Neuromuscular Dentistry

The 13 Points of Neuromuscular Dentistry

The following 13 points must be considered in understanding what “Neuromuscular Dentistry” is REALLY ABOUT. These points have been adapted from the writings of Dr. Robert Jankelson who has pioneered the clinical use of computerized Myotronic instrumentation along with his father Dr. Bernard Jankelson (the Father of Neuromuscular Dentistry).

1. Physical, physiologic and biological laws that govern articular and neuromuscular function at all structural levels of the human body apply to the masticatory apparatus. A rigid mechanistic concept of masticatory function is not consistent with generic physiologic knowledge.
2. The TMJ and intercuspal masticatory articulations are a continuum of the entire body posture articulation. Anatomic and/or physiologic changes at any postural level require compensatory neuromuscular accommodation.
3. Clinical dysfunction and symptoms occur when the need for structural and physiologic accommodation exceeds the ability of the organ system to accommodate.
4. Compression of anatomic structures is a generic medical model of pathophysiology, pain and dysfunction. Decompression of impinged anatomic structures is the medical therapeutic model.
5. General laws of homeostasis support the desirability of analysis of maxillo-mandibular posture from optimal muscle relaxation. Relaxation is good in the postural state. Muscle tension is bad in the postural state.
6. Good laws of homeostasis and entropy support physiologic closure along an isotonic path of closure to terminal intercuspation.
7. Relaxation of masticatory muscles prior to diagnosis and therapeutic procedures is a fundamental neuromuscular paradigm.
8. Ultra Low Frequency TENS (Myomonitor) is a well established and scientifically documented adjunct to facilitate masticatory muscle relaxation.
9. Objectively measuring occlusal function/dysfunction is consistent with scientific methodology. If the following three questions are answered affirmatively the measurement devices have scientific and clinical validity.
   • Can you measure a given physiologic function?
   • Are you measuring that physiologic parameter accurately?
   • Does that information add to the diagnostic information to assist diagnosis and treatment?
10. Electromyography (EMG) is a safe and efficacious technique to monitor muscle at rest and in function.
11. The medical and dental literature supports lowering EMG postural activities as objective data of improved muscle relaxation state which is a universal therapeutic medical objective.
12. Increased isometric force in the intercuspal position as a desirable objective is consistent with all generic physiologic and medical models of kinesthesia.
13. Mandibular malposition and occlusal dysfunction can initiate or contribute to temporomandibular disorders (TMD). TMD is a multi etiologic musculoskeletal dysfunction having common pathologic characteristic of all musculoskeletal disease. 

Appreciation is extended to all treating clinician’s who have realized the realities of the importance of a thorough diagnosis and understanding of this complex system in order to bring treatment to a finalize stage of postural/cervical/occlusal stability, muscular balance, dental aesthetics for the patient seeking comfort and satisfaction.

Related article to enhance your appreciation of NMD:

• Temporomandibular Disorders: A Position Paper of the International College of Cranio-Mandibular Orthopedics (ICCMO). The Journal of Craniomandibular Practice, July 2011, Vol. 29, No.3, pp. 237-244.

NEUROMUSCULAR DENTISTRY

• Neuro – pertains to the nerves, in this discipline of dentistry focusing specifically on the trigeminal (5th) and facial (7th) cranial nerves, the dentist nerves and entities related to the masticatory system.
• Muscular – pertains to the muscles of mastication.  Muscles that move the lower jaw, effect the swallowing, clenching, chewing, smiling and facial expressions mechanisms are associated with the all the branching nerves of the trigeminal (opthalmic V1, maxillary V2 and mandidubular V3 branches) and facial nerve systems.
• Thus…NEURO-MUSCULAR (it is not just nerves, not just teeth, not just temporomandibular joints, but all the symptomology and dysfunctions related to the neuromuscular system relating to the 5th and 7th cranial nerves and their dysfunctions.

Neuromuscular Dentistry (NMD) emphasizes the need to establish an occlusion based upon: 1) establishing a physiologic jaw position and function of the temporomandibular joints, 2) establishing resting posture and function of the masticatory muscles at a physiologic rather than a pathologic position and 3) scientific instrumentation is used to objectively measure these parameters during the diagnosis and treatment process aiding the clinician in determining the effectiveness of his/her treatment.  This approach differs greatly from the common dentistry approach that treats the teeth and assumes the teeth, active muscles, and the jaw joints will accommodate to a habitual/ acquired occlusion. NMD uses computerized electronic measuring technology that aids in the diagnostic and treatment process:

1. Low frequency TENS (transcutaneous neural stimulation) to relax spastic muscles
2. Computerized mandibular scanning (CMS) – Jaw tracking that measures and locates jaw position, junction and jaw movements.
3. Electromyography (EMG) – measures resting and functional modes of muscle activity.
4. Electrosonography (ESG) – measures jaw joint sounds, frequency, duration, location of sounds

Treating teeth by restorative procedures (crowns, bridges, and fillings) or common orthodontics (straightening teeth) are often overlooked and done without accurately determining a correct jaw posture and a proper vertical dimension! A Neuromuscular trained dentist can determine a proper resting jaw position that effects the facial, head and neck muscles, the teeth as well as the joints.  A physiologic resting position and body posture is often overlooked and not even considered as an important part of the whole dental diagnostic and treatment system, when performing restorative and prosthetic dentistry!  Finding a neuromuscular jaw position objectively and “physiologically” is paramount before a final restorative/ orthodontic phase of treatment is started to prevent muscular imbalances that would lead to instability of the teeth, supporting bone and compromised posture.  A comprehensive analysis and evaluation is highly recommended to assist the doctor in accurately diagnosing and developing a treatment plan that can best meet the patient’s needs for long term optimal dental health and comfort! Read more: Defining Neuromuscular Dentistry

• What is MYOCENTRIC?
• Neuromuscular Dentistry

• TMD Treatment Approach: NM or GNM?

• GNM Case Studies
• Defining Occlusion
• The Difference Between GNM Dentistry and NM Dentistry

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References:

1. Chan CA: How the stomatognathic system works, Occlusion I lectures, Las Vegas Institute for Advanced Dental Studies, 2000.
2. Chan CA: Advanced Principles of Physiologic Occlusion – Level 1 course manual, Occlusion Connections, Las Vegas, NV, 2008-present.
3. Cooper BC.: Craniomandibular disorders. In: Cooper BC, Lucente FE, editors. Management of facial head and neck pain. Philadelphia: W. B. Saunders, 1989:153-254.
4. Jankelson B. Neuromuscular aspects of occlusion: effects of occlusal position on the physiology and dysfunction of the mandibular musculature. Dent Clin North Am 1979;23:157-68.
5. Cooper B, cooper D. Lucente f. Electromyography of masticatory muscles in craniomandibular disorders. Laryngoscope 1991:101:150-7.
6. Jankelson B. Measurement accuracy of the mandibular kinesiograph: a computerized study. J Prosthet Dent 1980:44:656-66.
7. Jankelson B, Sparks S, Crane P, Radke JC. Neural conduction of the Myomonitor stimulus: a quantitative analysis. J Prosthet Dent 1975;34:245-53.
8. Jankelson B, Radke J. The Myomonitor: its use and abuse. Quintessence Int Dent Digest 1978;9:35-9, 47-52.