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Neuromuscular TMD

Neuromuscular dentistry is a specialized area in dentistry which focuses on how the jaws relate to each other.  Approximately 80% of the population have a pathologic bite, this means that when 80% of people bite their teeth together their muscles are working harder than they should.  About half of these people have symptoms related to this and might be unaware that it could be coming from their jaw muscles.  TMD (temporomandibular joint disorder) symptoms can include but not limited: headaches, migraines, jaw pain, jaw stiffness, popping or clicking or grinding in the jaw joint, ear pain, ringing in the ears, vertigo, neck pain, neck stiffness, sensitive teeth, worn or broken teeth, postural problems, etc.  Most of these symptoms can be reduced or eliminated by “bracing” the jaw in the most comfortable muscle position.  The reason why our jaw doesn’t automatically go to this most comfortable position is because of our teeth.  The human body wants to use the least amount of energy, and since we bring our teeth together thousands of times a day (swallowing, chewing, clenching), our body holds our lower jaw in close proximity to where our teeth touch.  In 80% of the population, the jaw muscles are always working harder to hold the jaw in that position.  Neuromuscular dentistry allows us to find the most relaxed position of the muscles and change to teeth if necessary, to allow for the least amount of effort expended while the jaw is functioning and at rest.  In order to find the most relaxed muscle position a neuromuscular workup would need to be completed which includes:

  • Eight channel electromyography – EMG’s are placed on the muscles  to determine the most relaxed position

  • Computerized mandibular scanner – CMS allows us to accurately capture the exact position of the lower jaw

  • Electrosonography – ESG if necessary can record noise in the joint and pin point where in the chew cycle it happens

Once the neuromuscular work up is complete, each patient would undergo a diagnostic phase of treatment which allows the patient to “test drive” the new jaw position.  This process is reversible so our patients are able to determine if their symptoms are reduced or eliminated before they decide to permanently change their jaw position.  Either a removable or a fixed orthotic is the diagnostic tool used for this process (see photos below).  Most of our patients have great results and want to permanently change their bite.  Since every patient is different and the amounts the teeth need to change to accomplish the new jaw position are different, treatment can range from an occlusal adjustment, to braces, to restorations on just the back teeth, to restorations on every tooth for very involved cases.

 

              Removable NM Orthotic                                                Fixed NM Orthotic

https://www.youtube.com/watch?v=mGFIsx8KW_w

http://www.mayoclinic.org/diseases-conditions/tmj/basics/definition/con-20043566

https://www.youtube.com/watch?v=d5Jy0-8QzTY

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