NEURO-MUSCULAR DENTISTRY

The NM Dentistry Difference

The craniomandibular system is an integral component of the upper body. Neuromuscular (NM) dentistry is an expansive branch of dentistry that takes an integrated approach to the head, neck, and shoulder girdle. The NM approach to treatment primarily includes TMJ, but also considers muscles, ligaments, and fascial connections. It also seeks to understand whether the patient's conditions are related to dysfunctions, occlusal disorder, or postural abnormality. 

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The end goal of treatment is to go beyond "straight teeth", as most patients come to expect. It is, instead, to find the "physiologic bite" where your jaw is most relaxed. Once that balance is achieved, the patient gets relief from migraine and chronic pain. Dr. Rahman's training has extended her learning and treatment to Gnathologic Neuro-Muscular (GNM) dentistry. This is a modern take on NM dentistry to include considerations of the jaw as well. 

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Scientific Measurements

At Annapolis Center for Advanced Dentistry (ACAD), we use state of the art equipment to measure the patient's range of jaw movement. This helps set the baseline for progress tracking as we proceed through treatment phases. Some of our commonly used instruments include: 

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• Ultra Low Frequency TENS: We use a J5 TENS machine to stimulate the jaw muscles. This helps relieve immediate pain associated with jaw spasms. A TENS session of between 45 to 60 minutes, in a peaceful and relaxed setting, allows the dentist to perform subsequent measures. 

• Electromyography: We use a Myotronics K7 machine to accurately track muscle activity around the jaw -- both at rest and in motion. This helps understand if the jaw is opening and closing on an optimum path. 

• Jaw Tracking: As part of the TMJ assessment, we track the patient's range of jaw motion in all three dimensions. It is a diagnostic process that goes beyond information obtained from radiographic imaging. MRI's do not quantify dyskinetic movement disorders or bradykinetic movement disorders. Therefore, MRI's alone are not enough to diagnose jaw movement disorders such as abnormal, slow, or jerky movement during jaw opening and closing. 

• Sonography: Jaw clicking and popping, vertigo, and ear congestion are common symptom among TMJ patients. We use sonography setting on the K7 to track where, when, and how much sound the jaw is making.  

• CT scanning: We take TMJ-focused CT scans to visualize the condyles and assess them for any abnormalities. 

• Pharyngometry: We use a pharyngometer to track the jaw position to ensure the patient would airway opening. This is fundamental to our treatment of sleep apnea. However, it is not enough to adjust the jaw position with no consideration for neuro-muscular balance. 

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Outcome and Benefits of NM Dentistry

NM dentistry, and specifically Gnathologic NM (GNM), advances the boundaries of diagnostic technique and principle. It combines temporomandibular joint dysfunction (TMD) care, orthopedic treatment, and restorative dentistry. This is a treatment approach is designed for patients suffering from complex TMD occlusion oriented problems. 

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During our clinical assessment, Dr. Rahman and her team recognizes the occlusal plane versus abnormal ("pathologic") planes of occlusion. This helps us establish optimal head, cervical, and overall postural alignment for long term stability. Our diagnostic and treatment protocols are divided into two phases. 

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In the first phase, we stabilize the patient's bite using a custom, wearable orthotic. This is an immediate but temporary relief for the patient. You can live your life as usual, while wearing an orthotic similar to a retainer or an Invisalign tray. We will set up periodic visits to continually monitor and measure the progress. Along the way, as your bite adjusts to the orthotic, we will adjust the orthotic as needed. 

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The second phase of treatment involves specific, targeted orthodontic treatment to move your teeth to the physiologic bite position where your muscles are most relaxed. This is the phase when you move from a temporary solution to a permanent cure. Once you have completed this step, we will train (and re-train as necessary!) you about bite management and maintenance of the optimal jaw position. 

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At the completion of treatment, your muscles should function under optimal conditions. They should no longer need to compensate for any abnormalities in your bite. Patients should experience reduced prevalence of acute, self-perpetuating chronic pain within the first three months.