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• NM brings to light the importance of measuring physiologic jaw responses as well as helps doctors appreciate the science of muscle health, temporomandibular joints as well as establishing a physiologic terminal contact position to which an occlusion (bite) can be established – It is foundational for all doctors to fully appreciate dental occlusion beyond the habitual occlusion, recognizing the musculoskeletal occlusal signs and symptoms.
• Gneuromuscular (GNM) Dentistry is really a combined approach, understanding and application of skill sets required to effectively treat the more complex TMD cases – It goes beyond establishing a myocentric target.   Gneuromuscular (GNM) is a blend of both gnathological concepts as well as neuromuscular (NM) dentistry principles.
• GNM brings both the significant value of objective measuring technology with advanced clinical occlusal application to the next level in understanding and treatment for our doctors at OC.
• GNM takes these NM principles to the next level by implementing advanced clinical techniques in refining the NM trajectory (shortens treatment time and office visits), refining how the anatomical lower orthotic should be designed to get maximum dental improvement (speeding up patient resolution), as well as refines the doctors understanding of vertical dimensions for both the restorative and orthodontic treatment (more conservative and effective to prevent relapse problems). 
• GNM also enhances the importance of all the anterior functional tooth contacts, excursive movements and anterior discluding schemes that are critical in improving head position, TMJ positioning and muscle function/stability which are missed detailed concepts in the NM teachings.

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By Clayton A. Chan, D.D.S. – “A Concerned Dentist”

A profound and noted motto often used by Bernard Jankelson’s (Father of Neuromuscular Dentistry also quoted Galileo Galilei’s basic postulates, “If it has been measured, it is a fact; if it has not been measured, it is an opinion.”

One of the greatest contributions Neuromuscular Dentistry has made to the dental profession has been one of being the first to bringing focus to “Objectivity” through objective measurements (technology) of bio-physiologic responses of the masticatory system. (These techologies don’t have any realization if they measure NM or CR or any philosophy or TMD method/approach…they just measure and document). This has never been achieved with any occlusal/ TMD philosophy that I am aware until more recently over the past 45 years in dental history. This is what makes NM unique and different than all former teachings we all have received from dental school training.

We dentist all often wondered why their lacks a confidence when it comes to the topic of occlusion and TMD, yet as dentist we keep practicing and doing what we were taught and told assuming things are right, but our TMD patients began to realize the teachings we all received and practiced were not good enough to answer and address the more challenging issues they were experiencing, such as why are there so many follow up occlusal adjustment visits after a crown or filling was placed (top 10-15% of the difficult cases in one’s practice), or why are my vaneers coming off, or why is their teeth breakage, gum recession or bone loss occuring beyond a lack of good hygiene care? How about why is their teeth sensitivities that go beyond endodontic issues? Why do patients complain of ringing in their ears or ear congestion feelings afte ra simple filing was redone? Could there be jaw/occlusal relationship problem that is being overlooked by our dental profession? Ignored….The patient has gone to see their ENT doctor and could’t find a reasonable cause for such. What about pressure behind the eyes? Is there a dental connection that most will pan off as some opthalmic problem unrelated to dentistry? What about headaches, facial pain, cervical neck issues? Does our profession ignore these issues, especially if our patients have been routinely visiting the physical therapist, massage therapist, chiropractors, etc with very little resolution that is resolving the problem, or our we just band-aiding the underlying problems with superficial splint therapies, injections, fancy passify words to our patients,etc. and not getting to the cause of these masticatory problems. (Of course in the busy every day dental practice most dentist wouldn’t want to ask too many indepth questions to their patients….because it will slow one down). This is what neuromuscular dentist have been questioning for years and wanting to find clinical answers to these kind of problems and more….our public faces challenges daily and are looking for answers.

We realize after years of clinical practice, being good students of dentistry, reading the scientific literature and furthering our training with post graduate education that the answers given are not sufficient and adequate to meet the next level of patient concerns within the public arena. We can no longer take at face value what is being said or written in the literature. We realize what we are seeing in our dental practices with our patients and what is being taught in dental schools and post graduate CE is not adequate, always meeting the needs. Questions are being asked to challenge the present day paradigms.

How does one objectively relate the maxilla to the mandible “physiologically”? That is a question few wet fingered clinicians can adequate answer with clinical objective proof.

Upper splints, lower splints, soft, hard, flat plane, anatomical, anterior discluders, gelbs, botox, trigger point injections, etc, etc. are all attempts given by many great doctors attempting to find an answer to the orofacial/TMD pain occlusal dilemma’s including trying to under the clenching, grinding, clicking popping joints issues all in association with the masticatory system. These issues goes beyond any one particular occlusal philosophy. (We know within each of our hearts what goes on in our clinical practices). As dentist we are looking for better answer, that make sense, and gives us a better clinical result. Certainly we all have success, be we also know we all have failures and challenges. It is these failures and challenges that we are looking for answers beyond the clinical subjective educated guessing that goes on. That is not good enough for some of us. We are more detailed and specific…..

• NM approach identifies pain problems with objective measurements.
• NM identifies masticatory muscle problems with objective measurements.
• NM identifies joint derangement problems with objective measurements.

Based on a comprehensive objective assessment combined with subjective comprehensive clinical examination, clinician’s should be able to make a multi-dimensional observation of signature patterns in jaw movements, positioning as well as muscle tonicity status confirming injury and or hidden pathologies objectively, not typically visualized on cursory manual palpation examination. These objective findings are incorporated in the clinician’s senses, exponentially enhancing his/her special visualization, interpretation and conceptual grasps of the functioning or dysfunctioning body parts related to the neuro-vaso-muscular masticatory cervical systems, while utilizing to the fullest the physical findings from the clinical examination of the patient.

How can this be done without objective bio-physiologic tools that quantify and objectively measure?

Neuromuscular Approach is just asking the tougher clinical questions (pushing the envelope of diagnosis, treatment, care and reason) to get better clinical answers that make logical sense to both the astute wet finger dentists and those whom we treat related to TMD, restorative and orthodontic care.

Clayton A. Chan, D.D.S.
Las Vegas, NV – Dentist
www.occlusionconnections.com

© 2013 Clayton A. Chan, DDS. All Rights Reserved.

Gneuromuscular Dentistry – An Objectively Measured Approach

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by Clayton A. Chan, D.D.S., M.I.C.C.M.O

Neuromuscular occlusion is not based on a manipulated condylar position, neither founded on bony pathologic relationships, but rather a scientific journey into the anatomical, bio-physiologic, and the neurologic realm of this DYNAMIC functioning stomatognathic system.  Scientific instrumentation has been added to help us better understand our traditional thinking.

“IT IS AN INTELLECTUAL and SCIENTIFIC SEARCH FOR THE TRUTH. ”

Advanced Occlusal Concepts for Forward Thinking Dentists

Whenever a new discovery is reported to the scientific world, they say first,
“It is probably not true.”

Thereafter, when the truth of the new proposition has been demonstrated beyond question, they say,
“Yes it may be true, but it is not important.”

Finally, when sufficient time has elapsed to fully evidence its importance they say,
“Yes, surely it is important, but it is no longer new.”
- Montaign 1533-1592

…so has been my experience and observations over these past 13 years. The term “Neuromuscular” has now been embedded within the dental profession. With the advancement of more and more doctors now having come to accepts the validity and overwhelming science of the neuromuscular principles as well as the undisputed precision and accuracy of computerized electronic instrumentation low frequency Myomonitor TENS, computerized jaw tracking (K7 by Myotronics), electromyography (EMGs) and electrosonography (ESG) the evidence is clear. A shift in thinking has taken because a few pioneering dentists where willing to speak the truth and stand on physiologic principles rather than perpetuate the occlusal dogmas of our profession. Advanced thinking does cause a shift. One thing certain is that further advances will take place with a continued resistance to change. It takes a few persistent ones to voice their believes, to challenge the system, ask the tough questions and speak the truths to find better answers.

Neuromuscular Dentistry

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