient should pursue instead.
“Measured Matters”; these are the words that the CNO embodies. Removing as many of the subjective parameters as possible to arrive upon a predictable and proper diagnosis and course of action; this will be the purpose of the CNO. Getting the bite right is more important than most people think, including those who are supposedly the experts in regards to dental occlusion (the dynamic bite). The vast majority of these experts are stuck on analog metrics, which show the practitioner little in regards to orthopedics, growth and development, force, timing and muscle activity. The CNO will show the serious student the way, typically without the use of splints, surgery, medications, lasers or physical therapy. “If I can reproduce an event predictably, that by definition is a fact. If I cannot reproduce an event predictably, that by definition is an opinion.” The CNO proffers measured, predictable and reproducible medicine as it relates to the function of one of the most important and essential systems within the human body, that of the stomatognathic system. Understanding how orthopedic and occlusal biomechanics, cervical, sympathetic and trigeminal inputs, inflammation, and frictional interactions between opposing teeth in time effects this system is key to understanding many cases of TMD and orofacial pain.
Dr. Nick Yiannios, DDS, MCNO