English Version

Recently, there are various discussions about what is meant by a term "qualified dentist"
or "dental specialist"? of the field in orthodontic dentistry.

However, I think that there is a lack of an important viewpoint in that a dentist does not

I believe that I must take care of a patient's oral cavity and occlusion as an orthodontist

up to a patient becomes elderly people, when I once treated the patient.

I think that the matter mentioned above will not be clearly understood by a practicing

specialized orthodontist (a dentist who participates only in orthodontic treatment).

I, myself is a dentist qualified by Japanese Orthodontic Society, and I have intended to

However There were some reasons, and I practice general dentistry including orthodontic
dentistry at present.

In general, Orthodontist in an academic office in a university comes up against many

difficulties in medical treatment in orthodontic dentistry, so that the doctor pays only

I have ever been one of such members in an office of a university, and I was believed in

Incidentally, it seems that there is scarcely such a case where dental treatment of

a certain patient is made continuously in the same clinic over his or her life at the present

This may means harmful effects involved in a system of medical specialists or such

a fact that specialized dentists in orthodontic dentistry cannot understand present status

In most cases, an infant patient in orthodontic dentistry stops to visit an orthodontic
clinic,

when the patient grows up to around twenty-five years old, and such patient goes usually

To be noted is that a patient of twenty to thirty years old who has completed in

Mother brings her child for asking dentist's advice about orthodontic treatment.

In the course of the advice, the mother states often that she has an experience in

The mother appeals further that I cannot comprehend that I should masticate foods or the
like at which site of tooth row,

Sometimes, young man or young woman who has ever experienced orthodontic
treatments

And they appeal their troubles that I feel pain in my jaw, that sometimes, I cannot open the
mouth, and the like.

In these days, I experience frequently such appeals as mentioned above from persons
who have ever experienced orthodontic treatments.

On the contrary, there are great deals of persons who have completed treatments in

Continuing general dentistry, it becomes clearer dangerous problems involved in
treatment

Recently, American Association of Orthodontists announces that treatments in
orthodontic

Many of Japanese physicians, dentists and academic conferences believe such

Nevertheless, how does it mean in rapid increase of special doctor's offices for

In also Japan, how does it mean in rapid increase of lecture classes for
temporomandibular dysfunction syndrome and relevant matters as to occlusion?

In this respect, how can we avoid problems of temporomandibular dysfunction syndrome?

THE RELATIONSHIP OF BETWEEN MANDIBLE MOVEMENT AND THE
BRAIN　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　日本語

Major organisms for mandible movement are bone structures, muscular tissues, and
nervous tissues.

Command from brain transmits through nervous tissues, so that lower jaw is moved by

Namely, "bone structures function as a rail track, while muscular tissues generate force and
speed."

I believe that only rail track and orbity should not be considered, but "muscular system"

and "nervous system" must be taken into consideration in case of studying mandible

When such command "bite any object!" is issued from brain, a person who has normal
dental articulation bites unconsciously the object to chew up it without thinking.

On the other hand, a man or woman who has a bad dental articulation does not apply his

or her natural rail track (because his or her brain recognizes experimentally that such

As a result, he or she finds another rail track by the application of which he (she) does not

feel pain (which is prepared by his or her brain by himself (or herself) under the pressure of
necessity).

In these situations, a man who accompanies impertinent occlusion must figure and find

consciously a pertinent rail track with a struggle in each occasion where he bites something
to eat.

Any human being has sensation of fear with respect to pain, and this is a signal for
biophylaxis.

Pain appears in the case where any irritation from the outside comes to be stronger and it
acts harmfully upon living body, and the living body feels such stress as pain.

Because of a circuit which is created selfishly by he himself or her herself so as not to
feel any pain, he or she forgets such circuit for some reason or other.

As a result, there is a case where he or she takes originally fixed his or her own rail track
for mandible movement.

Specific examples of such cases are described in detail in the following paragraphs,

but some of them will show herein, i.e. a case where he ate avidly a hard article of food
having nice taste, a case of clenching his or her teeth while sleeping, a case of competitive
swimming and the like.

Symptoms are classified generally into two categories, i.e. acute and chronic symptoms.

Chronic case means not so intensive symptom, while acute case means sudden appearance
of symptom.

I construe that temporomandibular dysfunction syndrome is a kind of torsional deformity.

According to a reference book, "the term, torsional deformity means a case where

articulation is forced by external force to carry out physical exercise over a region of

physiological exercise or exercise which is essentially impossible, so that a normal
interrelationship on articulo surfaces gets instantaneously out of order, but returns to the
original state at once.

In this case, excessive extension or rupture of appendant ligament arises" ["SEIKEI
GEKAGAKU" (Orthopedic Surgery) Kinbara Publishing Company].

I think that the external force may be classified into a so-called external force (i.e. brutal
power, or forces caused by traffic accident or tendency to fall) and his or her own

I have considered mandible movement from biodynamical point of view away from
difficult occlusal theoretical concepts such as CO, and CR.

In these days, I play golf, so that I make variously a study of my swing movement in golf.
My approaches are a comparison with respect to "occlusion".

When my golf was in a bad form, I read a golf magazine. In the magazine, I found
photographic playback in photos of a professional golf player.

It is said that a posture in addressing for striking a golf ball (behavior before striking a
golf ball) is the same with that in impacting the golf ball (an instant for striking the golf ball),
but only directions of a face of a golf club in both cases are the same with each other.

Particularly, a difference is in directions of a waist of a golf player.

Namely, a player's waist is in parallel to line of fly ball, while the player's waist is
considerably away from a direction of struck ball at the instant of impacting the ball.

This situation is the same with that in baseball, and more specifically, a batter's waist is
considerably dispread with respect to a direction of struck ball at the instant of impacting
the ball on a bat.

Namely, a player's muscular system functions to merely hold and support a club in case of
addressing for striking golf ball, while the muscular system functions to swing forcefully the
club in case of impacting the ball.

According to my opinion, it derives from differences in muscular systems applied, besides
differences in an amount of muscular system to be used in even the same muscular system.

Muscles for functioning to operate lower jaw as well as muscles for functioning to open
and close lower jaw are classified in two categories in general terms, i.e. they are
masticatory muscles and elevator muscles.

Masticatory muscles include mylohyoid muscle, digastric muscle, lateral pterygoid muscle
and the like, while elevator muscle includes masseter muscle, temporal muscle, medial
pterygoid muscle, zygomatic bone lower head muscle and the like.

In order to perform movements for moving the above-described lower jaw, different
muscles are used, respectively.

Even if the same muscles are used, amounts of muscles applied are different from one
another.

In other words, positional relationships between upper jaw and lower jaw are also
different from one another.

Movements of muscles must differ at a position where soft edible material is chewed from
that where hard edible material is chewed.

Muscles for supporting lower jaw against gravitational force must differ from one another
in a human being dependent upon a posture thereof, besides positions of lower jaws must
differ naturally from one another in different people.

An explanation is not necessary herein for such a matter that certain muscles to be
applied function for which movements of muscles, so that the description therefor will be
omitted.

Positions of lower jaw are divided into three cases dependent on movements in general
terms.

A condition wherein lower jaw touches lightly upon upper jaw in a just average manner.
In this case, muscles applied are a group of muscles for moving the lower jaw in elevator
muscles.

In this case, muscles applied are elevator muscles and masticating muscles, i.e. so-called
group of masseters, and the position of the lower jaw is somewhat closer to its distal
position.

A condition wherein a person clenches or bites his or her teeth in full blast. In this case,
muscles applied are the same as that in the case 1, but he or she applies fully group of
elevator muscles, and the position of the lower jaw is closer to its distal position than that
of the case 2.

More specifically, a position of lower jaw shifts gradually closer to its distal position in the
cases 1, 2, and 3 in this order.

This is because a position of lower jaw comes to be subtly different with respect to its
upper jaw due to differences in muscles applied and amounts of muscles applied as
described above.

I watched a scene in a film as to old Japanese army wherein a superior officer gave a
shout that "Clench your teeth and keep in your chin!" before giving his junior staff a blow.

In this respect, however, when a person clenches his teeth, his lower jaw is kept in by
itself (the case 3).

The most important case among the above-described three cases is the case 3.

The reason why is in that there is the largest amount of force in the case 3, and when
there is imbalance in the case 3, abnormal force is transmitted to temporomandibular joint.

Specific examples of such states as described above include a state of lockjaw in the
next morning after clenching or grinding while sleeping, a state after eating hard French
bread, a state after attending a swimming race, a state after running in full blast, and a
state after holding a heavy article for a long time.

There are many cases wherein temporomandibular dysfunction syndrome appears after
experiencing such a state as described above.

In this respect, I imagine that a considerable force is added to temporomandibular joint
due to a large amount of relevant muscles applied, so that affection appears easily.

The following problem is in that lower jaw should be got into its upper jaw in accordance
with which situation in approaching a course.

In this connection, I got a hint from my golf chum who he is the same age with me, a
branch office manager in a foreign-affiliated bank, skilled in English and French languages,
and a US license holder of airplane for business aims.

I asked him some questions such as "How can I take the license?" and "How do you feel
about the training?" etc.

I was told by him that there was a manner of "touch and go" for training in taking-off
and landing of airplane. It means training for steering airplane in which no sooner than an
airplane makes a landing, it takes off again.

In the instant of hearing, it came to me in a flash, i.e. this is the same situation with that
of occlusion.

For making a landing, a correct altitude and horizontal balance from three-dimensional
point of view are required.

For instance, a pilot cannot make a landing on a flight strip in either case where an
approaching height of an airplane is excessively high, or a case where it is excessively low.

Even if an altitude is correct, when body of an airplane is excessively horizontal, it
cannot make a landing.

In such a case, landing of the airplane is avoided by orders from a chief pilot or an
airport control tower, resulting in "Go around".

In this case, however, a landing with even slight imbalance results in such operations that
the balance must be once reattempted, and then, the airplane must take off.

If these operations were not performed smoothly and properly, there arises a fear of an
insufficient landing strip.

Incidentally, most of training for steering airplane expends for an answer of emergency
circumstances relating to "touch and go" and a stopped engine etc.

Referring to occlusion, it is concluded that when lower jaw molar teeth make a landing on
their upper jaw molar teeth in a symmetrical and well-balanced manner in the above-
described cases 1, 2, and 3, good results are expected.

When it is intended to make a proper landing, an airplane must take inevitably a suitable
flight route (a suitable track for lower jaw movement in case of occlusion).

In infancy, child has ability of self-adjustments, whereby his or her small imbalance in
occlusion can be retrieved, while an unbalanced condition in occlusion in adult life brings
about stress, resulting in tinnitus, cephalalgia, stiff shoulder, grinding while sleeping and the
like.

An occlusion system between lower jaw and upper jaw may be said that a kind of delicate
sense receptor which can discriminate even a thickness of a single hair.

Namely, when a skeleton specimen of human body is observed from the front thereof, "
only one bone which moves over a median part of human body is lower jaw" and in this
respect, I consider that if the lower jaw is inclined, its neck and vertebral column become
inevitably inclined.

When a pair of wheels aligned laterally touches down at the same time, inclination of the
airplane is slight, so that impact on a shock absorber (temporomandibular joint in case of
human body) for supporting the wheels becomes small.

However, when the number of wheels increases, it is difficult to touch down all the wheels at
the same time.

In case of orthodontic treatment, a technique so-called "Full Bands" is frequently
applied. According to the treatment, a single continuous wire is applied to both of upper
and lower dentitions, whereby the dentitions are made to be flat.

As mentioned above, simultaneous contact along a lateral direction becomes difficult with
increase in the number of contact points.

A probability of simultaneous contact of both the planes in a vertical direction is one in a
million.

Therefore, I think that occlusal adjustment at the final stage comes to be inevitably
necessary.

When a certain wheel is continued to use for a long term, it wears. After blowout of a
wheel on a side, when it is replaced by a metallic wheel on only the side in order to avoid
further blowout, wearing tendencies differ from one another on both right and left sides, so
that the body of airplane inclines.

In the case where any material has been packed in a dental treatment, I think it is required
to adjust its occlusion according to necessity.

Incidentally, where should it make a landing? I will describe hereinafter the matter with
respect to the most important case 3.

I have continued skiing from my student days. I have experienced an official assay
during my student days.

Ski jump is an item of the most out of one's element for someone who lives in a land where
there is no snowing.

During initial phases, I had a fall as a result of holding back my lumbar, and then, I had a fall
as a result of dashing desperately.

A stage for jump is essentially set up on middle of an oblique plane in skiing ground,

In the skiing ground, its landing slope is the same type of an oblique plane.

I have ever watched, in fact, the skiing ground, and I had admiration for such
circumstance wherein athletes play in such terrible stage for jump without restraint.

When we watch competitive jump in TV, we usually hear that extensive jumping over
point K is dangerous.

Accordingly, congress officials arrange to shorten a distance of runway in such case.

This is because points of touchdown are formed to become gradually flatter with increase in
distance. In other words, the officials are afraid that athletes jump excessively due to nice
and forcible wind.

I have never been physically damaged, even if I failed to touch down and had a fall over
and over.

I think the reason why is in presence of "oblique plane" in a skiing ground.

Now, turn to the subject, I think it is better that an occlusal relationship in the case 3
should be in "dental cusp versus oblique plane".

I believe it should be in that molar dental cusp of upper jaw goes into an oblique plane of
a distal side on the top of dental cusp of its lower jaw, while molar distal cusp of the lower
jaw goes into an oblique plane of an anterior side on the top of dental cusp of the upper
jaw. Due to the oblique plane, the whole mandibular bone shifts to an anterior side.

In this case, the mandibular bone must never shift to a more distal side than that of the
case 3. Because such position on the more distal side may bring about breakdown of
temporomandibular joint.

From the explanation as described above, I believe that a vertical treatment for
withstanding a large force applied to a molar section should be first established, and then,

a horizontal treatment for setting a guide in case of moving along a side direction and
establishing an operating and a non-operating sides should be finally established.

In case of orthodontic dentistry, checking for occlusion in the final stage is based mostly
on the case 1.

The state is an occlusal condition which is considered to be aesthetically attractive.

The condition is in a position where "muscles for moving" lower jaw are operated as
described above.

Occlusion in which functionally favorable dental articulation is attained can be realized by
using "favorably biting muscles".

For this reason, it is necessary for checking also the above-mentioned cases 2 and 3.

As a result of such checking, occlusal failure, temporomandibular dysfunction syndrome
and the like which might be experienced in the future will be kept from occurring.

In this respect, however, I think our proposition must be continued for a long time, and
accordingly, we must expect for evaluations by dentists of next generation.

I am a specialist of orthodontic dentistry, and I am engaged also in treatments of general
dentistry. During treatments, I am always thinking about why dental cusp has such
complicated profile.

I think that the complicated profile of dental cusp might be derived from an accurate
masticatory mechanism given by God, and it may be a defensive mechanism for tooth
fracture and breakdown of temporomandibular joint

A foundation of such orthodontic appliance was built up by famous Dr. E. H. Angle in USA.
Dr. E. H. Angle died in 1930, and immediately before his death, the therapy relating thereto
was systemized.

The therapy itself is a new one which doe not exceed a hundred year yet as of the year
2002.

Continual treatments for over a hundred year are required, and then, it may be said that
the therapy was established.

Manners for the therapy are divided into various types, but they are principally composed
with the use of bands, brackets, and wires.

Some of them are imported to Japan as they are, and on the other hand, some of them are
imported also from Europe.

Thereafter, Japanese professors Miura, Kuroda et al. have developed an innovative
Direct Bonding Method which is adopted by our orthodontists at present and has high
reputation for all over the world.

As mentioned in the above paragraph "THE SWING OF THE JAW", when each of
continuous wires is applied to both upper and lower rows of teeth, both the rows become
flat.

Under the circumstances, such a technique in which a flat plane is completely made to be
coincident with another flat plane is very difficult, and that is beyond human ability.

In this respect, I suppose that such difficulty will be avoided by sectioning an area to be
treated into an anterior teeth section, right and left molar sections, respectively in a final
stage of orthodontic treatment, even if it is slightly.

AUSCULTATION USING THE T.M.J. SCOPE　　　　　　　　　　日本語

A manner for hearing natural vibration sounded in human body by ears of a diagnostician
from the outside of the human body to diagnose any abnormal condition is called by the
name of "auscultation" [from "NAIKA SINDAN-GAKU (Internal Medicine Diagnostics)
authored by Kazu Yoshitoshi)].

Referring historically, auscultation which applies directly upon a breast of a person to be
diagnosed by ears of a diagnostician was implemented in eras of ancient Egypt and Greece.
Then, auscultation is conducted with use of an instrument prepared by rolling a note book
into a cylindrical shape.

French medical doctor, Laennec invented stethoscope in 1816, and the present auscultation
was established on the basis of such stethoscope.

Three symptoms of temporomandibular dysfunction syndrome have been already
mentioned in the above paragraphs.

In this respect, however, a patient who comes to my clinic because of a reason in which he
or she is annoyed with noise is scarce.

In general, a person does scarcely act except that he or she feels inconvenience in reality.
This is way of the world.

Namely, a patient comes to my clinic after he or she felt a pain, or after he or she could
not open mouth.

As my diagnosis, I observe first movement of entire body, walking figure, words and
deeds, quality of voice, facial expression of a patient, and then, make a diagnosis upon his or
her movement in jaws, sounds in temporomandibular joint, finally the inside of oral cavity
and teeth.

Although a very rare case in which there is a patient who sounds articular sounds which can
be heard even away from about one meter, while there is a patient who sounds no sound
which cannot be heard even with use of a stethoscope.

When articular sounds are heard with use of T.M.J. Scope, a variety of sounds are heard
interestingly.

When familiarized with T.M.J. Scope, slippage in timings between sounds sounded in dentition
on right and left sides as well as quality of sounds can be caught.

With the progress of treatment, such noise becomes inevitably smaller or disappears.

There are sounds from which it can presume a possibility of future appearance of
temporomandibular dysfunction syndrome.

Accordingly, T.M.J. Scope is effective for a preventive diagnostic appliance.

In accordance with T.M.J. Scope, sounds sounded from a patient who has ever experienced
temporomandibular dysfunction syndrome can be caught.

In case of temporomandibular arthrosis, most of patients have experienced the disease
on either side of rows of teeth, but not both the sides thereof.

A characteristic feature of T.M.J. Scope is in that such situation can be caught well and
understood by means of the scope.

Now, I will try to classify noises sounded from temporomandibular joint.

Dynamic noise: Noises sounded in the case where temporomandibular joint functions
normally.

In many cases, sounds are harmless noises which are mild and gentle sounds.

Organic noise: There is any organic change in temporomandibular joint, so that sounds are
produced.

Sometimes, there is a sound sounded by rubbing with use of abrasive paper.

Degree is determined in accordance with magnitude of sound, but in this respect, judgment
in such degree is somewhat different from one another according to a person who makes a
decision, so that digitization of such sounds is required.

There is a case where large sounds are produced one or two times at the time of moving
jaws of temporomandibular dysfunction syndrome.

In such a case, if the sounds are heard at the same time on both sides of rows of teeth, it
exhibits a condition where no problem is involved.

However, if there is a slippage in timings for sounding such sounds between both the sides of
rows of teeth, presence of temporomandibular dysfunction syndrome is concluded.

Furthermore, when treatment for temporomandibular dysfunction syndrome is well
progressed, there is a case where two times of large sounds are reduced to one time, or a
case where such sounds disappear.

However, I believe that only actual experience brings about clear understanding, even if a
detailed description is made upon T.M.J. Scope. Namely, "hearing is believing"??

When you experience T.M.J. Scope, I believe your diagnostic world must be dramatically
changed.

In order to achieve objective diagnosis, reproduction and retention of sounds in
temporomandibular joint are absolutely necessary.

For this purpose, I plan fabrication of a digital stethoscope in the future.

I am very interested in degree of sound volume, changes in sound quality before and
after treatment, and conversion of sounds into digital wave forms.

If such a diagnostic appliance can be realized, patient will be also satisfactory.

On one occasion, when I asked my foreign friend's opinion about the naming, his answer was
that "It is strange."

In this connection, since I intend to penetrate into international market by means of the
scope, it is renamed as T.M.J. Scope.

Under the circumstances, Your Majesties! Please take in my stethoscope, T.M.J. Scope
for diagnosis of temporomandibular dysfunction syndrome.

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Japanese 日本語