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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).
- 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.
- 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.
- Clinical dysfunction and symptoms occur when the need for structural and physiologic accommodation exceeds the ability of the organ system to accommodate.
- Compression of anatomic structures is a generic medical model of pathophysiology, pain and dysfunction. Decompression of impinged anatomic structures is the medical therapeutic model.
- 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.
- Good laws of homeostasis and entropy support physiologic closure along an isotonic path of closure to terminal intercuspation.
- Relaxation of masticatory muscles prior to diagnosis and therapeutic procedures is a fundamental neuromuscular paradigm.
- Ultra Low Frequency TENS (Myomonitor) is a well established and scientifically documented adjunct to facilitate masticatory muscle relaxation.
- 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?
- Electromyography (EMG) is a safe and efficacious technique to monitor muscle at rest and in function.
- 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.
- Increased isometric force in the intercuspal position as a desirable objective is consistent with all generic physiologic and medical models of kinesthesia.
- 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.
Posted by Clayton A. Chan, D.D.S.