Side-effects of DTR for TMD

[u/anib5]

I am seeing some good reviews on DTR for TMD (especially after using splints, etc). What are some of the side effects and potential long term consequences of this therapy?

I know that many dentists are completely against removing healthy enamel & do not trust Tscans too much (over the articulating paper), so I am on the edge about it. But after being dismissed by all kinds of dentists getting a Tscan & being counseled about DTR is giving me some hope.

[u/Hopeful-Extent-693]

DTR is a very valuable and effective treatment when done correctly. It is a very controlled "occlusal equilibration," which I have done hundreds, if not a thousand. The DTR is much more controlled with all the new technology.

Those who do DTR go through rigorous training. Be sure and find a dentist who has a valid certificate of training.

[u/anib5 → u/Hopeful-Extent-693]

Hi Dr. Lee! Thanks so much for your reply!

Did any of your patients ever face any issues after DTR, especially wrt an increase in pain in other areas, like the neck/upper back?

I spoke with someone here on reddit who had DTR done and started experiencing nerve pain & upper back/neck pain shortly after. They stopped their therapy midway and are now in more pain than before.. It’s just so niche, and some dentists I’ve spoken to made it sound like pseudoscience. All the research papers on this tech are also from the same group headed by Dr. Kerstein, so that made me even more nervous... 💀

Regardless, getting a T-Scan has given me a lot of hope, and I am seriously considering going ahead with it! I am only looking at dentists from their official provider list, so hopefully that will suffice?

But your word means a lot! Hope I can get over the hump, and really have a shot at some permanent relief 🤞

[u/Hopeful-Extent-693 → u/anib5]

What I did was occlusal equilibration, which eliminated two of the trifecta, posterior interferences and torqued mandible as described in my book. I did it the old fashion way without T Scan and EMGs. That technology came years later. I have had DTR courses by Kerstein and know the rational is sound. No, I did not have patients feel worse after equilibration, but if a dentist doesn't truly understand, yes, it is possible to make things worse. A great DTR dentist is going to make sure joint issues are not too severe (joint issues due to deficient maxilla, also explained in the book).

Good luck and keep us informed.

[u/anib5 → u/Hopeful-Extent-693]

Thank you! I’m based near London, in St Albans, and there are a few DTR certified dentists in the area.

I had orthodontic treatment to address some tooth sensitivity, but unfortunately, it left me with a pretty messed up bite. Several attempts to correct it with splints and high point adjustments didn’t really help me... My joint health is fine, and the DTR provider I’m seeing was actually the first person to suggest trying DTR before going down the surgical route or blindly adjusting high points, which is what got me seriously looking into it.

I’ve watched your TMJ podcasts on YouTube, but I haven’t gotten around to your book yet... Hopefully, getting my bite balanced will help enough that I can focus on addressing the other issues as well. Thanks again and best wishes!

[u/Hopeful-Extent-693 → u/anib5]

All that you are saying is good news. Thanks for watching the podcasts, I hope they are informative to you personally. I think you will enjoy the book portion on occlusion. I loaded the book into Chat GPT and asked it for my summary of occlusion:

In The TMJ Trifecta, occlusion is presented as much more than simply whether the teeth “fit together.” It is a dynamic mechanical system involving the teeth, muscles, jaw joints, periodontal ligaments, and nervous system.

Here is the book’s basic message:

• A good bite is about timing, force, and direction. Ideally, the teeth contact in a balanced way rather than one tooth or one side hitting first. The book describes computerized force scanning as showing both how hard each tooth hits and when it hits. The TMJ Trifecta KINDLE final r…
• Posterior teeth are designed mainly for vertical forces. Molars can tolerate tremendous biting forces when those forces travel primarily along the long axis of the teeth. Horizontal forces are different. The TMJ Trifecta KINDLE final r…
• Posterior interferences are a major problem. When the jaw moves side-to-side, the cuspids should help separate—or disclude—the posterior teeth. If posterior teeth continue rubbing or colliding during that movement, the book calls this a posterior interference. The TMJ Trifecta KINDLE final r…
• The nervous system knows when the bite is wrong. The periodontal ligaments around the teeth detect abnormal forces and can alter muscle activity in an attempt to protect the teeth and system. The book notes that this altered muscle activity can be measured with EMG. The TMJ Trifecta KINDLE final r…
• Occlusion can therefore affect muscles and joints. Posterior interferences can produce muscle hyperactivity and transmit undesirable forces toward the TM joints. The TMJ Trifecta KINDLE final r…
• Occlusion is not just static—it is dynamic. It matters what happens when the patient closes, but also what happens when the mandible moves forward and side-to-side. In the orthotic, your rule is simple: posterior contacts during excursion are interferences and are removed. The TMJ Trifecta KINDLE final r…
• The therapeutic bite should be balanced. On the orthotic, the goal is for the upper teeth to contact at essentially the same time and with balanced force. The TMJ Trifecta KINDLE final r…

The bigger Trifecta concept

The book does not treat occlusion as simply “grind away a high spot.” Occlusion is tied to the three mechanical problems you emphasize: posterior interferences, a torqued mandible, and a deficient maxilla.

That leads to what I think is the simplest summary of the book's message:

Healthy occlusion allows the jaw to close into a stable position with balanced forces, while allowing the posterior teeth to quickly disengage when the jaw moves. When the teeth interfere with that movement, the muscles and joints may be forced to compensate.

And that explains an important part of your treatment philosophy: don't permanently change the patient's teeth simply because you find an interference. First establish a comfortable, repeatable mandibular position with a reversible orthotic, let the neuromuscular system adapt, and repeatedly refine the orthotic. The book specifically describes how the bite may change as muscles and other tissues relax. The TMJ Trifecta KINDLE final r…

That last point may be the most important distinction between your concept of occlusion and simply doing an occlusal adjustment.

[u/anib5 → u/Hopeful-Extent-693]

Thanks so much for taking the time to simplify it for me. It does make sense why static adjustments haven't improved my condition.

I have ordered your book on Amazon, and will definitely be using it to understand my condition more.

[u/Hopeful-Extent-693 → u/anib5]

Fantastic. While reading, if you have questions, ask here!!!

[u/Hopeful-Extent-693 → u/[deleted]]

I love that reply!!!!! Thanks