Neuromuscular Orthodontics

Many dentists are realizing that there is more to a perfect bite than straight teeth. In dental school, we were taught that teeth are attached to the jaws, yet there are also muscles, joints, nerves, and blood vessels that make up the whole head and neck complex. When closing the jaw teeth, we guide the muscles to a position — but that's not always where the muscles want to be. If the bite is off, the muscles will fight to stabilize the jaw. If a person's bite is out of line with where the muscles naturally want to go, the muscles become strained and tired.
Neuromuscular dentistry goes beyond the hard tissues of the head and neck and includes the soft tissues, muscles, and nerves. It is important to understand that there is a balance between the body's ability to adapt to an imperfection and the stresses placed on its physiologic range of motion and posture. Therefore, the ability to objectively measure muscle function and correlate it to a proper jaw position and its movements in function is an important part of removing stresses and finding a balanced orthodonticly finished position.
Establishing an occlusion based upon the most stable position and function of the temporomandibular joints and the most relaxed posture and function of the masticatory muscles is a key component of neuromuscular dentistry.

Neuromuscular orthodontics emphasizes how the muscles, jaw joints, and teeth affect one another. The use of this state-of-the-art jaw recording instrumentation identifies a proper tongue and jaw position to help eliminate negative forces on teeth. Rather than guessing subjectively and assuming the jaw trajectory is correct, the instrumentation assists in identifying a correct jaw position before and after orthodontic treatment.

A low-frequency TENS (transcutaneous neural stimulator) is used to relax facial and masticatory muscles. Tensing is the first modality used to restore muscle to normal resting length prior to occlusal diagnosis. Muscle spasm and shortening is often found in patients with TMD signs and symptoms. It is also characteristic of patients with occlusal wear and dysfunction. By starting with a truly relaxed rest position of the mandible it is possible to establish a reference position to evaluate jaw position.

Tensing is an invaluable tool in your armentarium to begin restoring the patients masticatory system. Low-frequency TENS can be used in dentistry in three ways:
  • It relaxes muscles and allows the practitioner to determine a muscularly oriented jaw-to-skull relationship toward which we can now move the teeth.
  • It relieves pain caused by spasm and tension.    
  • It closes the jaw through space to a position that is most compatible with relaxed muscles. Many people have headaches, migraines or jaw pain and simply live with the discomfort­—from mild to severe—because physicians are often unable to locate a physiological cause. But it may come as a surprise that the pain can stem from your mouth, not your head, and be caused by a poor or misaligned bite. Muscles of the temple area and forehead play a key role in opening and closing the jaw.
We refer to the misalignment of the bite as temporomandibular (jaw joint) disorder, or TMD (also popularly referred as TMJ).. In addition to frequent headaches, common TMD symptoms include pain in the neck, clicking or popping of the jaw, clenching or grinding, swallowing problems, dizziness, ringing in the ears, tingling of the fingertips, and nervousness or insomnia.     
      If it is determined that the your bite is the likely cause of the pain, we identify a new jaw position that leaves your jaw muscles in a more relaxed state. Options may include reshaping the enamel of the teeth; reconstruction, which involves making the teeth higher by using crowns to permanently realign the bite; and moving teeth to optimal position with orthodontic appliances, such as braces or Invisalign.


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