Antagonist to the Scientifically Based Neuromuscular Philosophy

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FYI: I share my response with you all that I wrote back to a colleague yesterday who was inquiring about some who lecture and speak antagonistically against NM. (Posted on 7/20/23).

Dear Dr. XXXX,  

As you have recognized, there are some antagonist to the scientifically based neuromuscular philosophy who lecture and teach.   

For years they have attempted to disparage the FDA recognized Myotronics technology and NM concepts.  Science versus politics, rationale clinical minds vs. irrational academic logic continue to pervade our dental profession with the purposeful attempt to disparage the inextricably intertwined history of neuromuscular dentistry.  The science of neuromuscular dentistry is well chronicled in hundreds of scientific articles and textbooks, include past ICCMO Anthologies.  

Since the early years from 1967 to 1977, Dr. Bernard Jankelson (Dr. J) gave insights and appreciation for the science and technological advances that challenged the occlusionist establishment and their cherished dogmas.  Dr. J’s fight to bring a new technology and new paradigm to treatment of the dental occlusion unleashed an epic confrontation with all the intrigues described by Becker. “At this point the gloves come off. Already a lightning rod for the wrath of the Olympian peers, the would be Prometheius writhes under attacks on his or her honesty, scientific competence and personal habits.  The pigeons of Zeus cover the new ideas with their droppings and conduct rigged experiments to disprove them. In extreme cases, government agencies staffed and advised by the establishment begin legal harassment.” 

As Dr. Robert Jankelson (the son of Dr. J) wrote in the 1999 ICCMO (International College of Craniomandibular Orthopedics) Anthology, “The Politics and Science of Neuromuscular Dentistry 1965-1999”, “The second political era explores the politics following Dr. J’s death in 1987 and encompassed epic battles in the American Dental Association and U.S. Food and Drug Administration. By 1986, the scientific foundation for neuromuscular concepts and techniques was firmly rooted in the scientific literature. The technology was recognized as safe and effective for the purpose of intended by the American Dental Association Council on Scientific Affairs. The clinical techniques were precise, predictable and successful. Yet the neuromuscular clinicians, their philosophy and their instrumentation continued to be attacked by gnathology gurus whose status and livelihood depended upon the defense of the scientifically indefensible, by third party carriers [insurance companies] intent on denial of payment, by IME (insurance medical examiners) whose livelihood depended upon denial of patient claims, and by psycho-social academicians whose research funding depended upon adherence to a particular TMD paradigm.”  

For the past 60+ years, dating from the work of anatomist pioneering Harry Sicher and physiologist Hans Selye, clinicians and academics such as Shore and Bell have approached the problem TMD as a primary physical (biomechanical) etiological condition, albeit with concomitant secondary psychosocial overlays. This has been the reigning clinical paradigm for over 60 years.  The clinical and scientific evidence for such a model is consistent with anatomic and physiologic models of function/dysfunction.  It has served our patients well.  

It is over the past years that a small group from the Academy of Orofacial Pain have denied occlusal causality for TMD.  In its place they have attempted to posture TMD as a psychosocial disease caused by emotional stressors.  The 1996 National Institute of Dental Research Consensus Conference clearly define the biomechanical versus the psychosocial paradigm schism.  This is the next field to be fertilized by the pigeons of Zeus.  

The masticatory system with its unique mechanism of bilateral diathrodial joints, precise tooth intercuspation and highly developed proprioception of the trigeminal system suggests and supports a biomechanical pathogenic “bio- tensigritous) model.  A thought, I know you will appreciate. 😊 This is generic to other musculoskeletal structures.  Treatment to physiologically reposition the mandible to the cranium has been the foundation of TMD treatment for over 60 years.  The dental literature is replete with studies supporting the scientific and clinical basis for such treatment.  

When the biomechanical and psychosocial stressors impose demands that exceed the accommodative capacity of the organism, dysfunction and symptoms of TMD occur, including obstructed upper airway problems and sleep apnea.  Abnormal swallowing patterns, deficient vertical in the posterior regions of the oral cavity along with oral pharyngeal restrictions will contribute to these stressors.  The pathogenic model for TMD should logically embrace both the biomechanical and the psychosocial models.  

The present effort by a small academic group to impose a strictly psychosocial model in their teachings and political agenda to take control over their dental peers who also treat TMD is more related to political agendas, allocation of grants for TMD research, IME consulting fees and pretense for denial insurance re-imbursement, rather than sound scientific methodology for patient care.  It’s my personal belief that these leaders are working tirelessly to make Orofacial Pain specialty the controlling group to limit those who are using bio-electronic instrumentation (ie. Myotronics technology) in treating orofacial/TMD pain problems. The ADA and FDA victories of neuromuscular and Myotronics battle for truth over the many years attest to the strength of this conviction and fact to this day.  Our profession as a whole as seen the value and power of objective measured recordings.  Data does not lie.  When our profession has no data and measured recordings of the health status of our patients bio-physiology our profession cannot progress forward neither will it evolve in deciphering academic opinions versus facts and evidence.  

Interestingly, they continues to perpetuate a distorted view of neuromuscular and how it is practiced.  He and his minions have deceptively, I believe through back door hand shake deals (not transparent) strong armed their way to establish Academy of Orofacial Pain as now an ADA specialty.  The neuromuscular dentist will be well served by technologic advances for dentistry’s future.  Computer interface modules, faster hardware for jaw tracking, easier to use software, EMG spectral analysis to give new insights into muscle fatigue states as well as further development of electrosonographic (ESG) analysis will only make clinical procedures and our dental profession better and accountable.  Objective measurements using advanced technology of TMD patient’s conditions is only a reasonable method to document the quality of our patient’s bio-physiologic health status.  “However, as long as there are “pigeons of Zeus covering new ideas with their droppings” and anti-instrumentation agenda with adhominem diatribe there will be more political battles and more victories to win” (Jankelson) as the young and progressing generation of today’s dentists all around this world begin to see the science and reasonable methodology that neuromuscular (NM) and GNM approach brings to our profession.  

I have attached some articles for you to read as a brief insights of a long historical battle for truth.  I hope this email will give you some perspective as you converse with those of another perspective.

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