Let me give you my personal thoughts on this question (I am a practicing dentist). First, I want folks to know that I appreciate these fb forums. Wow…amazing exchange of knowledge and information.
Centric Relation Success – Gnathologic
I was formerly trained as a Centric Relation (gnathologically) minded dentist. That means I practiced many years believing that the TM joints was the center and focus of TMD care. Success rate in my San Diego, CA practice was at best 80% success of what I understood as TMJ occlusal problem cases and treatment. Over time I soon realized TMD problems are dfferent for different folks and they all had varying degrees of issues…and so did I…some had more joint derangement condyle disc problems while others didn’t have as much, while others had muscle pain problems and or worn down teeth. At times I was bewildered clinically. It was kind of a pot shot hodge podge of results, some good, some just OK, sometimes great…but there were times I knew things weren’t working out for the patient. At that stage I didn’t realize there could be better ways to approach these problems…but for me it was all about equilibrating everyone’s bites to some occlusal balanced position to calm the muscles…(I hoped). Well, after many years of practicing that way, I thought that it was great way and the only way!,,,but guess what?…10-15% of these TMD cases in my practice were not getting better..and I knew it. I kept strict logs and data on my successes and also failures. I knew something was not right…sure I could say I was successful….80%??? After a while I was really bothered and asked myself why the 10-15% of these cases were not getting better after coming back to my office 10-12 and even up to 15 follow up visits. Still not getting better. I soon realized my occlusal TMD philosophy was lacking and greatly missing something and I just didn’t know what it was.
Neuromuscular (NMD) Success
In 1995, I learned about NM occlusion and instrumentation (jaw tracking, TENS, EMGs, etc). I learned it and started to experience my TMD patients were getting better faster and quicker, with less follow up visits. I then realize I was on the right track…using removable NM orthotics….after after many years of practicing NMD ….still with a better percentage of success than my former CR philosophy…I was happy! After more years of practice…. I still wasn’t satisfied with the smaller remaining percentage of TMD cases that I realize were in fact more challenging than prior years, but not getting the result I knew was possible, but didn’t know how. I wanted to know why I wasn’t getting the results I wish to have even with my great NMD knowledge and training. Sure my TMD patients were getting better. 90% Great “Success”. Sure I could say I was a successful TMD dentist…but down deep in my heart I knew exactly which cases were struggling and which cases were not getting better to the level I knew they should…but I didn’t know what was missing in my NM K7 paradigm …was it me? or was it the patient’s problems that were beyond the NM dental concepts? I started to continue looking for answers…..
The cases that were not improving for me in my practice were the cases that had cervical dysfunction problems combined with TMD headaches, joint and muscular issues…for me the NM approach was good but something was still missing. Then there was the true “TM joint” problem cases.. sure NM worked…but I still knew something was missing in these folkes cases…. then there were the class II div 2 retrognathic and paining anterior open bite cases….at this stage, Yes, I was using the NM orthotic concepts with great micro occlusion…they improved, but not completely in these more complex combined type problem cases….Sure I could say I was having great NM success…way better than my former years… BUT I knew something was still missing…I knew as a dentist something was had to be done to fill in this missing gap in my mind… even when I was using J5 TENS, K7, EMGs and all the micro occlusal adjustments I thought that was the answer…BUT….. there is more….
Gneuromuscular (GNM) Success – Another Level
Now after practicing different gnathologic CR concepts, then moved on to the NM based concepts after many years, even using K7 and TENS and micro adjusting concepts…I can now say…I learned more and definitely have an even better success rate clinically, better addressing those 10-15%er TMD cases I formerly couldn’t figure out…but with GNM..wow!…..although GNM may appear to seemingly be similar and the same as NM to the untrained eye…I can testify it is definitely not the same in the finer details and nuances clinically…the understanding of it all is at a higher more disciplined level. Better success rates bar non! I think I can comfortably say…having now a GNM understanding, practiced if for many years… even using TENS and K7, at a whole different refined level, etc…the overall experience with my patients is more precise, more specific, less doubt in my mind, less wasting of time, knowing what better to do, as to these even more complex TMD case problems than prior years. In short, I know my experience applying the GNM concepts are able to take on the more challenging issues with a greater awareness is issues, understanding and appreciation of NM and even CR concepts from a bigger perspective.
Oh…yes, as Jill indicated there is a difference. GNM is not the same as NM!… as NM is not the same as CR. They are all great philosophies and teachings…but now I know the difference…and so do my patients! It’s a different level of success in spite of the TMD occlusal muscles cervical challenges we face. Please excuse my longer post. Just wanted you all to know one dentists clinical perspective.
– Clayton A. Chan, D.D.S. – Las Vegas, NV
