Neuromuscular dentistry

Neuromuscular dentistry is a philosophy recognized by the International College of Cranio-Mandibular Orthopedics (ICCMO) and the International Association of Comprehensive Aesthetics (IACA), while the American Academy of Craniofacial Pain (AACFP) has a neuromuscular section. These professional associations consider that the health and welfare of temporomandibular joints, muscles of mastication and central nervous system mechanisms may follow the same physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting the physiologic "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry can correct the relations of the tissues involved, which include muscles, 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:
*headaches / migraines
*sleep apnea & upper airway resistance syndrome
*facial pain
*back, neck and shoulder pain
*tinnitus (ringing in the ears)
*vertigo (dizziness)
*trigeminal neuralgia (tic douloureux), a neuropathic pain disorder unrelated to TMD
*Bell's palsy, 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 posture)
*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 Bell's palsy
The National Heart Lung and Blood Institute (NHLBI) of the U.S. National Institutes of Health (NIH) published Cardiovascular and sleep-related consequences of temporomandibular disorders following a 2001 workshop. This report considers the entire spectrum of disorders related to TMJD.
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 diagnosis and treatment of joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency transcutaneous electrical nerve stimulation (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 before 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;
2. restorative dentistry to the new bite position;
3. neuromuscular functional orthodontics; or
4. a combination of any of the above.
Phase two dentistry options are "conventional" dental procedures such as crowns, bridges, implants, partial or full dentures.

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