TMD Treatment Approach: NM or GNM

NM or GNM — Which TMD Treatment Approach Does Your Patient Actually Need?

Not every TMD case requires the same level of clinical precision. Basic neuromuscular dentistry addresses the foundational 80% — early muscle problems, basic joint pain, moderate masticatory dysfunction. But for the remaining cases — cervical dysfunction that won’t resolve, anterior open bites that relapse, Class II Division 2 patterns with chronic pain, long-standing joint derangements — a more advanced framework is required. That framework is GNM. The difference is not just philosophy — it is clinical application, diagnostic precision, and a systematic elimination of every inappropriate interference that standard NM approaches leave unresolved.

IF YOU HAVE THESE SYMPTOMS HOW WILL IT BE TREATED?

• GNM is Not the Same as NM – Recognize the Differences

Mechanistic joint-centric (CLASSICAL) vs. Myo-centric (NM) vs. Gnatho physiologic (GNM).

There are different approaches to neuromuscular (NM) dentistry that have evolved in order to advance the effective diagnosis and treatment of myofacial pain, cervical dysfunction and temporomandibular joint problems with accuracy and precision.

The difference lies in the appreciation for the multi-faceted nature of TMD beyond just a joint position or relaxed muscles or a bite relationship that feels good when you tap or chew. It lies in GNM’s commitment and appreciation to those patient’s whose problems have related beyond their past experiences in dentistry related to accidental traumas, health histories involving occupational or recreational activities affecting posture, muscle movement problems which further influenced TM joint and bone anatomy and or any previous or current stresses to the structural masticatory system  involving the emotional, pharmacological and or even a genetic component.
It’s a recognition of these kinds of TMD issues for which the patient presents as not an isolated dental problem, but a global, full body problem that plays such an enormous role in the health or “dis-ease” of the individual.  Each person is unique and the GNM approach attempts to work WITH each person in a mutual, investigative manner using trained diagnostic skills, knowledge and experience with each individual’s cooperation, commitment and understanding of how GNM methodology can improve their current pathology and pain condition.
BASIC NM DENTISTRY – It may meet your needs
What kind of problems does NMD treat – Easy, simple, moderate.

1. It recognizes the many basic musculoskeletal occlusal signs and symptoms.
2. Addresses TMJ and muscular problems at a foundational level.
3. Early, moderate head muscles problems.
4. Basic joint pain problems
5. Shorter term problems?.
6. NM is known to treat basic muscle, basic joint, and basic musculoskeletal occlusal signs and symptoms.  Is that fair to say?
7. A focus on EMGs showing relaxed muscules or fatigue muscles.
8. Cervical problems – basic level
9. A joint-based approach (centering a condyle in a fossa)
10. Occlusal problems at a basic level

NM (Neuromuscular) Application:

11. NM is foundational and rather generic as to the bio-physiologic needs of the TMD patient. Detailed application and protocols maybe missing.
12. NM dentist are followers of what they were taught to do.
13. An NM splint is an upgraded stopper. It attempts to reset the joints but it cannot stop the strong slamming forces at the back that can still affect the frame of the door. The neck muscles may still hurts.

GNM DENTISTRY (Sophisticated and Advanced) – It may meet your needs  
What kind of problems does GNM treat – Easy, simple, moderate, difficult, complex

1. Occlusal problems at a more detailed level – elimination of EVERY inappropriate interference is a CRITICAL distinction!
2. Joint derangement problems
3. Anterior open bite
4. Lateral pterygoid and medial pterygoid problems.
5. Pain at lower posterior corner of mandible
6. Facial/ masseter pain
7. Unresolving temporal tension
8. Occipital pain behind the head
9. Shoulder tensions
10. SCM pain and tension problems
11. Restricted head rotation problems
12. Restricted mouth opening problems
13. Addresses TMJ and muscular problems at a more advanced level.
14. Addresses cervical problems at a more advanced level.
15. GNM is focused on the muscles in the back of the neck, not just the front of the neck, with the EMGs.
16. It recognizes the musculoskeletal occlusal problems at a more advance level – recognizing there are clinical solutions to the chronic pain cases.
17. Adult stages.
18. Chronic problems (length of time).
19. Long standing joint and muscles issues in the mature person.
20. Treats more sophisticated complex TMD cases – A whole body postural awareness.
21. CNS
22. Emotional disorders
23. Movement disorders
24. Trigeminal N.
25. Menniere’s
26. Tinnitus (ringing in the ears)
27. Vertigo

GNM Points of Application:

A smaller percentage of individuals who experience pain, masticatory dysfunction and have joint derangement problems may need the accuracy of GNM and K7 kineseographic analysis.
Implementing and applying the correct techniques and methods with skill requires the dentists to be more trained thus the increased cost along with a great value for such treatment.  In essence “you get what you pay for”.

• GNM is more detailed and customized for the TMD pain patient.
• GNM dentists are problem solvers. They are the one’s who implement a “thinking process” to figuring out ways to solve the problem.
• A GNM orthotic is like a hydraulic stopper. Its special custom design takes the contacts away from the back when the slamming (closing jaw) forces are applied and allows for a softer closing of the door.
• The biting surfaces are curved like real teeth to gear the bite in a manner that allows for smooth opening and closing of the jaws.  The orthotic aids the temporomandibular joints and  musculature to be comfortable and happy.
• GNM doctors understand gnathology principles and apply them in designing and adjusting the orthotic.  This is a critical distinction!
• The bite registration is taken at the most optimal position where the muscles are all relaxed and the discs are well positioned.
• GNM uses Sapphire a special bite recording material to record the optimal bite relatioship.
• Green occlusal wax is used to refine the occlusal surfaces of the GNM orthotic for comfort.
• GNM approach recognizes a natural occlusal plane orientation, different than most NM concepts.
• GNM recognizes that there is a more optimal bite relationship that exists beyond classical NM techniques.  This is what there is a focus on Optimized Bite and Optimization.
• GNM is focused on how the front teeth work together on the customized orthotic, as a critical part of healing and recovery.
• Anterior coupled occlusion is critical to the GNM approach.

It isn’t our passion for GNM that inspires our patients, it is our undying optimism that even the most complicated problems can be solved with GNM. We believe that GNM can find ways to  remove and cure symptoms to ensure that our patients can live a life free of pain and fear.

A definite difference in application of Myotronics kineseographic, K7 recorded testings as well as understanding and interpretation of jaw tracking, EMG and ESG data provides a more accurate assessment to distinguish the type of TMD case involved.  Having this kind of assessment will provide the patient and doctors toward specific treatment options and outcomes.  Connecting the dots with each patient how the human bite must work with each and every movement possible allows for proper functioning of the masticatory system.
GNM is a systematic elimination of EVERY inappropriate interference which is a CRITICAL distinction with this approach!
GNM is not a one solution fits all box in which we corner our patients and stuff them into – it is specifically tailored  to meet the individual requirements of each and every patient.

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Written by Clayton A. Chan, D.D.S. — Founder and Director, Occlusion Connections | Las Vegas, Nevada