Neuromuscular Dentistry: What, Why, and How to Get It
Neuromuscular dentistry is becoming a hot topic on TMJ/TMD social media outlets. Patients and dentists are wanting to know more about what it is, why is it being talked about, and how to find it. Neuromuscular dentistry has been around for over fifty years and was first practiced by Dr. Barney Jankelson, the father of Neuromuscular dentistry. Understanding neuromuscular function, in general, will help you understand neuromuscular dentistry.
Understanding Neuromuscular Function
Any movement of the body and its parts are neuromuscular functions. If a dust particle gets in the eye, sensors in the eyeball and eyelid send signals to the brain. The brain tells the tear ducts to produce tears and tells the eyelid to blink and keep blinking and producing tears until the particle is flushed out. These sensors continue to monitor the situation until everything is back to normal. More than likely, the brain has also sent a message to the arms and hands to help with the problem and to wipe away any tears. Every action is considered a neuromuscular function.
Roles of Neuromuscular Dentists
Neuromuscular dentists are experts in neuromuscular functions of the muscles, jaws, teeth, and joints. Their primary focus of patient care is relieving TMJD pain patients of their pain. Most TMJD pain comes from overstressed muscles and myofascial trigger points. Sometimes it is the temporomandibular joint itself that generates pain. It is the goal of neuromuscular dentists to find a harmonious relationship with the muscles, jaws, teeth, and joints to stop the pain.
Many people with TMJ disorders have abnormal jaw motions on closing in the search for a stable bite. These abnormal motions can be due to deformities of the jaw/teeth complex, missing teeth, stress, etc. Abnormal motions cause stress and strain on the jaw, teeth, joints, and muscular system. An example is overworked muscles creating painful trigger points as demonstrated in the image below:
Any movement of the jaw is considered neuromuscular. The roots of all teeth have periodontal ligaments (PDL). Within the PDLs are ligaments which are sensors that are directly wired to the brain. It’s the PDLs that tell a person having a picnic on the beach that there is a grain of sand in the sandwich. When a patient gets a filling and says, “My tooth was OK until you worked on it!” It’s the work of the PDLs. The PDLs tell you if food is hot, cold, soft, or hard and if a filling has been done correctly.
Putting the Bite Back in Harmony
The PDLs contain mechanoreceptors that tell the brain where to move the jaw during chewing and swallowing, both being neuromuscular functions. Most people don’t think about chewing, they just let the PDLs, the brain, muscles, tendons, ligaments, and fascia do the communication and action. Neuromuscular dentistry is the study of those movements. If they are not in harmony, bad things can happen. The problems can be slight, like worn teeth, or a clicking joint or they can be life-robbing pain, pain so horrible, it incapacitates. It takes knowledge, skill, and proper technology, for a dentist to put the bite back in harmony. Harmony can be achieved by using a neuromuscular orthotic that follows neuromuscular protocols and procedures.
To measure the dental neuromuscular dysfunction of the pain patient, EMG sensors are placed over the muscles of mastication to record their activity. An extremely sophisticated jaw tracker is used to show jaw position and muscle activity at the same time. The jaw tracker uses a magnet placed on the labial of the lower incisors and a sensor is placed outside of the mouth to detect the magnetic field generated by the magnet as the jaw moves in space. Movements can be detected in less than a millimeter on a computer screen. The screen shows a grid in millimeters. Superimposed over the grid, is a computer-generated mandible. The goal is to find the jaw position where the muscles are in harmony. Once the position is found, the grid is marked so that it can be repeatedly found. It’s a measured bite that gives predictability and repeatability. The neuromuscular doctor and patient become a team with both looking for the proper position of the mandible where the neuromuscular function achieves the most harmony.
Once the proper, measured position is found, the bite recording material is flowed between the upper and lower teeth. It is imperative that the jaw remains perfectly still and does not move. Any movement, even a tenth of a millimeter, would make the bite wrong and unmeasured. Because the jaw is still being tracked, the doctor can tell if the jaw moved while the bite material hardened. Impressions or digital scans of the upper and lower teeth are also taken and sent to a dental laboratory that is trained in neuromuscular dentistry. The doctor’s prescription to the laboratory asks for the fabrication of a precision, plastic, removable orthotic that would mimic a harmonious, stabilized bite.
Like a custom shoe orthotic, a neuromuscular orthotic is designed to correctly support and align the lower jaw’s teeth to the upper jaw’s teeth in a harmonious position. It achieves this by overlaying the lower teeth with removable plastic that mimics a harmonious closure of jaws, teeth, joints, and muscles. If the diagnosis is compressed condyle, the orthotic gives the lower jaw a solid landing platform that decompresses the condyle. If the diagnosis is torqued mandible, where one side hits before the other, the orthotic compensates where all back teeth hit at the same time. If the diagnosis is posterior interferences, the orthotic is designed to overcome the malocclusion. Since the appliance is removable, it is reversible.
Neuromuscular dentists also use an Ultra Low-Frequency TENS unit to relax the muscles of mastication. Before TENs, muscle activity is measured via EMGs to get a baseline. They are measured again after a period of muscle relaxation via TENs. It only makes sense to take the jaw-to-jaw relationship when the muscles are relaxed.
Please go to ICCMO.org to learn more and to search for a neuromuscular dentist in your area.