Neuromuscular Dentistry

Neuromuscular dentistry (NMD) is the science of dentistry that embodies accepted scientific principles of patho-physiology, anatomy, form and function.  NMD objectively evaluates the complex relationship between teeth, temporomandibular joints and the masticatory muscles in order to achieve an occlusion that is based on the optimal relationship between the mandible and the skull — Neuromuscular Occlusion.  Dr.  is among the 5% of dentist in the country that have the training, skills and knowledge to provide NMD.

Neuromuscular dentist follow generic physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that objectively focuses on correcting misalignment of the jaw at the temporomandibular joint (TMJ).   

The goal of the Neuromuscular Dentist is to relax the muscles controlling jaw position to establish a true physiological rest position upon which treatment considerations are based.

Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms that relates to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry recognizes the need to solve the root of the misalignment problem(s) by understanding the relationships of the tissues which include the muscles, teeth, temporomandibular joints, and nerves. In short, neuromuscular dentistry and technology add objective data and understanding to previous mechanical models of occlusion.

Symptoms of temporomandibular joint disorder (TMD) are claimed to include:

Headaches / migraines

Facial pain

Back, neck and shoulder pain

Tinnitus (Ringing in the ears)

Vertigo (dizziness)

Trigeminal neuralgia (Tic douloureux), a neuropathic pain disorder unrelated to TMD

Bell's Palsy, a nerve disorder unrelated to TMD

Sensitive and sore teeth

Jaw pain

Limited jaw movement or locking jaw

Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)

Worn or cracked teeth

Clicking or popping in the jaw joints

Jaw Joint pain

Clenching/bruxing

Tender sensitive teeth

A limited opening or inability to open the mouth comfortably

Deviation of the jaw to one side

The jaw locking open or closed

Postural problems (forward head posture)

Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing

Pain in the muscles surrounding the temporomandibular joints

Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head

Pain behind the eyes

Swelling on the side of the face and/or mouth

A bite that feels uncomfortable, "off," or as if it is continually changing

Older Bells palsy

 

Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG) and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS).

 

Combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS the dentist is able to locate a "physiological rest" position as a starting reference position to find jaw relationship between the upper to lower jaw along an isotonic path of closure up from physiologic rest position to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording.

 

Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthosis is commonly worn for 3-6 months (22 hours per day) to realign the jaw.  use of the orthotic as a "orthopedical realigning appliance", allows Dr. Camacho to evaluate this position as it rehabilitates the joints, muscles, and nerves, which will lead to improve or in most cases eliminate the symptoms completely.  After it is determined that your natural bite has been the cause of the symptoms by testing a different bite( Neuromuscular Bite) then a permanent correction could be recommended for a permanent treatment.  These permanent solutions could be a simple adjustment of your teeth to equilibrate your bite, replacing missing teeth, a partial or full mouth reconstruction, orthodontic treatment, or simply continue to wear the orthosis.

In summary, NMD is the science of occlusion encompassing not only the teeth, but the objective evaluation of the status and function of the jaw muscles and joints — before, during and after treatment — to achieve the optimal result.

Why is Neuromuscular Dentistry Important and Is There Scientific Support for its Efficacy?

Occlusion is the foundation of dentistry. It is of key importance in the success of every major dental procedure. Occlusion is affected by a triad of factors — the teeth, the muscles and the temporomandibular joints. Traditional dentistry has focused on the teeth — what might be called "one-dimensional" dentistry. Neuromuscular Dentistry (NMD) is a term that has been applied to the additional consideration of the "second & third dimensions" — muscles and TM joints.

The limited time in the dental curriculum makes it difficult enough for schools to prepare dentists to deal with the teeth. Muscles and joints typically get a cursory once-over. As dentists go into practice, it is not uncommon to hear them say that they have done procedures "by the book" and yet have less than satisfactory results. Or, that a case is so complex they refer the case out rather than treat it themselves.

Neuromuscular Dentists commonly report that taking muscle and joint status into consideration aids them in optimizing treatment, minimizing the times that they are "surprised" by less than ideal outcomes, and gives them the added insight needed to treat complex cases.  There is a significant body of literature published over the past 44 years that supports the efficacy of neuromuscular dental principles.