When the teeth, facial muscles, and temporomandibular (jaw) joint are out of alignment, the painful symptoms of what is often called “TMJ” or “TMD” (temporomandibular joint syndrome or temporomandibular joint dysfunction) often arise. While traditional dentistry evaluates primarily the teeth, bones, and gums, neuromuscular dentistry works with the hard tissues and the soft tissues, muscles and nerves.
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What is Neuromuscular Dentistry
Neuromuscular dentistry is an approach to resolving this dysfunction and its symptoms by correcting the misalignment. By doing this, neuromuscular dentists reduce stress on the muscles connected to and the hard tissue within the jaw joint itself. This treatment is based on the work of medical pioneer Dr. Bernard Jankelson and the research on skeletal muscles done by Dr. Janett G. Travell. It is believed that the majority of pain complaints originate from stress and tension in muscles which are caused by their relationship to the body’s bone structures.
The goal is reducing stress on the muscles of mastication (chewing) by realigning the position of the jaw in relation to the teeth to restore proper jaw function. Neuromuscular dentists use non-surgical means to relieve jaw, head, including headache, and neck pain that are associated with this jaw dysfunction. First the dentist determines the optimal position of the jaw by measuring the relaxed position of the head and neck muscles, and then repositions the jaw to achieve those exact measurements.
According to Dr. Mark Duncan, DDS, the clinical director of LVI Global, considered by many the world’s leading post-graduate dental school, up to 85% of TMD symptoms can be resolved by creating proper realignment of the jaw through the non-surgical means utilized by neuromuscular dentists and without the need for ongoing use of prescription drugs. While there is not an official credential for neuromuscular dentistry through the American Dental Association, only properly trained dentists practitioners should refer to themselves as “neuromuscular dentists” without misrepresenting their education, training, the technology that they use in diagnosis and their ability to adequately treat TMD symptoms through the methods explained here, according to Dr. Duncan.
How Neuromuscular Dentists Diagnose TMJ Dysfunction:
Evaluation and Discovery:
An initial evaluation will include a discovery conversation that will allow the neuromuscular dentist better insights into the exact causes and symptoms of each case of TMD. Since there are many reasons that may lead to jaw pain, migraines, a popping jaw joint, lockjaw or any other number of TMD symptoms, it is extremely important to understand which of these are present in each patient. The fact is TMD does not have a singular cause or universal treatment so this stage is vital to finding the correct next step.
Questions you can expect your neuromuscular dentist to ask include:
- Is your pain or dysfunction occurring on one side or both sides of the jaw?
- What are the common symptoms that recur?
- If there is pain, is it acute or generalized over a wide area?
- Have you had past injuries to the jaw?
- Do you have a history of arthritis or joint inflammation?
- Is there a possibility of infection or nerve related issues?
- Do you experience popping, clicking or grating noises from the jaw?
Learn more about neuromuscular TMD diagnosis here.
Assessment of Jaw Alignment:
Since an estimated 85% of TMD cases are caused by a misaligned jaw, a neuromuscular dentist must investigate the actual alignment and motion of the jaw. Additionally, other factors must be ruled out to ensure that the root cause is being treated rather than simply masking symptoms or providing a treatment that may not be effective. Not every case of TMD will be able to be resolved by realignment of the jaw, in some rare cases more extensive treatments such as surgery or pharmaceuticals may be required. It is important for the your doctor to have the knowledge to properly rule out other causes.
If infections and nerve issues can be ruled out, a neuromuscular dentist may then proceed with a physical examination. It is important to understand how TMD sufferers teeth align, whether there is a bad bite (what is called malocclusion) and if there may be an issue with worn teeth caused by symptoms of neuromuscular tension like night grinding (bruxism). They will also assess the jaw path during opening and closing of the jaw to see if this is potentially causing or exacerbating jaw pain issues. Finally they may feel the TMJ itself and different muscles around the TMJ to understand how they are interacting and if there may be areas of tension leading to symptoms.
With this information they may be able to recommend a treatment or decide that further testing is required. “This is where having a neuromuscular dentist that has been trained to use the correct technology and analyze its results is vital” Dr. Duncan explains. Unless they have been trained and have the right tools, dentists or medical doctors may be taking a best guess and make recommendations absent the necessary empirical evidence.
Neuromuscular TMD Diagnosis Instruments:
Technology has enabled neuromuscular dentists to distinguish their assessment from other health practitioners. It has also vastly increased the efficacy of their treatments for the right cases. If your dentist does not have the right tools it will limit their ability to provide the best treatment possible. In the final phase of the TMD diagnosis your neuromuscular dentist may recommend using the following tools:
This is a tool that allows a neuromuscular dentist to monitor the electrical impulses generated by the muscles that are related to movement of the jaw and alignment of the bite. It can help to determine whether the muscles remain stressed at their resting position and the relative stress at different jaw positions. By analyzing this data they are able to tell if the cause of the jaw pain is structural or muscular.
This tool emits sound waves to produce an image. In the case of the jaw there are varying densities of materials including bone, soft tissue and muscle. While ultrasonography may not give full view of the deepest area of the discs in the jaw joint it provides other information that can give insight into the inner working of the entire jaw. The neuromuscular dentist can use this imaging to analyze the structure of the jaw in different positions. This allows them to determine the specific cause of stress leading to pain.
Dr. Bernard Jankelson successfully utilized the kinesiograph and published his findings in 1980. This tool is highly effective in diagnosing neuromuscular dysfunction as a cause of TMD. The instrument tracks the movement of the jaw during speech and provides insight into the plane of movement of the jaw. This allows a neuromuscular dentist to isolate abnormal movement that may lead to jaw dysfunction.
Creating an image in sections provides information on the bone structure such as the condyles and their relationship to the mandibular joint in different open and closed positions.
Neuromuscular Dentistry TMD Treatment
TMJ Syndrome treatment options in neuromuscular dentistry include adjusting the bite using orthotics, orthodontics, or restoring the teeth to their correct positions. The following are details about the treatment options that may be used in most cases to correct TMJ dysfunction.
In cases where the neuromuscular dentist is able to determine that the alignment of the jaw is causing dysfunction, the next step is to find the natural resting position of the jaw. In order to do this a TENS, transcutaneous electric nerve stimulation, unit may be used to relax the jaw muscles and to allow it to settle into its natural position. Learn about TENS therapy here
The next step that a neuromuscular dentist may take to resolve TMD symptoms is to fit a patient for customized orthotic, a device resembling an athlete’s mouthguard. These mouth guards are particularly effective for symptoms such as bruxism at night (teeth grinding), sleep apnea, and lockjaw. Many jaw pain patients report near-immediate relief of symptoms they have had for years upon using an orthotic. Learn about choosing the right tmj mouth guard here.
Orthodontics and Restorative Dentistry:
In many TMD cases involving a misaligned jaw, a properly fit orthotic resolves the symptoms. In other cases there may be an issue with the way the teeth align. In order to prevent the jaw from moving back to a bad position and leading to recurring symptoms, dental orthodontics or restorative dentistry may be recommended. This is done to ensure that the teeth and jaw work together and allow the muscles of mastication to work in the correct position, one that doesn’t result in stress leading to neuromuscular pain.
How to Find a Neuromuscular Dentist
It is true that neuromuscular dentistry is not going to be able to resolve every case of TMD. However, a properly trained neuromuscular dentist will take extensive steps to diagnose the cause of a sufferer’s pain as alternatives to extreme treatments that other practitioners commonly recommend such as a condylotomy surgery or long-term use of prescription painkillers. Those treatments have a long recovery cycles, or may simply mask the pain and have side effects, unlike the treatments that a neuromuscular dentist may recommend.
There are institutions such as LVI Global that will be able to make a referral for your local area. Or, you can use the Leading Dentist database by searching on this site to locate a TMD specialist nearby. All dentists listed have completed the Core VII post graduate course at LVI Global, which has the world’s largest and most prestigious neuromuscular dentistry educational curriculum. Additionally you may ask for a referral from your primary care provider.
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