NEUROMUSCULAR DENTISTRY in its simplest form involves techniques and procedures to find the correct jaw position. Dental treatment must take into consideration not only the teeth as in traditional treatment but also the nerves and muscles which operate the the movements of the mandible (lower jaw). There must be harmony between the teeth, muscles and temporomandibular joints (TMJ's) to attain a comfortable and functional occlusion (bite). The principles of the neuromuscular philosophy may be applied to all areas of dental treatment since any treatment has the potential to adversely affect the occlusion.  

The TMJ's are the most complex joints in the body. The TMJ's must provide the bilateral coordinated movements of sliding and rotation which occur in an infinite combination of movements and functions. The relationship of the mandible and the maxilla (upper jaw) must be maintained in a position which allows unstrained coordinated muscle function and proper joint alignment at rest and in function. If the relationship of the jaws is adversely altered, the muscles of mastication (chewing muscles) go into spasm. This may lead to a chain of events where other muscles with the same nerve innervation may also go into spasm causing pain in the head, neck and possibly the back. Pain may vary from intermittent to constant depending on the abililty of muscles to accommodate to the new stresses. Many patients may describe these pains as migraine headaches. The muscle imbalances may eventually lead to TMJ's which have clicking, popping or grating sounds.

TMD/MSD may involve a large group of interrelated muscles, nerves and supporting structures (bones, ligaments and tendons) which relate to the TMJ's. TMD/MSD is frequently misdiagnosed due to the many overlapping symptoms which mimic other medical/dental conditions. Mechanically, the mandible may be too close (over closed) to the maxilla, displaced back in the TMJ or deviate to one side during opening and closing movements. The dysfunctions which arise from these abnormalities may be caused by a variety of maladies including premature loss of teeth, interferences on the surfaces of teeth, clenching/grinding, poor tongue position, imbalances in the head and neck muscles, poor posture, mouth breathing, osteoarthritis, rheumatoid arthritis or trauma. For whatever reason, incoordination between the teeth, muscles and TMJ's leads to TMD/MSD. Symptoms may range from mild to severe. Each of us has a different tolerance for pain and the ability to adapt and accommodate varies widely between individuals.

Symptoms May Include:

Headache Facial/Neck Pain Ringing in the ears Feeling of congested ears Jaw Pain - Sore TMJ Click or pops in TMJ Sensitive Teeth

Clenching/Grinding Limited mouth opening Worn down or broken teeth Loose Teeth Tingling in fingertips Forward head posture

In our office, we strive to develop an occlusion (bite) which results in an optimal functional position for the TMJ's and allows the masticatory muscles (chewing muscles) to have both an optimal resting position and maximum function.

The following diagrams illustrate destructive internal changes in the TMJ caused by dysfunctions discussed above:

With the advances in technology and computerization, we are able to use state of art computerized electro-diagnostic insrumentation to correctly and accurately position the mandible in relation to the maxilla. Use of this intrumentation gives us objective measurable data related to muscle at rest and in function and recording of the mandibular range of motion. The components of the computerized electro-diagnostic instrumentation include:

Computerized Jaw Tracking to record range of motion, rest positions, habitual occlusion, habitual path of closure and bite registrations.

    

Electromyography to monitor muscle activity at rest and during function.
    

Transcutaneous Electrical Neural Stimulation (TENS) ultra low frequency stimulation to relax spastic hypertonic masticatory muscles.

    

   

Sonography to record aberrant TMJ sounds to assist in diagnosis.

In addition to the computerized-diagnostics, a comprehensive TMD examination also includes a complete dental/medical history, necessary radiographs, extraoral and intraoral muscle palpation, diagnostic molds of the teeth and photographs.

The goal in treatment of TMD/MSD is to determine a position for the mandible where the masticatory muscles can be in a neutral unstrained state when at rest but can reach maximum function when called upon. This is the " physiologic rest position". It also places the TMJ's in a comfortable unstrained position. The mouth must be able to close where the muscles are most comfortable. After determining the physiologic rest position with the computer diagnostics, the bite is recorded at that precise point for fabrication of an orthotic. The orthotic is an interdental device which serves as a new biting/chewing surface where the patient can readily find their new neuromuscular position. The orthotic alleviates myofacial pain and allows the TMJ's to be stable. The orthotic is generally worn for 4-6 months after which the occlusion can be finalized by the use of bite restorers (semi-permanent orthotics), orthodontics, fixed reconstruction (crown and bridge procedures), partial or complete dentures or any combination of these treatments. TMD/MSD treatment frequently requires referrals to physical therapist, chiropractors or massage therapists. Resolution of the muscular imbalances and postural concerns are an integral part of TMD/MSD treatment. If you feel you suffer from TMD or bite related problems, please contact us for a complimentary consultation.