Neuromuscular dentistry is the science of dentistry that evaluate the complex relationships between the teeth, temporomandibular joint and masticatory muscles in order to achieve an occlusion based on the optimal relationship between the mandible and the skull. Neuromuscular dentistry aim to get rid of temporomandibular joint disorder (TMD) by reducing stress from the jaw muscles. It also helps in correcting the bite or occlusal disturbances resulting in healthy muscles and joints by eliminating the painful symptoms to an extend if not cure.
Neuromuscular dentistry was introduced by Dr. Bernard Jenkelson in 1960’s by considering the relationship between the upper and lower jaws, temporomandibular joints (TMJs) and their muscles and nerves. He states that when the teeth, jaw muscles and TMJs are misaligned, then TMD occur. Sometimes patients complain of sensitive teeth, tired facial muscles on waking up in the morning or visiting a dental clinic after a restoration or an extraction with complains of pain in and around TMJ, headache or neck pain. But few dentists will be able to recognize and diagnose the underlying causes.
While doing any dental procedures masticatory functions and long term results should be taken into considerations. The relationship between the dental occlusion, body posture and TMD is a controversial topic in dentistry. During routine oral evaluation, if signs and symptoms of occlusal disease is observe then it should be treated as early as possible because early detection and treatment of occlusal disease can have long lasting and healthy teeth as occlusal disease can affect the TMJ and neuromuscular system.
Sign And Symptoms Of Neuromuscular Diseases
- Jaw pain
- Headaches
- Mobile teeth
- Neck, shoulder and back pain
- Clenching or grinding of the teeth and jaw
- Clicking sounds while opening and closing of the mouth
- Dentin hypersensitivity
- Fractures of the restorations
- Pathological wear and tear of the teeth
- Bone loss secondary to periodontal disease
Posture And Neuromuscular Diseases
TMJ is link to the cervical and scapular region by neuromuscular system so any postural changes of the head and body can have an adverse effect on TMJ and can cause TMD. Also alteration in masticatory muscles can cause changes in the head posture and vice versa. Therefore, manipulation of the muscles of the mandible can result in alterations in the usual head posture.
There is also a positive correlations between dental occlusion (vertical occlusal dimension) and head and neck posture. Dental Occlusion can have a detrimental effect on the general health of the patient in the long run. Moreover, occlusal position affect postural activities significantly. Pain and tired facial and masticatory muscles or TMJ pain is the most common symptom associated with occlusal disease. To measure occlusion and posture, techniques like surface electromyography, kinesiography , postural platforms, etc can be used.
Sign and Symptoms of Dental Occlusion
- Headache
- TMJ pain
- Tired facial and masticatory muscles
- Clicking sound on opening and closing of the mouth, etc.
One of the main factor which influence neuromuscular disease is Occlusal Splint and changes in occlusion can affect the normal masticatory function. Unilateral cross-bite can develop asymmetric jaw growth and unbalanced muscle activity. Besides, tongue thrusting habit can also cause change of occlusion and disturb facial muscles.
Forward head position is forward extension of the head along with upper cervical spine (C1–C3) and flexion of the lower cervical spine (C4–C7) thereby increasing the cervical curvature, this condition is called hyperlordosis and is commonly seen in TMD patients.
Diagnosis
Several diagnostics use to determine TMD are:
Digital and Computerized X-rays to see jaw joints, its movements and resting positions
Electromyography (EMG) to rule out any anatomic defects of the jaw joints and to measure the stressed and relaxed positions of the jaw muscles
Sonography for joint sounds and to detect presence of abnormalities.
Treatments
If the jaw is not properly aligned, neuromuscular dentistry help in ruling out the underlying causes and correcting them (Jaw joint, muscle or tooth positions) by adjustments of the bite or occlusal disturbances with the following approaches.
A. Conservative Approach
I. Orthodontic treatment
Removable or fixed techniques are used for proper alignment of the teeth
Oral appliances like splint or mouth guard until the bite is stabilize permanently.
II. Other treatments options like dental restorations, tooth recontouring or crowns, etc may also be use to restore the misaligned teeth.
III. Ultra-Low Frequency Transcutaneous Electrical Neural Stimulation (TENS) device to relaxed the muscles around the jaw and allow us to correct and re-align the bite and the jaws using electromyography, sonography, etc and record the muscle stress at rest and while at functioning. For this procedure, electrodes are placed in the jaw, neck and shoulder where a mild electrical stimulation help in repeatedly contracting the jaw muscles in order to relax them.
IV. Posture exercise
Though it may be a bit painful and difficult initially follow the rules and with little patience and effort one can achieve a good or right posture.
B. Surgical Approach
In severe cases where conservative approach fails to cure the underlying cause, surgical approaches like Jaw surgery is perform for a stress free and relax neuromuscular system.
Conclusion
The cost of neuromuscular treatments depends on the clinical scenario, procedures to treat the conditions, etc and may require full mouth reconstruction involving oral surgery procedures, periodontal treatments, etc. Besides, early detection and treatment of Neuromuscular Disease can lead to long lasting, healthy teeth and a wider beautiful smile.
