Articles

Application of the Principles of NMD Media Interviews Studies on NMD & Myotronics Equipment Applying the Neuromuscular Principals in TMD and Orthodontics - Part 1 Applying the Neuromuscular Principals in TMD and Orthodontics - Part 2 Computerised Electro-Diagnostic Instrumentation - The Missing Link Neuromuscular Dentistry Partial List of Studies Substantiating the Efficacy of Neuromuscular Dentistry and TENS, EMG, CMS and ESG Dental Treatment - A Neuromuscular Approach The Politics and Science of Neuromuscular Dentistry 1965 - 1999

Dr Fred Calavassy

Dr Sam Guirgui

Neuromuscular Dentistry
by Dr Fred Calavassy and Dr Sam Guirguis

Recently, when asked to write an article on Neuromuscular (NM) Dentistry, the first reaction was, "Where do we start?" Dentistry had changed and evolved so much over the past 15 years we have been practising. In that journey of evolution, we too have changed from being a "tooth mechanic" to a "whole mouth physician". This journey began several years ago when we were exposed to neuromuscular dentistry. For those of you interested in occlusion and various occlusal philosophies, it represents a very different and exciting way of looking at the entire stomatognathic system.

As dental clinicians we often underestimate the amount of help we can offer our patients besides the "drill, fill and bill" type of dentistry. If we make many of our decisions based on science, with regards to overall treatment regimes and protocols, why then should the treatment of our patients "as a whole" be any different. Many clinicians are unaware that symptoms such as temporal and frontal headaches, neck aches at the base of the cranium (back of the head), possible ringing in the ears, decreased range of motion, clenching, bruxing and jaw joint pathologies have a lot to do with our dentistry and impact the dentistry we provide. Unfortunately, "what we cannot see we cannot treat!"

It is often we hear dentists and specialist practitioners talk about occlusion and say the patient has "a good occlusion". Let's start by defining occlusion.

"Occlusion is the dynamic biologic relationship of all components of the masticatory system to the contacting surfaces of the teeth in function and parafunction, i.e. the integrated function of jaw muscles, temporomandibular (TM) joints and teeth."

What constitutes "a good occlusion"? Is it the way the teeth fit together? Or, as described in the definition above, is it the way the entire dentomuscular-skeletal apparatus interacts? As neuromuscular physicians, we think the latter. Neuromuscular dentistry looks at a theory of functional "occlusion" to harmonise the entire stomatognathic system based on neuromuscular physiology.

What is NEUROMUSCULAR DENTISTRY?
Traditional dentistry, as we had been taught, concerns itself with only the hard tissues -- teeth and joints and the soft tissue -- periodontal attachment. It is very mechanically oriented in nature and does not objectively acknowledge the effects of muscle physiology as it pertains to the posture of the mandible to the skull.

Neuromuscular dentistry goes beyond not only the teeth, periodontal attachment and joints, but also the nerves and muscles of the head and neck and the dynamic relationships related to the physiologic range of motion and body posture. This is based upon the ability to objectively and scientifically measure muscle function and correlate it to a proper jaw posture and its movements in function.

Neuromuscular dentistry emphasises the need to establish an occlusion based upon:

• The optimal position and function of the temporomandibular joints and

• The optimal resting posture and function of the masticatory muscles

But how can this be measured? Over 25 years ago, Dr Bernard Jankelson, one of the world's pioneers of occlusal physiology, challenged the old mechanical schools of occlusal thought with the words: "If it has been measured it is a FACT, if it has not been measured it is an OPINION." A good portion of his remaining life was devoted to developing instrumentation to quantify occlusal function. Medical instrumentation abounds to unlock secrets through diagnostics.

Biomedical instruments are used in cardiology, radiography, neurology etc to provide measurement or imaging that helps us distinguish that which is NORMAL from that which is ABNORMAL or OPTIMAL from NON-OPTIMAL. With all this technology being used by our medical colleagues, why not dentistry?

This is where neuromuscular (NM) dentistry enters. NM dentistry sets about to MEASURE the muscular skeletal apparatus and diagnose and treat based on quantitative assessment of the data. NM occlusal objectives include:

Providing an occlusal relationship of the mandible to the maxilla that minimises the need for muscle accommodation and posturing.

Provide an occlusal relationship that allows normal decompression of neural and vascular intracapsular tissue and associated connective tissue.

Elimination of NM and TMJ compression.

Restoration of postural components with minimal activity at rest.

These NM objectives can be achieved with the use of the following tools of occlusal diagnosis and treatment.

1. Ultra-Low frequency TENS	2. Electrosonography (ESG)
3. Electromyography (EMG)	4. Computerised Mandibular Scanning (CMS)

It has been said in the past, "the less you know, the more normal your patient will appear" and since attaining the knowledge in NM dentistry, it is amazing how many NM conditions can be overlooked and go untreated, not through lack of care, but rather through lack of knowledge.

This series of articles on NM dentistry will evolve around the diagnostic data and the evaluation of this data with ultimate treatment of the patients we see in our day to day practice. For those seeking further information on NM dentistry there are many active sites on the internet to commence your knowledge acquisition or learn from some of the global leaders in NM dentistry at the Las Vegas Institute for Advanced Dental Studies.

The road to discover the benefits of NM dentistry is a road well worth travelling. One only needs to experience first hand the joy in a patient's face when they tell you "I haven't had a migraine since we started treatment. I haven't felt this good in six months", to appreciate the benefits that we...dentists, can give to our patients