Neuromuscular Dentistry - A Discipline of Physiologic Dentistry

by Clayton A. Chan, DDS, MICCMO

For the past forty three years, dentistry has enjoyed an exciting evolution in the delivery of care. Technological advances have predominantly driven this evolution. Scientific advances have resulted in dental materials as technological break throughs using bio-instrumentation that have completely changed our perspectives on how dentist diagnose, manage and treat their cases. Technological advances have also allowed us to go beyond visualizing occlusal relationships solely from an anatomic perspective.

The early years from 1967 to 1977 gave insights and appreciation for the intellectual and courage of Dr. Bernard Jankelson (the Father of Neuromuscular Dentistry) single handedly challenged the dental occlusionist establishment with science and technology we now may take for granted and is available today.  Dr. Jankelson fight for new technology and new paradigmns to dental occlusal treatment brought to light the dogmas, scepticisms and epic confrontations from various levels of the profession.

After Dr. Jankelson's death in 1987, battles erupted in the American Dental Association and U.S. Food and Drug Administration.  By 1986 the scientific foundation for neuromuscular concepts and techniques were firmly ground in scientific literature and the technology was recognized as safe and effective for the purposes intended by the American Dental Association Council on Scientific Affairs.  The clinical techniques which continue to be advocated by his son Drs. Robert Jankelson, James F. Garry and Clayton A. Chan and others (through 2005) have been found to be precise, predictable and successful inspite of some continued attacks from those who ignore the documented science.  Neuromuscular clinicians who have endorsed this philosophy, approach and use of technology today continue to be attacked by leaders whose status and livelihood depended upon the defense of the scientifically indefensible, by third party carriers intent on denial of payment, by IME's whose livelihood depend on dential of patient claims, and by psycho-social academics whose research funding depended upon adherence to a particular TMD paradigmn.

The Neuromuscular Paradigm
New knowledge and understanding of the influences of occlusal proprioception on the human body requires intimate knowledge of the histological, anatomic and physiologic realm of the neuromuscular complex. The dentist should not only be the caretakers of the dentition, but of the health of all the structures innervated by and/or associated to the trigeminal nerve. Understanding the physiologic mechanisms of the stomatognathic system allows simplified clinical procedures that can be applied in all facets of dentistry including the TMD dentist, orthodontic dentist and restorative dentist to treat his/her patients with greater precision and predictability. Neuromuscular principles of occlusion are not new to the profession, but further builds on past gnathological concepts on which our present dental profession is based on. The use of scientific instrumentation has been used to objectively quantify and validate physiologic discoveries to occlusion. This new knowledge and training confirmed with advanced technology allows the restoration of pathologic dentitions to stable healthy dentition previously unattainable for function, self preservation and aesthetics.
 Our profession is now realizing the significance and importance of objectivity, especially when transitioning from academic knowledge to clinical treatment for our patients when: 1) an optimal bite is needed to begin a diagnosis for eventual treatment, 2) the importance of bite management during the phase I stabilization stage and finalizing the orthodontic and/or restorative phase II stage, and 3) finishing the bite to meet the physiologic parameters of stability and dental health.

Today’s dental practitioners are recognizing the necessity to incorporate the latest biomedical technology into their contemporary dental practice. As dental science has evolved and new discoveries are being made through the aid of computer technologies greater responsibilities, capabilities and opportunities for the dental profession are being realized.

Physical, physiologic and biologic laws that govern articular and neuromuscular function at all structural levels of the human body apply to the masticatory apparatus. Generic biologic and physiologic principles that apply to all articular, muscular, neural and central nervous system organs are better realized and understood through the use of computerized Myotronic instrumentation that enhances the clinicians perspective of what is truly physiologic occlusion. Clinicians are recognizing the potential and effectiveness of applying the above mentioned neuromuscular principles to TMD, orthodontic and restorative dentistry. Myotronic instrumentation is able to deliver the reality of these profound NM concepts especially in the clinical setting. These concepts are unfortunately missed by many practitioners.

Five basic principles of occlusion that the physiologically minded clinician realizes when desiring optimal masticatory stability:

1. Acknowledges the multifaceted Musculoskeletal Occlusal Signs and Symptoms.

2. Identifies an optimal starting point for diagnosis and treatment “PHYSIOLOGIC REST” (Homeostasis) - without manual intervention.

3. Recognizes a physiologic mandibular opening and closing NM TRAJECTORY along an isotonic path for STABILITY at a terminal contact position.

4. MICRO-OCCLUSION- Eliminates the afferent and efferent noxious proprioceptive stimuli of occlusion during mandibular closure with FREEDOM OF ENTRY and EXIT.

5. Can accurately OBJECTIVELY MEASURE and RECORD muscle and postural responses of the mandible in establishing an occlusion before, mid and after treatment.

Many do not see the power of micro-occlusion, the importance of finding an optimal NM trajectory, starting from physiologic rest, the importance of removing mandibular torque, the importance of proprioception as it relates to the trigeminal system. These are the ingredients for an “optimal bite” many treating clinicians have been searching for to bring long term stability and success in their dentistry. Many have either over look these principles or gave up too quickly to relinquish their role of being a treating “dentist”, to other adjunctive modalities, because they did not see the connection of these points to their clinical problems. In short they got distracted from perfecting their main role of what they were licensed to do, being a dentist dealing with all the issues relating to the trigeminal nerve and THE BITE (Occlusion).

Thousands of clinicians all around the world have found that by applying these profound neuromuscular principles first that they are able to effectively get the results of some of the most challenging TMD, orthodontic and restorative patients who present with numerous musculoskeletal occlusal signs and symptoms, involving cranio-mandibular, neurovasomuscular/cervical/occlusal dysfunction.

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