by Dr. Lee Ann Brady
Occlusion is not just for TMD specialists. So who is it for?
It’s for every dentist who has a willingness to learn and consider patient treatment from a different perspective.
My most recent posts have discussed the philosophy behind occlusion, but now I’m going to start wading into the hands-on depths of diagnosis and treatment.
First up on the plate is the lateral pole palpation. I’ve put together some key points that will allow you to get the most value out of this diagnosis method.
Lateral Pole Palpation: The Golden Rules for Success
The above image perfectly embodies how you should not approach a lateral pole palpation.
Think of your patient’s joints as the egg and an aggressive palpation as the mallet. You need to find the right balance of appropriate pressure to gauge pain and responses to it.
Rule #1: Don’t fit technique to form, fit form to technique.
You’re compressing a soft tissue between two hard surfaces. This is a delicate process that requires an emphasis on carrying out the palpation as carefully as possible.
There are two different kinds of nerve response fibers: proprioceptive and nociceptive (one tells us if we’re being touched and one tells us if we’re experiencing pain). If you trigger a pain response through touch, it tells you that those tissues are inflamed.
Rule #2: Know where to press and then learn how to press with the right amount of pressure.
A pain response is like somebody turning the volume up on those fibers. You and your patient are going to know immediately when it happens.
If you try too hard to elicit a response, you may be causing unnecessary discomfort and obscuring an accurate diagnosis.
About one to two pounds of pressure is all that’s needed for joints and one to five is all that is needed for muscles. What does a pound of pressure amount to? Press on your fingernail until it blanches: That’s one pound of pressure.
This demonstration makes it clear why excessive pressure is so detrimental in lateral pole palpation. Five pounds of pressure will lead to pain regardless of whether joints are healthy or unhealthy.
Nobody benefits from a “cracked egg” scenario.
How do you determine the right amount of pressure for a lateral pole palpation? We’d love to hear from you in the comments!