Neuromuscular Dentistry Myths

Myth # 1: Neuromuscular Dentistry doesn't work because the most comfortable mandibular position is centric relation (CR).
There is no study to confirm it. In fact, when study was undertaken to evaluate this assertion, seventeen out of the eighteen subjects were the most uncomfortable in CR (centric relation), one person was the most comfortable in CO (centric occlusion), and all eighteen were most comfortable in a neuromuscular position.
It's easy for CR experts to say that the most comfortable mandibular position is CR, but there is no study that measures or quantifies this.

Myth # 2: Neuromuscular dentists are having temporary success because any orthotic that creates cuspid guidance will work.
We have seen patients who wore orthoditcs built in the CR position. When tested the comfort of their muscles using an EMG machine, they all had high readings. However, when we made them an orthodontic in the ideal neuromuscular position, their muscles immediately clamed down. Many of them experienced quick relief of the pain they were experiencing. NMD (neuromuscular dentistry) orthodontic doesn't work because it provides cuspid or anterior guidance; it works because it creates the most comfortable position for the mandible.

Myth # 3: Using a TENS (Transcutaneous Electrical Neural Stimulation) unit to find the physiologic rest position of the mandible isn't accurate because the TENS relaxes all the muscles except the lateral pterygoid.
First of all, this is physiologically impossible. Since the stimulation is transmitted via the V and VII cranial nerves, there is no way the stimulation would bypass one muscle innervated by these nerves. The fact that TENSing is neurally, not surface, stimulated can be proven by a test using the administration of succinyl-choline. When the chemical is administered, the pulsing stops. If the muscles were surface stimulated, the pulsing would continue.
The reason NMD opponents perpetuate this myth is that they don't completely understand physiology. They assume the contraction of the lateral pterygoid is the only way the mandible will come down and forward. Yet by relaxing all the appropriate muscles, gravity will bring the mandible down and forward. Imagine a man sleeping in a sitting position. Is his mandible CR? Of course not. His mandible moves down and forward - often with an open mouth.

Myth # 4: The neuromuscular position is not desirable because you will bite stronger in that position. This isn't good because the stronger bite increases the chance of patients breaking their restorations.
This is the exact opposite of myth # 3 above. CR advocate is teaching that the NM position is not desirable because it creates a stronger biting force that will break restorations. This goes against the objective of any medical treatment done by any specialty. The result of any therapeutic position should be an improvement in muscle function. If you broke your arm, would you want the physician to restore it in a position of weakness? If you had an artificial joint placed, would you want the physician to make your arm or leg weak to protect the joint?
The truth is that we have very few restorations break in the posterior. If our restorations do break, it's generally in the corner of the mouth (laterals, cuspids and first bicuspids) because of interferences. Yet the greatest biting force is the posterior. In conclusion, if you want the strength to bite something, you want to make sure it's available. That's optimal muscle function. NMD does the best of creating optimal muscle function.

Myth # 5: If you relax the muscles at rest, they might atrophy.
This myth is untrue. If makes no sense at all. Muscles relax during sleep. Do we then tell our patients not to sleep because their muscles might atrophy? Of course not. With NMD, the muscles are relaxed at rest. This is the way it should be. They're resting up for the next big chomp, swallow or spoken word.

Myth # 6: It doesn't matter if the occlusal plane is level as long as all teeth hit at the same time.
One of the basic tenets of NMD is that the occlusal plane must be level. To say this is not important would be like saying it doesn't matter if one of your legs is longer than the other as long as both feet hit the floor at the same time. Sure, both feet would be touching the floor, but the rest of the body would have to compensate for the tilt that is created. The same thing happens in the mouth when the occlusal plane isn't level. It causes extensive muscle disharmony and creates improper biting forces. The muscle disharmony can cause pain, and the improper biting forces can break restorations.

Myth # 5: NMD does full-mouth reconstruction in two visits.
Any dentist would be crazy to try to do a full-mouth reconstruction in two visits. Here are typical steps of a full-mouth NMD reconstruction.

NMD is not one procedure (full-mouth reconstruction). If full-mouth reconstruction is chosen as the treatment of choice, it is certainly not done in two visits. It is true that qualified neuromuscular dentist can prepare an entire mouth in one visit and seat the restorations in one visit. This is a huge benefit to their patients. Above all, NMD is a systemic way of evaluating and caring for patients that includes many treatment options.