Neuromuscular dentistry is a specialized field focusing on the complex relationship between the teeth, jaw joints, muscles, and nerves, collectively known as the stomatognathic system. Unlike traditional dental practices that focus primarily on the structural alignment of teeth and bone, this approach views the jaw’s function as a dynamic biological system. The goal is to identify and correct a misaligned bite position that may be causing strain on the surrounding muscles and nerves.
Core Philosophy of Neuromuscular Dentistry
The fundamental difference between conventional and neuromuscular dentistry lies in their primary focus. Traditional dentistry often centers on the teeth’s static relationship, aiming for a bite where the teeth fit together based on structural landmarks. Neuromuscular practitioners, by contrast, prioritize the health and harmony of the jaw muscles and nerves, recognizing that a structural misalignment forces the muscles to constantly work to compensate.
The core objective is to locate the “Physiologic Rest Position” or “Myocentric Bite,” which is the position where the jaw muscles are fully relaxed. This ideal position is defined as the point where the mandibular muscles have the minimal electrical activity necessary to maintain postural rest. By achieving this muscle-guided position, the temporomandibular joint is often decompressed and relieved of strain. Establishing this balanced, relaxed state is the necessary precursor to any permanent corrective procedures.
Specialized Diagnostic Procedures
Neuromuscular dentists rely on objective, high-tech diagnostic instruments to measure the function of the jaw and its associated structures. The first step in this process is often the use of Transcutaneous Electrical Neural Stimulation (TENS). TENS involves applying low-frequency electrical impulses to the nerves that control the jaw muscles, specifically the fifth and seventh cranial nerves. This gentle, rhythmic pulsing causes the muscles to relax and release the learned, often strained, position of the jaw that the brain has mistakenly adopted.
Once the jaw muscles are relaxed (typically 45 minutes to an hour), the dentist records the true physiological position. Computerized jaw tracking, or kinesiology, is used to chart the exact path and trajectory of the lower jaw as it moves from its relaxed state to closure. This tracking helps to confirm the ideal neuromuscular trajectory and ensures the jaw joint is moving without interference.
Surface Electromyography (EMG) is another tool used to objectively measure the electrical activity of the jaw and neck muscles. Electrodes are placed on the skin to monitor muscle tension during rest and function. Readings of muscle activity below a certain threshold, often around 2.0 microVolts, confirm that the muscles are fully relaxed and the newly found bite position is stable.
Conditions Treated by Neuromuscular Dentistry
A strained or misaligned bite can affect the entire head and neck complex, leading to a range of chronic symptoms. Neuromuscular dentistry is most commonly sought out for treating Temporomandibular Joint disorders (TMD), which involve pain and dysfunction in the jaw joint and the muscles that control movement.
Patients often present with chronic facial pain, such as persistent discomfort around the ears or temples. Unexplained headaches and migraines are also common symptoms, as muscle strain in the jaw can refer pain throughout the head. Other mechanical signs addressed include clicking, popping, or grating sounds in the jaw joints, which indicate issues with the joint disc. Muscle imbalances can also cause related pain in the neck and shoulders.
Stages of Neuromuscular Treatment
The general sequence of treatment is divided into two main phases following the initial diagnosis and the determination of the optimal bite position. Phase I, known as Reversible Treatment, focuses on stabilization and immediate relief of symptoms. This involves fitting the patient with a custom-made, removable orthotic, which functions like a specialized mouthguard.
The orthotic is designed to hold the lower jaw precisely in the newly measured neuromuscular position, allowing the muscles and joints to rest and recover. This phase is considered diagnostic because it confirms that the corrected jaw position alleviates the patient’s symptoms before any permanent changes are made. Once the symptoms have significantly decreased and the jaw position is stable, the dentist moves on to the long-term solution.
Phase II, or Permanent Correction, is designed to maintain the corrected bite position without continued reliance on the orthotic. This permanent solution takes several forms depending on the patient’s needs and the extent of the misalignment. Options include specialized orthodontics to permanently move the teeth into the new, relaxed jaw position. Alternatively, reconstructive dentistry may be used, involving restoring the teeth with crowns or veneers to permanently build up the bite.