NEUROMUSCULAR (NM) DENTISTRY

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How your bite is aligned translates throughout your posture. For most patients, it is not top of mind when they visit the dentist with imminent pain, noticeable dental condition, oral discomfort, or cosmetic goals. Even if they suffer from long-term medical issues such as chronic headache, jaw pain, neck pain, fatigue, tongue thrusting, or muscular disturbance, they generally do not think to report it during a dental visit. This limits the dental service to simple, symptom-driven treatment. 

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Neuromuscular (NM) dentistry is an advanced area in dentistry that takes an integrated approach to teeth, muscles (and associated nerves), and joints. NM brings together different tools and treatments to investigate the root cause of occluso-postural abnormalities. The treatment goal is to restore dental form and function as well as bring postural balance and harmony. 

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Dr. Rahman practices neuromuscular dentistry in Annapolis and serves patients from the D.C.-Maryland-Virginia (DMV) area. She is trained at the internationally renowned Occlusion Connection program under Dr. Clayton Chan. She extends NM to include gnatholoy (study of the jaw / masticatory system). Dr. Rahman uses state-of-the-art tools and techniques to identify the most relaxed jaw position and balanced posture for the patient.

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The team at Annapolis TMJ is trained to provide specially curated long-term care. All our services—smile design, TMJ treatment, and sleep apnea treatment—utilize the principles of NM dentistry. 

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TEMPOROMANDIBULAR JOINT (TMJ) DISORDER

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The TMJ is a hinged synovial joint that connects the mandible to the temporal bone at the skull base. Its posterior boarder is the anterior boarder of the external auditory canal. It is one of the few synovial joints with an articular disc and it functions as both a hinge joint and a sliding joint. Mouth closing, or Adduction of the mandible, is performed by the masseter, temporalis, and medial pterygoid muscles. Mouth opening, or Abduction, is performed by the lateral pterygoids and digastric musculature. Temporomandibular disorder (TMD) is a nonspecific term used to describe orthopedic and myofacial disorders that affect the TMJ. Researchers estimate that approximately 30% to 45% of the population suffer from TMD. 

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Treatment for TMD can be broadly classified into three categories: 

• Non-pharmacologic treatment: It is a non-intrusive treatment method that utilizes a wearable occlusal splint. The neuro-muscular orthotic device is designed to hold the patient's bite at its more physiologically balanced position. This helps de-program the muscles over time. Patients are to wear the orthotic device for 20 to 22 hours each day. While wearing the device, patients report observable improvement in postural balance. 

• Conservative pharmacotherapy: It is a non-intrusive treatment that involves the application of Botulinum Toxin. It helps address myofacial TMD receive immediate relief lasting up to three months. We discuss this in detail below. 

• Open surgery: The third and most invasive method is to undergo oral surgery to fix any disorders of the TMJ joint. We do not offer this service, but refer patients out to the best oral surgeons in the area. 

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THERAPEUTIC BOTOX FOR TMJ PAIN RELIEF

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Botulinum Toxin (popularly known as "Botox") is commonly associated with esthetic use such as dermal fillers. However, it could have significant positive effect on the patient's lifestyle by providing immediate relief from temporomandibular joint (TMJ) and myofacial pain, chronic migraine, and head and neck pain. We focus on these therapeutic cases to provide you with a pain-free living—and in some cases, esthetically focused treatment if you so desire. 

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The application of BoTN/Botox helps provide immediate relief by relaxing the hyper-functioning muscles. Patients notice a reduction in clenching, muscle ache, and head and neck pain.