What is Neuromuscular Dentistry?

The term Neuromuscular Dentistry or NMD is based on the work of a father and son team, Dr. Bernard and Robert Jankelson. It then has been fortunate to have leapt forward with the volume of practical application at LVI and in the offices of the LVI Alumni.

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There are some fundamental factors that need to be addressed to ensure the case is being managed from a complete perspective that includes not just hard tissue and tooth evaluations, but a total system evaluation.

  1. The body functions as a biologic being and cannot be treated as if it were simply a machine. The stomatognathic system is no exception and the anatomy and physiology of the entire system must be considered.
  2. The oral complex is directly and constantly connected to the rest of the organism. The evaluation necessarily includes an appreciation of posture beyond the jaw-to-jaw relationship.
  3. The system is adaptable and will attempt to self-correct, however there is a point where the system can be pushed past the body’s ability to compensate. This is where dysfunction and symptoms begin to occur.
  4. The body is designed to function in a decompressed state, allowing for proper blood supply as well as lymphatic drainage and optimal physiologic function. Compression is inconsistent with health and function and often creates pain.
  5. The body is designed to function with significant reserve capacity for activity. The resting jaw relationship should be from a physiologically relaxed position.” If the ‘resting’ muscles are under tension that is a destabilizing and pathologic position.
  6. Proper physiologic function allows for an open/close pathway of the jaw that is comfortable in the entire range of motion including the final Centric Occlusion.
  7. Diagnosis should be the initial step in any interaction with the patient and should start from a neutral and relaxed physiologically optimal position.
  8. Ultra Low Frequency TENS has been demonstrated to be an exceptional tool to facilitate muscle relaxation.
  9. Objective measurement and recording is an art and science that is too often missed in dentistry. Diagnostic information is the key to treatment success and answers to some basic questions will contribute to optimal success.
    • Can you measure a given physiologic function?
    • Are you measuring that physiologic parameter accurately?
    • Does that information add to the diagnostic information to assist diagnosis and treatment?
  10. Electromyography (EMG) is an efficient and effective way to assess muscles both at rest and in function.
  11. Muscles at rest should have low resting EMG readings and objective measurement allows the doctor to achieve a more ideal therapeutic outcome.
  12. Optimal recruitment of the musculature when in function is essential to predictable positive outcomes.
  13. TMD is a broad range of dysfunctional issues that can have a number of different symptoms and may well mimic a variety of other ailments. In fact, TMD dysfunction can lead to a number of other systemic compromises as well.

Neuromuscular science is a broad and all encompassing approach to finding the stable physiologic neutral zone. Historically occlusal theories focused on the hard tissue structures in the system but lacked comprehensive perspective to be able to create predictable outcomes. With the inclusion of the soft tissue analysis along with the hard tissue science, we can arrive at an objective and complete analysis of the entire system including musculature and bone and teeth to create a stable result from multiple perspectives, including posture of the head, neck, body, and jaws. In addition, the muscular balance will create better occlusal stability and long term restorative or orthodontic/orthopedic stability as well as enhanced esthetics for the patient.

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