Centric Relation is one of the topics that we get many questions about. In fact, in our Examination & Records course, we spend an entire day on what Centric Relation is, why it's important, how you find it, and how you record it. We're going to talk about, "How can I be sure that I'm in CR?" We're going to talk about healthy, intact joints, which brings up another point you need to know, the anatomy of the joint.
When we think of the implication mindset, Dr. Dawson has talked to us for a long time about a way for us to think about dental problems and approach to dental treatment as a way to communicate with our patients and help them move forward with their treatment. One way to look at it is, when we find dental concerns in a new patient exam, we speak to our patient in terms of 'is this urgent?'
There's many benefits to sequencing treatment plans that we come up with. Sequencing allows us to consider the logical sequence, predictable sequence AND economical sequence for the patient.
At The Dawson Academy, we teach you all a system of how to practice, starting from a new patient exam and all the way through prep and delivery. So, for example, the new patient exam.
This video is an excerpt from the June 2015 Dawson Faculty Office Hours with Drs. Jeff Scott and Steve Hoard. Moderating is Dr. Pio Modi (PM). To watch the full office hours and to sign up for future office hours, visit the Videos and Webinars page.
The following is a transcription of this video excerpt.
Question: What do you do with a pain patient who has more pain after wearing a B-Splint?
JS: The first thing is: take it out. You knew that already. The point is - the pain got worse. Now I don't know exactly what pain that person had to start with (because that information wasn't provided with this question) - was it joint pain or muscle pain?
If you're wearing a B-Splint, typically that's an anterior deprogrammer, that appliance is designed to help with muscle incordination and clenching. Now we can't get rid of clenching completely. We just decrease the amount of muscle contractive force by 70% by putting an anterior deprogrammer in. So you say, well it's not going to 0, but a person that's had a lot of headaches and pain from clenching will get a lot better by wearing a B-Splint.
One of the key components of a complete exam is the palpation of the masticatory muscles.
During this part of the exam, we are looking for signs of muscle tenderness or pain. This pain is an indication of hyperactivity resulting from incoordinated muscle activity caused by a build-up of lactic acid due to the muscle(s) being overworked as they hold the jaw in an avoidance pattern during closure to maximum intercuspation.
In the practice of complete dentistry the dentist is committed to an examination, diagnosis, and treatment planning process and has developed the skill of recognizing the signs of instability in a patient’s masticatory system.
It is our responsibility to offer the patient the most conservative treatment method to achieve the desired end result- a stable, comfortable, healthy dentition and supporting structures that matches their esthetic desires. The most critical skill to be developed in evaluating a patient’s occlusion is locating and verifying centric relation. If the examination reveals stable healthy TMJ’s and load testing is negative, Centric Relation serves as the starting point to determine the amount of discrepancy between CR and MIP.
I attended the first Dawson Academy dental course in St. Petersburg, Florida in my first year of practice. What I heard was not a product-driven technique, but rather a comprehensive system of practice that included an emphasis on simplifying complex cases which begins with a complete new patient exam.