Neuromuscular Dentistry

Dr. Williams is the original neuromuscular dentist in Atlanta, having learned about its significance in the 1970′s, taught it in his dental seminars in the 1980′s, and having used it on a daily basis for the past 22 years.

He lectured with: Myotronics, BioResearch, Napili, Pentegra, USDI, TMJ Framework & Framework Seminars, Quest, ICCMO in Canada, Italy and Japan, Atlanta Craniomandibular Society, Misch Implant Institute, AAID, Tennessee Cranio, Arkansas AGD, Bass Study Club in Alabama, Solstice Group, Hinmam Dental, Chicago Midwinter, Academy of General Dentistry annual session.

What is “Neuromuscular Dentistry?”

Neuromuscular dentistry differs from “traditional” dentistry in the emphasis that is placed upon the activity of the muscles that move the jaw. Unlike neuromuscular dentistry, traditional dentistry uses the position that the teeth come together and the position where the jaw joint is positioned in a joint space in the skull as a reference point to restore the teeth.

Neuromuscular dentistry recognizes that the muscles that move the jaw must be in a comfortable, relaxed position in order to not be in conflict with the teeth and joint.

Common symptoms that occur when teeth, jaws and muscles are in conflict include:

• Headaches
• Loose teeth
• Worn, chipped, or cracked teeth or fillings
• Clenching or grinding
• Ditched root grooves
• Pain or clicking and popping in joints
• Shoulder, neck, and back pain
• Numbness in arms and fingers
• Pain behind the eyes
• Facial pain
• Difficulty swallowing
• Pain and sensitivity in teeth
• Crowded teeth
• Receding gums
• Ringing or congestion in the ears

At Suwanee Dental Care, we utilize a number of computerized instruments in our practice of neuromuscular dentistry to find the position of the jaw where the jaws, teeth, and muscles operate in harmony.

The first goal of neuromuscular dentistry is to find the position of the jaw where the muscles are relaxed and at rest. This is a three dimensional position in space and is often irrespective to the position of the teeth.

We utilize devices called the BioTens (above) and the Myo-Monitor to relax the muscles. It is a low frequency T.E.N.S. (Transcutaneous Electrical Neural Stimulation) unit. This device delivers a mild electrical impulse to the muscles that move the jaw.

The rhythmic pulsing (once every 1.0 to1.5 seconds) relaxes the muscles. In addition to relaxing the muscles, it sets up ideal muscle function by increasing blood flow, flushing out toxins. We often find that after 45 minutes of stimulation, the muscles are in their ideal position.

At this point we utilize the Myotronics K-7, our computerized diagnostic equipment to record this position and transfer it to casts or models of your teeth.

The K7 Evaluation System

The K7 Evaluation System provides the dental clinician or researcher with three distinctly different technologies for measuring, displaying and storing objective data on physiologic and anatomical status and function. This objective data enhances the doctor’s diagnostic and treatment considerations with information not previously available.

The K7 Evaluation System is supplied in a compact housing that can be plugged in to the serial port of virtually any PC type computer, desktop or laptop. Small and portable, the unit and its peripheral apparatus can be quickly stored in the provided protective case for ease of transportation.

Windows based software simplifies operation and color graphics make it easy to distinguish overlapping data from multiple channels and to print attractive reports for patient education, insurance or referring doctors.

For over thirty years, Myotronics has been dedicated to strong customer support. One small example is “Kevin’s Pearls”. Registered owners of K6-I or K7 Evaluation Systems can have helpful users tips sent by e-mail every week. These tips from our head programming engineer aid customers in deriving maximum benefits from their instruments.

A number of useful testing protocols referred to as “Scans” are pre-programmed for the convenience of the user. Additional custom protocols may be programmed by the user to fulfill unique needs or preferences. The three individual modules and their capabilities are listed below.

K7/CMS Computerized Mandibular Scanner (CMS – Jaw Tracking)

Multiple sensors in an extremely light weight (four ounce) spectacle-like array, track the motion of a tiny magnet attached to the lower incisal gingiva with adhesive material. The configuration is totally non-invasive and, unlike clutches, does not interfere with patient function.

The opposing sensors are wide apart permitting unobstructed access to the oral cavity for taking bite registrations and other clinical procedures, and the system is virtually immune from effects of slight head motion or nearby metallic or electronic interference. A patient education mode is included to simplify patient understanding and staff training.

K7/EMG Eight Channel Electromyograph (EMG)

Utilizing high quality bipolar surface electrodes, EMG data can be taken from up to eight muscle sites simultaneously and in real time. The program permits taking electromyography data either at rest or in function.

All eight channels may be displayed simultaneously, for a period of 15 seconds (one visual screen width). The K7/EMG signal processing circuitry provides unsurpassed protection against system noise or motion artifact. The patient education mode permits quick and easy patient education as to status of masticatory muscles.

These scans provide an objective measurement of masticatory muscle electrical activity which accurately represents the physiologic state of rest.

Model K7/ESG Electrosonograph (ESG)

TMJ Vibration (Sound) Evaluation System. A lightweight headset holds highly sensitive vibration transducers over each TM joint, enabling simultaneous, bilateral capture of tissue vibrations emanating from joint sounds. Vibration (sound) data is correlated to vertical dimension of opening and closing, providing clinicians with valuable information to aid in assessing the status of articular disk and joint function.

The ESG includes the ability to document TM joint status through recording joint sound vibrations — simply and non-invasively.

Surface EMG

Surface EMG is the worldwide standard method for recording muscle-specific activity in skeletal muscles. It has been proven reliable in numerous studies over many years and is a clinical procedure that can easily be performed in any dental office

Once we have verified the comfortable position of the lower jaw, we can fabricate an orthotic that allows the jaw to close to this ideal position. In this position, the muscles are at an ideal length and will not go into spasm.

Muscles will heal, pain trigger points will go away, and joint capsules will heal. This orthotic is left in place for three months to stabilize the bite and insure that all symptoms are gone.

At this point a decision is made to wear the orthotic indefinitely, have orthodontics done to move the teeth to this ideal position, have one or two arches of teeth restored, or to adjust the bite to this ideal position. For more information on neuromuscular dentistry, please contact our office.

The Eight Channel Electro-myograph is used to verify that this new position results in decreased muscle activity. Muscle activity is measured by recording the amount of electrical activity in individual muscles.

NEUROMUSCULAR Bite Registration

With the K-7, the clinician records the Neuromuscular trajectory and positions the patient’s mandible along this path. The EMG can also be used with this technique to ensure that the patient’s cranio-facial musculature is relaxed in the new position.

The yellow dots on the X-Y display precisely mark the average relaxed rest position and the average peak pulse position. The orange dashed (- – -) line shows the Relaxed Pulse Trajectory in the sagittal and frontal planes. Today, it is easy to find your patient’s “neuromuscular” vertical dimension using the accurate EMG and K-7 Jaw Tracker.

These scans are invaluable three dimensional representation of mandibular rest, the relaxed neuromuscular path of closure, centric occlusion, habitual path of closure and protrusive guidance that allows the clinician to record an optimal occlusal position.