Neuromuscular - LVI

Neuromuscular dentistry is a dental treatment philosophy recognized by the International College of CranioMandibular Orthopedics (ICCMO) and the International Association of Asthetic Dentistry (IACA) and The American Academy of CranioFacial Pain has a Neuromuscular Section these professional associations consider the health and welfare of temporomandibular joints, masticatory muscles and central nervous system mechanisms a follow the same physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting th e pysiologic "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry can correct the the relations of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion.

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

• Headaches / migraines
• Sleep Apnea & •Upper Airway Resistanc Syndrome
• 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)
• Torticollis
• 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

The National Heart Lung and Blood Institute (NHLBI) of the National Institution of Health (NIH) published CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS. This report considers the entire spectrum of disorders related to Temporomandibular disorders.[1]

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). By 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 a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording.[citation needed]

Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3–6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.

Neuromuscular Dentistry is generally provided in two Phases. Most commonly, the first phase is performed for patients that are symptomatic, usually acute pain such as headaches, etc. Some Phase One patients do not have symptoms, but rather their occlusion or bite needs to be corrected prior to restoring their mouths with crowns, veneers, or NM Functional Orthodontics (often termed an Esthetics case). Phase Two treatment is preferably decided upon PRIOR to embarking on Phase One treatment by the NM Dentist and the patient. Phase Two treatment can be: 1. Continuing to wear the lower orthosis with knowledge that replacements will need to fabricated over time (at patient expense) 2. Restorative Dentistry to the new bite position 3. Neuromuscular Functional Orthodontics 4. Combination of any of the above. There are separate fees for Phase One and Phase Two treatment options. Phase Two Dentistry options are "conventional" dental procedures such as crowns, bridges, implants, partial or full Dentures.

The treatment plan involves utilizing low frequency TENS (transcutanous electric neural stimulation) prior to a passive bite registration in her resting mandibular neuromuscular position to create a medically necessary orthopedic repositioning appliance. This device is used to position the condyles in the fossa in a less pathological, more true anatomical position, reduce stress to the jaw joint, increase joint space, allow remodeling of the condyle, heal retrodiscal tissue, re-capture the dislocated articular discs, provide proper alignment of the mandible to the skull, reduce myospasm and pain, and maintain the muscles of mastication at their proper physiologic resting length. Please note that all treatment is neuromuscular and orthopedic in nature and necessitated by a medical condition resulting in head and neck pain and should be considered as a medical necessity. At this time, the treatment does not involve the teeth, periodontium, or surrounding structures, but is for a structural, orthopedic, neuromuscular problem that must be stabilized (Phase I). The teeth will be treated at a later date (Phase II) to hold this new, stable orthopedic position using

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