Neuromuscular dentistry

# Overview
Neuromuscular dentistry is a medical paradigm in which TM Joints, masticatory muscles and central nervous system mechanisms 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).  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 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.
Because of the additional training needed and because of the complex computer systems and hardware required, neuromuscular dentistry is more expensive than conventional dentistry. The costs can range from $3,500 to $25,000 for usually four to six months and/or up to one year or more of treatment depending on the complexity of the case. (This does not include any additional orthodontics or restorative treatment).