Neuromuscular Dentistry
What is NEUROMUSCULAR DENTISTRY and how does it differ from common dentistry.
Neuromuscular dentistry differs from "traditional" dentistry in the emphasis that is placed upon the activity of the muscles that move the jaw. Unlike neuromuscular dentistry, traditional dentistry uses the position that the teeth come together and the position where the jaw joint is positioned in a joint space in the skull as a reference point to restore the teeth.
Neuromuscular dentistry recognizes that the muscles that move the jaw must be in a comfortable, relaxed position in order to not be in conflict with the teeth and joint.
Common symptoms that occur when teeth, jaws and muscles are in conflict include:
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Headaches |
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Loose teeth |
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Worn, chipped, or cracked teeth or fillings |
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Clenching or grinding |
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Ditched root grooves |
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Pain or clicking and popping in joints |
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Shoulder, neck, and back pain |
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Numbness in arms and fingers |
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Pain behind the eyes |
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Facial pain |
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Difficulty swallowing |
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Pain and sensitivity in teeth |
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Crowded teeth |
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Receding gums |
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Ringing or congestion in the ears |
The Focus
In our office Neuromuscular Dentistry emphasizes the need to establish an occlusion based upon:
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the optimal position and function of the temporomandibular joints and |
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the optimal resting posture and function of the masticatory muscles |
This approach differs greatly from the common dentistry approach that treats the teeth and assumes the teeth, active muscles, and the jaw joints will accommodate to the treated occlusion. Treating teeth by restorative procedures (crowns, bridges, and fillings) or common orthodontics (straightening teeth) are often done without accurately determining a correct jaw posture and a proper vertical dimension.
A Neuromuscular Dentist can determine a proper resting jaw position that effects the facial head and neck muscles, the teeth as well as the joints. A physiologic resting position and body posture is often overlooked and not even considered as an important part of the whole dental system.
Our success is in the philosophy of taking a neuromuscular approach in all facets of our dentistry including orthodontics, TMJ/ myo-facial pain problems, occlusal (biting) problems, all areas of restorative and aesthetic treatments.
Computerized Diagnostics
In this day of technology and computerization, our dental office use state of the art technology to find a correct and accurate jaw posture substantiated by objective measurable data of the muscles in function and atrests.
The above recording depicts a "PATHOLOGIC JAW POSITION" that is contributing to this patients TMJ pain symptoms. The diagnostic test indicate that the jaw should be 2.1 mm forward (physiologic path of closure). Dotted line indicates the ideal physiologic path of closure both frontally (green lines) and sagittally (blue lines).
Same patient is now able to function at a natural unstrained position (the normal opening/ closing path is equal to a physiologic opening and closing path). Notice that the 2.1 mm discrepancy is no longer present. The blue and green lines verify that the jaw is properly aligned to a "Neuromuscular" position. This patient is comfortable and free of myofacial pain.
Computerized diagnostics make it possible to accurately find a physiologic position that meets the parameters of each individual patient.
Those patients that are seeking state of the art care and treatment, especially those that find themselves in the difficult to complex category (top 5-15%) should seriously consider this approach. Those patients that are tired of educated guesses, trial and error treatment protocols and having experienced splints that are not effective should stop and re-evaluate by what philosophy you would like your care and treatment.
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Computerized jaw tracking instrumentation - is used to record jaw movements, range of motion, path of closure, protrusive guidance, rest positions, habitual centric occlusion, and determine freeway space. |
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Electromyography -is used to monitor the muscles in function. |
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Sonography - records jaw joint sounds and helps detect abnormalities. |
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Myo-monitor (low frequency TENS) - is used to relax the hyperactive facial muscles. |
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Tomography - are special x-rays of the jaw joints to evaluate the jaw joint condition and position. |
Finding your neuromuscular jaw position is paramount before a final restorative/ orthodontic phase is started to prevent muscular imbalances that would lead to instability of the teeth, supporting bone and compromised posture.
A comprehensive analysis and evaluation is highly recommended to assist the doctor in accurately diagnosing and developing a treatment plan that can best meet your needs for long term optimal dental health and comfort.
Are Your Joints Healthy?
The temporomandibular joints (the TMJ's) are two joints that are a part of the chew and swallowing functions. They are important in supporting the mandible to the skull by means of many muscles. Without two jaw joints our ability to open and close the mouth and move the jaw from side to side will be greatly diminished.
The TMJoints are often overlooked and not seriously considered, since on routine examinations the joints are hidden behind tissue. The oral cavity, the gums and teeth, are mostly seen since those are the parts that we see the easiest. Routine x-rays are taken of the teeth to check for cavities. Pocket probing measurements around the teeth and gums are recorded regularly to check for gum disease. But the jaw joints are rarely considered as important. Most dentist, physicians, chiropractors, osteopathic physicians, etc. are consider these two joints in their overall evaluation since most of the health professionals have had very little training in this area.
JAW JOINTS ARE JUST AS IMPORTANT AS TEETH AND GUMS!
The following tomographs show unstable joints that have given these patients a list of problems. Jaw joints need to be checked! Dentists use x-rays to check our teeth for cavities and evaluate the underlying bone for pathology around our teeth routinely.
THE TEMPOROMANDIBULAR JOINTS ARE NO LESS AS IMPORTANT!
Case 1
This patient presents with constant headaches and jaw joint dysfunction. The left jaw joint has very little pathology. The right joint shows abnormal joint surfaces (osteodegeneration-beaking).
Do you think that the teeth will be stable and be easy to fix when dental work is done? Notice the right tomogram shows the joint in an up and back position near the ear hole. Yes, this patient experiences "fullness in the ear" feelings. By the way, his teeth bite together evenly and appears to have good occlusion (in a habitual bite). They even appear straight.
What does one do for this problem? Ignore the joints? At one end of the mandible (jaw bone) are teeth. At the other end of the same bone are the joints (TMJ's). If the teeth are in the wrong position don't you think that they will also effect the joint in a wrong way as well?
Case 2
These joints belong to an 18 year old female. She experiences constant head and neck pain for the past three (3) years.
Tomograms reveal severe joint pathology. Notice the thin/ narrow shape of these condyles. The neck of the condyles are bent. Notice the sclerotic (white) bone in the upper portion of the joint. The left tomogram - teeth are biting together. Right tomogram - mouth wide open. Patient has constricted mouth opening. Patient can bite her teeth together, but the joints are in a strained position causing muscular pain and numerous TMJ symptoms.
SHOULD WE DENTIST CONTINUE TO IGNORE THE JOINTS? AND JUST CONTINUE DOING OUR "TOOTH DENTISTRY"?
The condition of the temporomandibular joints must certainly be considered especially when any form of dentistry is being considered!
If any restorative work is being considered such as fillings, crowns, bridges and implants, the health of the joints should seriously be considered. Most jaw joints do not give the patient pain directly, but many symptoms that are indirectly related will effect the occlusion (the bite), the comfort of the teeth and the overall comfort of the supporting muscles.
It is only obvious that if the joints are not stable and have compensations in the opening and closing paths of mouth movements, it will later impact the stability of the teeth and any dental work that is performed!
For the "Occlusion" (the bite) to be stable, the jaw joints must be stable and healthy.
Let us not forget that the TMJoints are connected to the same jaw bone (mandible) at one end and at the other end of the jaw are our teeth. They do effect one another! Muscles are the driving force to move them together.
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