GNM is Not the Same as NM

Why Gneuromuscular Dentistry? – The Next Level of Advancement

Gneuromuscular (GNM) dentistry is about being particular and detailed in the diagnostic and treatment process. The application of the physiologic/neuromuscular and gnathic principles is key to our success.

The classical NM doctors need to understand that it is not simply G + NM. The NM in GNM is NOT the same old classical NM that they are thinking about. It is an entirely new paradigm, but rather a NEW, improved NM concept married with Gnathological principles.

GNM was developed by Dr. Clayton Chan (Founder/Director of Occlusion Connections, Las Vegas, NV) to continue pursuit, further and deepen the neuromuscular principles set forth by Drs. Bernard and Robert Jankelson using Myotronics equipment (J5 TENS unit and K7 for EMGs, ESGs and CMS) with a heavy emphasis on:

Optimized orthopedic position of the mandible
K7 scan interpretation to diagnose then guide treatment
Detailed adherence to gnathology (occlusal principles) with a neuromuscular emphasis.
GNM is dedicated to the physiologic principles pioneered and recognized from Myotronics K7 and Myomonitor TENS at advanced levels – a foundation to objective measurements and occlusal detailed application.

Bite Optimization

With a plethora of literature supporting the specific use of approved Myotronics equipment, GNM essentially picked up the baton from NM and continues the “race” with the goal being to apply discipline and detail to dentistry for the relief of pain symptoms and optimal care for patients. At this time, NM/Physiologic Based centers have been abandoning the “NM” moniker and now are adopting a different paradigm that includes “some” traditional NM principles with other techniques and ideas that, as of yet, have not stood the test of time. The term “physiologic” sounds great. NM and GNM have ALWAYS given attention to the whole body and the multi-factorial nature of TMJ problems. Continued research in areas such as airway, sleep, posture, etc., continue to add where valid to the NM/GNM world.

Today’s “NM/Physiologic” trained dentists continue to advocate an HIP (hamular notch, incisive papilla) plane of occlusion in their phase 2 treatment. Cosmetic minded restorative dentists use HIP to mount their maxillary cases in a simplistic, yet abnormally distorted orientation that is proven unphysiologic to long term stability of the cervical head posture.

GNM uses a modifed Fox Plane to orient the head and occlusal plane correctly to horizontal level (physiologic, better matching a normal head and maxillary occlusal plane orientation (see lateral cephalograms when the head is level to horizon). Numerous tests and research has shown that HIP produces a flat occlusal plane parallel to horizontal level. This is absolutely pathologic and unstable. Modified fox plane technique as advocated at OC is physiologic – the occlusal plane is set up to a natural angled plane relative to horizontal level. This is important, significant and a principle related to head posture stability and mandibular stable positioning especially when phase 2 full mouth restorative treatment is involved to finish a case restoratively. GNM does not want to see patients with unresolved cervical neck problems passed off as whiners and complainers. NM does not believe in Fox Plane angled occlusal plane cervical stability as proven by their implementation of their teachings.

A Review of the Clinical Significance of the Occlusal Plane: Its Variation and Effect on Head Posture: Optimizing the Neuromuscular Trajectory – a Key to Stabilizing the Occlusal-Cervical Posture. Chan, CA: International College of Craniomandibular Orthopedics (ICCMO) Anthology VIII, 2007.

UNDERSTANDING RELAXED MUSCLES

Individuals who are looking for optimal dental treatment must consider the status of their muscles of the face, jaw, neck and shoulders. Ideal treatment is typical rendered when muscles are not tender or strained and the jaw functions with a stable bite. If the muscles are tense and or strained they can affect the health and condition of the teeth, jaw joints as well as jaw posture. When dental restorative treatment, orthodontics and or TMJ treatment is rendered, especially if the biting surfaces of the teeth are changed or altered while the present chewing muscles are tense and or strained, it is possible that the patient may experience a shift in their bite during and after treatment. Any slight shift or change in jaw position can lead to an increased awareness of the teeth resulting in bite problems, headaches, facial pain, neck pain and shoulder aches.

Working with a dentist who understands and respects these issues is key to optimal care. Patients must recognize that there are various levels of philosophies as well as various levels of training among dentists. Those dentist who have training in gnathologic principles as well as neuromuscular principles have been found to be better qualified to address more complex bite problems that relate to TMJ, comprehensive restorative procedures and orthodontics.

Definition of GNEUROMUSCULAR DENTISTRY

The field of dentistry that “clinically applies” the gnathologic principles with the neuromuscular science at the highest levels. Gneuromuscular (GNM) uses objective measuring technology and principles to quantify the quality of those physiologic responses of the masticatory system which includes the morphology, anatomy, physiology and patho-physiology of the cranio-mandibular cervical complex. It acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms and relates them to an “optimal” mandibular to cranial/ cervical relationship associated with body posture and alignment.

Optimal function as well as optimal resting modes is key to addressing the central nervous system responses in order to reach “Maximum Dental Improvement” (MDI).

Detailed application and protocols to addressing some of the more difficult and complex issues have been missing and have been realized by many NM clinicians.
It acknowledges the entire masticatory system as it relates to mechanics of bordered movements relating to optimal disc and condylar positioning within the glenoid fossa as well as functional movements along an optimized isotonic trajectory supporting freedom of entry and exit to a stable terminal contact position of occlusion.
It is a field of dentistry that bridges that gap between gnathologics and neuromuscular occlusal philosophies as advocated at occlusion connections.
It is the refinement of clinical methods, protocols, knowledge and skills that allow dentists to perform at an optimal level using all their training, resources, thinking and understanding.
It is based on the doctors “THINKING PROCESS” that distinguishes itself from cook book methods, other teaching philosophies and training.
Treats more sophisticated complex TMD cases – A whole body postural awareness.
Long standing joint and muscles issues in the mature person.
Chronic problems.
It recognizes the musculoskeletal occlusal problems at a more advanced level – recognizing there are clinical solutions to the chronic pain cases.
GNM is focused on the muscles in the back of the neck, not just the front of the neck, with the EMGs.
Addresses cervical problems at a more advanced level.
Addresses TMJ and muscular problems at a more advanced level.
It is a refined Occlusal management process at another gnathic level.
Restricted mouth opening problems
Restricted head rotation problems
SCM pain and tension problems
Shoulder tensions
Occipital pain behind the head
Unresolving temporal tension
Facial/ masseter pain
Pain at lower posterior corner of mandible
Lateral pterygoid and medial pterygoid problems.
Anterior open bite
Joint derangement problems
It addresses these occlusal problems at a more detailed level – elimination of EVERY inappropriate interference is a CRITICAL distinction!

Gnathology:

a science dealing with the masticatory apparatus as a whole, including morphology, anatomy, histology, physiology, pathology, and therapeutics., thus gnatholog´ic
a field of dental or medical study that deals with the entire chewing apparatus, including its anatomic, histologic, morphologic, physiologic, and pathologic characteristics. Diagnostic, therapeutic, and rehabilitative procedures result from these studies.
the study of the functional and occlusal relationships of the teeth; sometimes also used to identify a specific philosophy of occlusal function.
the science dealing with the masticatory apparatus as a whole.

Neuromuscular:

Neuromuscular (NMD) dentistry is the foundation (basic) to understanding the musculoskeletal occlusal signs and symptoms – teeth, muscles and temporomandibular joints.

Addresses the basics dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal systems.
It is a treatment modality of dentistry that focuses on correcting “misalignment” of the jaw at the temporomandibular joint (TMJ).
Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region.
Neuromuscular dentistry recognize that “misalignment problem(s)” can be corrected by understanding the relationships of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves.
In short, proponents of neuromuscular dentistry acknowledge technological instrumentation (objective measurements) innovations of this century adds objective data and understanding to previous mechanical models of occlusion.

Gneuromuscular (GNM) Approach – A logical advancement that makes clinical sense:

Although gneuromuscular (GNM) approach may seem to be same or similar in nature to other neuromuscular (NM) dentistry concepts, they are not similar in the way the principles and concepts are practiced, clinically applied and understood.

It is the combined approach applying and implementing both gnathic and neuromuscular concepts at their highest levels of understanding make GNM valued and unique.

Both GNM trained dentist use Myotronic K7 Occlusal Evaluation technology and J5 Myomonitor TENS. The OC GNM trained dentists understand the important diagnostic factors that distinguishes their diagnostic and treatment methodology when applying the K7 and TENS technology that most NM dentist do not:

With GNM we understand why electromyography (EMG) recordings of muscles sometimes goes up after low frequency TENS (it is important for all dentists to understand why EMG recordings increase and under what circumstances EMGs may decreased. Knowing what causes the EMG patterns to go up or down is crucial to know if treatment is to be effective for the TMJ primary, cervical dysfunction, class 2 division 2 and anterior open bite tendency type cases.
GNM understands why TENS does not always relax muscles (although NM has advocated that TENS relaxes muscles). OC continues to be a strong proponent of J5 Myomonitor TENS since it enhances the GNM trained dentists diagnostic and clinical awareness.
GNM understand why TENS is very important in helping to find a more accurate mandibular position when recording a bite registration using the K7 jaw tracking technology (we don’t like to manually manipulate or guess the patients maxillary to mandibular position and relationship physiologically).
GNM trained dentist use specific techniques and bite optimization protocols learned at Occlusion Connections different than other neuromuscular K7 techniques.
GNM dentist uses the Myomonitor TENS for very important reasons in spite of many within the dental profession say it is not reliable of effective (most dentists don’t measure their patient’s muscle responses objectively nor understand “GNM optimization protocols” using mandibular position technology since they have limited understanding or training in this field of dentistry, thus it is only their opinion).
The GNM trained dentists use the Myotronics K7 brand of technology specifically for its precision and accuracy to achieve the diagnostic insights of the patients problems and effective clinical results.

GNM (Gneuromuscular) dentistry is the advanced level of CLINICAL application of the science, TREATING the simple to complex problems at a more detailed level – treating the whole body.

These are just a some of the few things that distinguishes GNM teachings from NM teachings. We recognized that low frequency TENS does not always relax muscles. The GNM dentist recognizes these factor as significant diagnostic responses. The GNM trained dentists knows why and implements that information strategically in their diagnosis and application of specific occlusal protocols. The OC teachings realizes why it is important for the GNM trained dentists to use J5 Myomonitor TENS. It is the training and understanding of these advanced GNM concepts that further distinguishes the Occlusion Connections (OC) teachings and perspectives beyond classical neuromuscular teachings.

NOTE: GNM may not be the answer for every one and for every situation. People should temper their expectations, since no technique works for everyone, but GNM is an approach that is based on advanced principles, specific detailed protocols and bio-physiologic science that requires the clinician to skillfully implement the knowledge and understanding they have acquired with their patients.

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