by Clayton A. Chan, DDS, Las Vegas, NV
There are some patients trying to understand the differences in Neuromuscular Dentistry. This brief article will help you understand some of those differences and recognize key points that are clinically significant.
As far as NMD is concerned its not just about doctors using electronic instrumentation that makes them NM. There are many who are starting to use the TENS and various electronic instrumentations yet with little understanding how the muscles are effecting the bite and posture. Some doctors can even say they have been trained in NM, but one should consider what level of understanding do they have in regards to:
Today, the term “neuromuscular” and “NM” has been misused by some dentists for strictly marketing purposes. It may sound cool, attractive and unique for some, but once the astute patient begins to dig into the matter and begins to ask the deeper questions they begin to recognize that there are philosophical difference in what NM means to different doctors.
Some believe neuromuscular/NM is about having electronic instrumentation (EMGs, kineseograph – jaw tracking, T scan, JVA/ ESG, etc.) as a promotional to tell the world they use technology in the office. Others believe NM is all about posture and body alignment. While others believe it is about implementing various forms of splints, MORA, anterior deprogramming appliances in some functional anterior superor (down and forward) manner using the words “NM” in the conversation with no clue about objectivity as to how they determine the inter occlusal (bite registration) position of their patient’s. Some clinicians have focused their understanding on JVA ( joint vibrational analysis of the jaw joint sounds) without an appreciation or need to see the importance of relaxing muscles with TENSing. Other NM clinicians focus on TENSing (a device used to relax tense masticatory muscles) and not so much on JVA/ ESG (electrosonography). Others just like to use the words “neuromuscular” and don’t see a need to use instrumentation to measure muscles responses and or jaw location problems. Others “NM” dentist may just use EMGs and various types of TENS to do their dentistry. A majority of dentists don’t use TENS clinically and just use appliances to try to treat TMD without measuring physiologic responses and or understanding the importance of mandibular positioning. Many don’t use K7 jaw tracking combined with TENS to determine their patients jaw position when delivering a TMD intra oral appliance for treatment.
I believe just because one has technology and uses instrumentation doesn’t mean the doctor is “NM” in his/her convictions of philosophy of treatment.
The Father of Neuromuscular Dentistry (Bernard Jankelson who coined the term originally indicated – “If it has been measured, it is a fact: if it has not been measured, it is an opinion”.
Does the NM doctor really measure the physiologic responses of his/her patient when presenting for treatment of TMD problems? Do they really understand what they are measuring correctly? If they do, does the clinician understand how to properly interpret the data before, during and after treatment in order to diagnose the problem accurately. Or are they guessing what the scans mean or are they just by chance use TENS, EMGs and or advocate some form of an appliance, splint or orthotic because they were told to do so in order to market an impression of being comprehensive?
- In what order of importance does the clinician really believe and apply their electronic instrumentation at the highest levels of understanding, using them appropriately?
- Does the “NM” doctor believe JVA/ESG (electrosonography) technology to record joint sounds is the most important technology available today that aids in the diagnosis and treatment of TMD?
- Or does the doctor value EMG recordings more importantly to adjust and balance the patient’s occlusion beyond the importance of first relaxing muscles (using TENS) and finding objectively the proper mandibular position with jaw tracking technology accurately?
- Or is jaw tracking important and valuable to determine a proper mandibular/ joint position for treatment?
- Some NM proponents say TENS is important. Some say it is not important…what is the answer?
What really is important? Which technology helps to convey the thought process and philosophy by which a treating dentist uses these various measuring tools to help his/her patients?
I believe one should find clinicians who value the following:
- Low frequency TENS (not high frequency) to relax muscles to remove spastic pathology (Does TENS really relax muscles? A topic for another discussion to clear the misinformation and confusion why in some instances TENS may increase headaches…the profession needs to understand what this means and why chronic muscles in pain respond in such a way).
- Jaw tracking to visually see where the mandible positions relative to centric occlusion (habitual occlusion – CO). Without an accurate jaw locating device one will know accurately know where the mandible is suppose to physiologically be positioned to meet your needs accurately and precisely. (Low frequency TENS should be used in combination with accurate jaw tracking technology to accurately determine one’s jaw position properly).
- EMGs to measure objectively before muscle TENS and EMGs to see what muscles responding before treatment) to accurately diagnose whether the case is a joint problem primarily or a cervical neck muscle problem (this data is key to know, helping to guide the dentist in knowing exactly how to design and adjust the orthotic and occlusion. Without this basic EMG understanding the dentist will be randomly adjusting the occlusion (another form of guessing) and
- ESG/JVA to confirm what level of joint derangement if any is present.
If the NM doctor believes in the reverse order of this listing, the sequence of the use of “NM” instrumentation and technology used in a dental office is the order and sequence by which the doctor believes – that is his/her philosophy. Order and sequencing matters!
It’s more than a philosophy. The DIAGNOSIS of the TMD and occlusal problems is based on the dentists experience, his/her understanding of of what recorded data should be gathered, how to gather the data, the dentist’s ability to properly interpret the recorded data and their ability to bring proper meaning of the information gathered with logical sense to the patient. As the saying goes, “What information do you not want to know”?
It’s about your health, comfort and well being.
Read more: GNEUROMUSCULAR DENTISTRY – the Next Level of Advancement