Neuromuscular dentistry
Encyclopedia
Neuromuscular dentistry is a dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system
mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal system
s. It is a treatment modality of dentistry
that focuses on correcting "misalignment" of the jaw
at the temporomandibular joint
(TMJ). Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry claims that "misalignment problem(s)" can be corrected by understanding the relationships of the tissues involved, which include muscle
s, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion
.
Symptoms of temporomandibular joint disorder
(TMD) are claimed to include:
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG)
and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator
(TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording.
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3–6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Neuromuscular Dentistry is generally provided in two Phases. Most commonly, the first phase is performed for patients that are symptomatic, usually acute pain such as headaches, etc. Some Phase One patients do not have symptoms, but rather their occlusion or bite needs to be corrected prior to restoring their mouths with crowns, veneers, or NM Functional Orthodontics (often termed an Esthetics case). Phase Two treatment is preferably decided upon PRIOR to embarking on Phase One treatment by the NM Dentist and the patient. Phase Two treatment can be:
1. Continuing to wear the lower orthosis with knowledge that replacements will need to fabricated over time (at patient expense)
2. Restorative Dentistry to the new bite position
3. Neuromuscular Functional Orthodontics
4. Combination of any of the above.Category:Dentistry
There are separate fees for Phase One and Phase Two treatment options. Phase Two Dentistry options are "conventional" dental procedures such as crowns, bridges, implants, partial or full Dentures.
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal system
Musculoskeletal system
A musculoskeletal system is an organ system that gives animals the ability to move using the muscular and skeletal systems...
s. It is a treatment modality of dentistry
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
that focuses on correcting "misalignment" of the jaw
Jaw
The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
at the temporomandibular joint
Temporomandibular joint
The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. There are two TMJs, one on either side, working in unison. The name is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium , and the lower jaw bone called the...
(TMJ). Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry claims that "misalignment problem(s)" can be corrected by understanding the relationships of the tissues involved, which include muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion
Occlusion (dentistry)
Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary and mandibular teeth when they approach each other, as occurs during chewing or at rest....
.
Symptoms of temporomandibular joint disorder
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
(TMD) are claimed to include:
- Headaches / migraines
- Facial pain
- Back, neck and shoulder pain
- TinnitusTinnitusTinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
(ringing in the ears) - Vertigo (dizziness)
- Trigeminal neuralgiaTrigeminal neuralgiaTrigeminal neuralgia , tic douloureux is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It has been described as among the most painful conditions known...
(tic douloureux), a neuropathic pain disorder unrelated to TMD - Bell's PalsyBell's palsyBell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII that results in the inability to control facial muscles on the affected side. Several conditions can cause facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause...
, a nerve disorder unrelated to TMD - Sensitive and sore teeth
- Jaw pain
- Limited jaw movement or locking jaw
- Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
- Worn or cracked teeth
- Clicking or popping in the jaw joints
- Jaw joint pain
- Clenching/bruxing
- Tender sensitive teeth
- A limited opening or inability to open the mouth comfortably
- Deviation of the jaw to one side
- The jaw locking open or closed
- Postural problems (forward head postureForward head postureForward head posture is the anterior positioning of the cervical spine.It is a posture problem that is caused by several factors including sleeping with the head elevated too high, extended use of computers, lack of developed back muscle strength and lack of nutrients such as calcium...
) - Torticollis
- Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
- Pain in the muscles surrounding the temporomandibular joints
- Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
- Pain behind the eyes
- Swelling on the side of the face and/or mouth
- A bite that feels uncomfortable, "off," or as if it is continually changing
- Older Bells palsy
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG)
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator
Transcutaneous Electrical Nerve Stimulator
Transcutaneous electrical nerve stimulation is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes...
(TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording.
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3–6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Neuromuscular Dentistry is generally provided in two Phases. Most commonly, the first phase is performed for patients that are symptomatic, usually acute pain such as headaches, etc. Some Phase One patients do not have symptoms, but rather their occlusion or bite needs to be corrected prior to restoring their mouths with crowns, veneers, or NM Functional Orthodontics (often termed an Esthetics case). Phase Two treatment is preferably decided upon PRIOR to embarking on Phase One treatment by the NM Dentist and the patient. Phase Two treatment can be:
1. Continuing to wear the lower orthosis with knowledge that replacements will need to fabricated over time (at patient expense)
2. Restorative Dentistry to the new bite position
3. Neuromuscular Functional Orthodontics
4. Combination of any of the above.Category:Dentistry
There are separate fees for Phase One and Phase Two treatment options. Phase Two Dentistry options are "conventional" dental procedures such as crowns, bridges, implants, partial or full Dentures.