Full Mouth Neuromuscular Reconstruction: Planning and Execution is essential for success.

This was originally a Google +  Post.  Due to an incredible response from viewers of that post I decided to repost with comments on the I Hate Headaches site.

A full mouth reconstruction is the ultimate in dentistry but it can also be a patient's worst nightmare.

The relation of the jaw to the head affects and is affected by the entire body. Ideally a full mouth reconstruction is done to physiologically healthy muscles joints breathing and function.

This video is of a patient who started with a single quadrant of crowns that morphed into a non-physiologic reconstruction. I saw him after three reconstructions of his entire mouth to treat his symptoms. The first was a Centric Relation Reconstruction and the second two were Neuromuscular Reconstruction. His final reconstruction was done well but failed to resolve many issues.
I did not do any of these reconstructions but worked to idealize his current restorations. These two videos describe a small part of the difficult journey this patient has travelled.

Correcting physiological issues should be done at the start of a case. This patient did not go looking for a full mouth reconstruction but fell into it.

It is unfortunate that a fabulous person and excellent physician fell into a trap not of his making.


https://www.youtube.com/watch?v=YxPB8eso5pg

https://www.youtube.com/watch?v=RaRqa2akLMA

Additional patient videos:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

The reason there are so many issues with full mouth reconstruction is that many dentists, even etremely wel educated and proficient dentists do not understand the importance of head posture on their treatment.  Many take bites and do adjustments with the patient reclined in the dental chair.

The Quadrant Theorem of Guzay is extremely important to dentists because it explains in engineering terms how the center of jaw rotation is not in the TMJoint.  Rather, it is on the Dens process of the second vertebrae (Axis) that passes thru the first cervical vertebrae (atlas).
This is because the TMJoints acting together go thru two distinct movements rotation and translation.  These movements alwys happen simultaneously and there is no time during normal function in which pure rotation occurs.
The concepts of Centric Relation's approach to occlusion is that it is found by the dentist moving the patients jaw in a pure rotation at a border position of the joint.

The usefulness is that it is easy to transfer this information to the dental laboratory.  The problem is it is not a physiologic position and in fact the most dangerous position for all joints is in border positions.   Patients don't funtion there.

The use of TENS in  Neuromuscular Dentistry is to take the muscles to a healthy relaxed state.  This creates a three dimensional relation between the cranium (head) and mandible (lower jaw).

This relation changes when the head position changes.  It is vital to evaluate the bite in upright sitting and standing positions.  This also means that you cannot ignore the rest of the body when doing a full mouth reconstruction without risk of long term instability.


Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
Member, Academy of Cosmetic Dentistry
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org


#fullmouthrecostruction #fullmouthneuromuscular #oralreconstruction #problemswithfullmouthreconstructions #disasterswithfullmouthreconstructions #fullmouthCRRecostruction #avoidingproblemswithfullmouthreconstructions #centricrelationfullmouthreconstruction #failedCRfullmouthrecosnstruction
#CentricRelationReconstruction #fullmouthreconstructiondisaster
#ChicagoFullMouthReconstruction #HighlandParkFullMouthReconstruction
#NewYorkFullMouthReconstruction #costfullmouthreconstruction #fullmouthreconstructionsteps #verticaldimension #verticaldimensionofocclusion

POSTUROLOGY , FORWARD HEAD POSITION, SLEEP APNEA AND TMJ (TMD) DISORDERS

POSTUROLOGY BRINGS TOGETHER OF OF THE GROUPS WHO WORK WITH MUSCLES, BONES, JOINTS, POSTURE, BITES, LEGS AND FEET. CHIROPRACTERS, OSTEOPATHS, DENTISTS, MASSAGE THERAPISTS, EXERCISE THERAPISTS AND OTHER THAT DO MANUAL BODY WORK MEET ON COMMON GROUND.

WHAT MANY OF THESE OTHER SPECIALTIES MISS THAT IS WELL UNDERSTOOD BY NEUROMUSCULAR DENTISTS IS THE IMPORTANCE OF AIRWAY AND BREATHING DURING WAKING HOURS AND DURING SLEEP.

PARADOXICAL BREATHING DESTROYS NORMAL POSTURE AS DOES A DEVIATE SWALLOW. THESE SAME PATIENTS FREQUENTLY HAVE SNORING AND SLEEP APNEA DURING THE NIGHT.

POSTUROLOGY AND BREATHING CORRECTLY DURING SLEE AND AWAKE HOURS CAN HAVE AN INCREDIBLY POWERFUL EFFECT ON OVERALL HEALTH.

CHECK OUT MY I HATE CPAP.COM SITE TO UNDERSTAND HOW TMJ AND BREATHING ARE INTIMATELY CONNECTED.

POSTUROLOGY AND TMD (TMJ) DISORDERS: WHY THIS IS IMPORTANT TO PATIENTS WITH CHRONIC DAILY HEADACHES, MIGRAINES AND TENSION-TYPE HEADACHES.

THE JAW IS ESSENTIAL IN THE REGULATION OF NORMAL BODY POSTURE. THE SWALLOW SERVES AS A NEUROMUSCULAR RESETTING MECHANISM THAT CAN CORRECT OR CAUSE POSTURAL PROBLEMS THROUGHOUT THE ENTIRE BODY.

THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.

THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.

IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.

THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.

ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"

UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.

NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.

THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,

THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.

FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.

THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.

Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.

PMID: 16128357 [PubMed - indexed for MEDLINE]

TMJ disorders, headaches and facial pain frequently involve cervical musculature. Acute pain relief is accomplished with cervical muscle injection

An article (pubmed abstract below) in the Journal of Orofacial Pain. "Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients." dicusses the use of cevical intramuscular injections to turn off acute pain in the ER. The study showed that 94% of patients had complete of partial relief with injection of a long acting anaesthetic.

There is a connection between the jaw and the neck that is incredibly important in the treatment of muscular headaches, facial pain, migraines, chronic daily headaches and TMJ disorders (TMD). The jaw acts as a counter-balance to the head and allows maintenance of head posture minimal excessive muscle adaptation. This is well described mathematically in engineering terms in the "Quadrant Theorem of Guzay". The jaw position is vital to body posture and abberations in jaw position can act as a descending disorder that can effect the entire body.

Forward head posture is frequently seen in TMJ and Headache patients. This forward posture cause exponential increases in muscle work just to maintain head posture.

Rcobado estimated that it takes double the muscle work from cervical muscles to low back for every centimeter of forward head posture, Three centimeters forward head posture would increase chronic muscle adaptation 8 fold (2X2X2=8) while a 5 centimeter forward head posture would increase it 32 times (2X2X2X2X2=32). The reason muscular injections work so well in relieving acute and chronic headaches and facial pain is that these muscles are grossly overworked in TMD patients.

Treating the muscles can give relief of acute pain but returning the system to a more normal physiologic state can give long term relief to patients.

A diagnostic neuromuscular orthotic allows the jaw to function in an ideal physiologic position. This allows gradual restoration of normal head posture and a return to normal physiologic function of the neck. I work closely with Atlas Orthogonal and/or NUCCA Chiropracters to correct the first two vertebrae early in treatment. These areas are especially prone to problems in TMD patients. As the foward head posture occurs the patient must rotate their head on the Atlas and Axis (first to vertebrae) to maintain sight lines. This is well explained by the Quadrant Theorem of Guzay which shows that the actual center of rotation for the jaw when both rotation and traslation movements are calculated is on the odontoid process of the Axis (2nd vertebrae)

Patients with TMD who are in car accidents never recover fully if their jaw issues are not addressed.

Posturology is the study of whole body posture. Posturology recognizes the importance of the jaw position. The normal swallow is a neuromuscular resetting procedure but most TMD patients have deviant or reversed swallows and are not even aware they swallow wrong. This can lead to GI problems but is primarily a structural problems that makes long term successful treatment of pain impossible without correction of neuromuscular jaw issues. A diagnostic orthotic allows patients to experience relief of head and neck pain prior to and permenant occlusal alterations.


J Orofac Pain. 2008 Winter;22(1):57-64.
Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients.
Mellick LB, Mellick GA.
Source
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA. lmellick@mcg.edu
Abstract
AIMS:
To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.

METHODS:
A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.

RESULTS:
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.

CONCLUSION:
This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.

Headaches and TMJ Disorders are related to whole body health.

A new article in Practical Pain Management "Head and Neck: Kinetic Chain from the Toes Influences the Craniofacial Region " discusses the kinetic chain and how what happens in the body effects the craniofacial region and how jaw problems, bite stability and joint stability influences the entire body as well. These postural changes are a major cause of Tension-type headaches, neck pain and other types of myalgias.

The field of Posturology is how our posture affects the entire body. Posture includes how we stand, sit, lay down, sleep, work out and more. If we overwork muscles we can cause repetitive strain injuries that lead to myofascial pain and dysfunction.

There are three set points in the body that serve as neuromuscular resetting mechanisms. The teeth when we bite and swallow, our hips when we sit and our feet-legs-hips when we stand.

A second article in the Clinical Journal Pain. 2010 Aug 20. "The Influence of Cranio-cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients With Myofascial Temporomandibular Pain Disorders." found that their data "supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures." The trigeminal nociceptive system is integral in almost all chronic headaches and migraines. (abstract below)

Another recent article "Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects" in Oral Surg Oral Med Oral Pathol Oral Radiol looks at the posture of violinists and how it affects TM Joint stability and symptoms. This is a special case of postural distortion. (abstract below)

Head and Neck: Kinetic Chain from the Toes Influences the Craniofacial Region
Practical Pain Management, 08/04/2010
Rubenstein D – This article on plantar toe flexion and the kinetic chain is very interesting and offers an insight that may play a clinical role in diagnosis of TMJ and facial pain of kinetic postural and muscular origin. It serves to demonstrate that the TMJ and cervico/mandibular regions are both influencers of, and are influenced by, postural stresses, degenerative changes and dysfunctions that are often unrecognized by pain management clinicians.

Clin J Pain. 2010 Aug 20. [Epub ahead of print]
The Influence of Cranio-cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients With Myofascial Temporomandibular Pain Disorders.
La Touche R, París-Alemany A, von Piekartz H, Mannheimer JS, Fernández-Carnero J, Rocabado M.

*School of Health Science, Department of Physical Therapy daggerGroup for Musculoskeletal Pain and Motor Control Clinical Research double daggerOrofacial Pain Unit of the Policlínica Universitaria, Universidad Europea de Madrid, Villaviciosa de Odón paragraph signDepartment of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain section signFaculty of Business, Management and Social Science, University of Applied Science Osnabrück, Osnabrück, Germany parallelProgram in Physical Therapy, Columbia University, New York, NY musical sharpSchool of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile.
Abstract
OBJECTIVE: The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular disorders pain.

MATERIALS AND METHODS: A total of 29 patients (19 females and 10 males) with myofascial temporomandibular disorders pain participated in the study, aged 19 to 59 years (mean years+/-SD; 34.69+/-10.83 y). MMO and the PPT (on the right side) of patients in neutral, retracted, and forward head postures were measured. A 1-way repeated measures analysis of variance followed by 3 pair-wise comparisons were used to determine differences.

RESULTS: Comparisons indicated significant differences in PPT at 3 points within the trigeminal innervated musculature [masseter (M1 and M2) and anterior temporalis (T1)] among the 3 head postures [M1 (F=117.78; P<0.001), M2 (F=129.04; P<0.001), and T1 (F=195.44; P<0.001)]. There were also significant differences in MMO among the 3 head postures (F=208.06; P<0.001). The intrarater reliability on a given day-to-day basis was good with the interclass correlation coefficient ranging from 0.89 to 0.94 and 0.92 to 0.94 for PPT and MMO, respectively, among the different head postures.

CONCLUSIONS: The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.

PMID: 20733480 [PubMed - as supplied by publisher]

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan;109(1):e15-9.
Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects.
Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A.

TMD and Orofacial Pain Unit, Faculty of Medicine and Odontology, University of Murcia, Murcia, Spain. fcojavier@um.es
Abstract
OBJECTIVE: The aim of this study was to determine if there is an association between violin playing and the presence of signs and symptoms of temporomandibular disorder (TMD).

STUDY DESIGN: We studied a group of violinists in the Murcia region of Spain, who were examined for TMD. The results were compared with those from a random control group who did not play any musical instrument. The groups were matched by age and gender. Statistical analysis was carried out using SPSS 15.0 statistical software.

RESULTS: Compared with the control subjects, the violinists as a group had significantly more pain in maximum mouth opening (P < .005), parafunctional habits (P = .001), and occurrence of temporomandibular joint sounds (P < .005) as determined by chi-squared.

CONCLUSIONS: Violin playing appears to be a factor associated with TMD-related findings.

PMID: 20123363 [PubMed - indexed for MEDLINE]

NEUROMUSCULAR DENTISTRY: FIND A NEUROMUSCULAR DENTIST

NEUROMUSCULAR DENTISTRY is an exciting field not only about teeth, jaws and jaw joints but intimately involved with neurology, orthopedics, rehabilitative medicine, physiatry otolaryngology and osteopathic medicine. Patients who can benefit from Neuromuscular Dentistry cover almost every field of medicine.

Headaches are especially well suited to treatment by Neuromuscular Dental proceedures. A wide varienty of headaches may respond well to the first step of Neuromuscular Dental treatment, the Neuromuscular Diagnostic Orthotic. Patients with Classical Migraine, Atypical Migraine, Opthalmic Migraines, and Chronic Daily Migraine all frequently respond well to Neuromuscular Dental Treatment due to the connections to the Trigeminal Nervous System. Almost 100% of all types of Migraines are in full or in part mediated by the Trigeminal Nervous System and are therefore amenable to treatment with a Neuromuscular Dental Orthotic. A Neuromuscular Dental Orthotic is designed to decrease pathologic accomadation of the trigeminal neuromuscular system to decrease nociceptive input to the central nervous system. This nociceptive input is actually the bodies attempt to correct physical malalignment of the masticatory system. This results not only in central nervous system overload of the trigeminal system but also to repetitive strain injuries to the piostural muscles of the head and neck.

Muscle Spasm Headaches, Tension-Type Headaches, Chronic Daily Headaches, Cervically referred headaches (cervicalgia), Muscle Tension Headaches and headaches secondary to Myofascial Pain and Dysfunction Synrome are all examples of repetitive muscle strain disorders that result in headaches that are always upsetting and often disabling but fortunately these headaches almost always respond to Neuromuscular Dentistry. The Neuromuscular Dental treatment always begins by using an Ultra-Low Frequency TENS (transcutaneous electrical neurostimulation) to relax the muscles by utilizing anti -dromic impulses and by pumping waste products out of the muscles and allowing nutrients in to allow the natural (holistic) relaxation of the muscles. Once a TENS treatment has created a healthier state in the muscles and nervous tissues a diagnostic testing work-up utilizing EMG (electromyography) and MKG or CMS (madibular kinesiograph or computerized mandibular scan) is utilized to identify the ideal mandibular (lower jaw) position for healthy functioning of the cervical and jaw musculature and healthy postural position. This correction is achieve with a Diagnostic Neuromuscular Orthotic.

AND THEN THE MAGIC BEGINS!

The changes are not magical but often they seem that way to patients who have suffered from years of chronic pain and dysfunction. "Suffer No More: Dealing with the Great Imposter"
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor is an excellent article in Sleep and Health Journal that explains a few of the consequences of TMJ disorders and compromisd Neuromuscular functioning. There is anthother article http://www.sleepandhealth.com/neuromuscular-dentistry in Sleep and Health Journal that explains the scientific basis of Neuromuscular Dentistry.

The Diagnostic Orthotic of Neuromuscular Dentistry corrects the underlying pathology that has created muscle pathology and neuromuscular nociception. When the underlying pathology is eliminated the body "naturally heals" itself. The return to healthy homeostasis is a basic premise of Neuromuscular Dentistry as originally described by Dr Barney Jankelson. Dr "J" as he was affectionally known was a prosthodontist who drastically change the field of entistry by using healthy physiology as a basis for treatment instead of the outdated mechanistic theory of centric relation. Centric Relation actually has over 26 different definitions as old theory was adapted to new scientific facts and measurements. The definition of Centric Relation has little to do with healthy physiology and a lot to do with transferring information to an articulator for labratory procedures.

Orthopedic corrections of forward head position thru Neuromuscular Dentistry is n incredibly complex physiologic process that ocurs quickly after placing a neuromuscular diagnostic orthotic. The Quadrant Theorem of Guzay explains much of the complex changes that occur. The size of the airway also has a lot to do with correction of forward neck posture. Patients with compromised airways assume a forward neck posture with rotation of the atlas/ occipital and axis to maintain an open airway. It is this complex relationship that led the NHLBI (NTIONAL HEART LUNG AND BLOOD INSTITUTE) to release the report "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS".

Chronic muscle pain, Fibromyalgia, Myofascial Pain and Dysfunction and numerous other chronic muscle problems relate to sleep disorders as outlined in that report.

ENT symptoms including Ear Aches, Otalgia, Eustacian Tube Dysfunction, stuffy ears, clicking and popping noises in the ears, dizziness and equilibrium problems are frequently secondary to these muscle problems. These problems are also closely related to abnormal jaw function and neuromuscular dental disorders.

Sleep disorders and Neuromuscular Dentistry are intimately related and are a major cause of morning headaches.

New Developments in Migraine Treatment and how they relate to Neuromuscular Dentistry and Posturology

A recent article in Current Opinions in Neurology reviewed Migraine treatments. While it mentioned the use of medications such as Botox (onabotulinum toxin type A), triptans , Topiramate, gabapentin, petasites and tizanidine and a new nasal form of dihydroergotamine it also discussed risk factors associated with Temporo-mandibular (TMJ, TMD) disorders, sleep apnea and treatments like occipital nerve stimulators.

These are important aspects of Neuromuscular Dentistry which utilizes ultra-low frequency TENS to stimulate the Cranial Nerves V, VII and XI. This would create effects on occipital nerves as well. The use of Botox on cranial muscles shows that they are responsible for many migraines. Reducing pathological muscle activity is relatively easy utilizing a neuromuscular diagnostic orthotic. The occipital muscles respond to postural changes in the head position that have been well described by the Quadrant Theorem of Guzay. NUCCA and A/O (atlas Orthogonal) chiropractic are both extremely effective with chronic daily headaches and migraines however the adjustments do not hold without neuromuscular correction of the jaw position.

The use of medications to treat migraines is essential for some patients but the same therapeutic changes in brain chemistry can be accomplished for many patients by changing neural input to the brain via the Trigeminal nerve which (dentist's nerve) which also controls vascular headaches thru control of blood flow to the anterior two thirds of the meninges. The primary control of vascular flow to the brain is always affected by the health of the stomatognathic system. The blood flow to the brain from the internal carotid is also indirectly affected by jaw position and its effects on head posture and carotid blood flow.

The blood flow to the brain is provided by "The circle of Willis (also called the cerebral arterial circle, arterial circle of Willis or Willis Polygon) is a circle of arteries that supply blood to the brain. It is named after Thomas Willis (1621–1673), an English physician" (from Wikipedia) The arteries are "The circle of Willis comprises the following arteries:[2]
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)" and also the basilar artery and middle cerebral arteries, though they supply the brain, are not considered part of the circle of Willis. All of these are directly controlled by the Trigeminal Nerves or indirectly affected by head posture.

Neurologists agree that nearly all chronic daily headaches and migraines are controlled to a large extent by the Trigeminal Nerve. Correction of pathology in the oral systems changes the input to the brain and corrects autonomic functioning.

This study (below) qualifies TMD as risk factors but does not delve into how EMG spectral analysis of masticatory muscles could be used to define in a quantitative manner risks of migraines and chronic daily headaches.

Posturology may be considered a new field that combines and correlates many different specialties.

As defined by Wikipedia:
"Posturology is the scientific study of posture.
Posturology science involves comprehensive knowledge within every scientific specialization dealing with motor system as:
- biomechanics
- neurology
- antropology
- empbriology
And a good theoric and clinic knowledge of every function and aspect of anatomy that may directly or indirectly interface with motor system:
- otorhinolaringology
- dentistry
- angiology
- endocrinology
Posturology may take advantage of all instrumental resources that are already in use among those specialties but requires new protocols of measurement to be prototyped for either research and clinical use.
Posturology is aimed at setting up new evaluation methods to provide multi dimensional model of posture and it's variables, not neglecting resoureces such as patient's collaboration which, with adeguate rigour, may take advantage of the most accurate afference processing system: the patient's brain.
Posture is nowadays a challenge for scientific society as the discipline-oriented-approach of medicine organization does not comply with the functional-model of posture: a motor function implementation requires interdisciplinary perspective to be thoroughly evaluated and, so far, medicine does not provide a single figure with multi discipline skill.
Given the absence of scientific society interest in posture and the presence of obscure posturologist professionals, posturology is way far from from yielding scientific results, moreover, the current lack of scientific knowledge of posture and the growing ascertainment of relationship between diffused social deseases and the postural disorder, makes posturology research demand much more urgent than posturology clinic demand.
Posturology specialization, at present, is not scientifically aknowledged, but, if appropriately conceived, not only might overcome the lack of overview of the current scientific discipline-model approach but is the only way to provide the required functional-model approach to scientific research." (end wikipedia quote)


The following is taken from the posturology (http://www.posturology.eu/pages/acc2.htm) website:
"" What is responsible for these pathologies : the system thrown out-of-tune by the abnormal information signals it receives from the peripheral sensors : feet, eyes, teeth, skin etc.

The aim of posturology is to provide a treatment no longer based on the symptoms (pains) but on the causes, and one of reprogramming those out-of-tune sensors in the system.

The latest neurological research has shown that the control of the body’s spatial equilibrium does not depend exclusively on the internal ear, as was believed for a long time, but also on other sensors of the system, of which the feet and the eyes are the most important.

GOOD FEET, GOOD EYES

...These two elements constitute the primary inputs of the system, any disturbance due to ground-contact or of optical origin will have repercussions on the postural ensemble. These sensors being out-of-tune is extremely frequent, and most of the time is present without being noticed.

While feet and eyes provide the principal and most frequently encountered causes, there are others too that give rise to postural imbalance : certain types of scars, the manducatory system (teeth, muscles and articulations), the muscles etc.

GOOD TEETH ARE IMPORTANT

...Another neglected component of the sensorial system is the teeth, muscles and jaw articulation. Bad dental occlusion gives rise to neck-aches, head pains, dizziness, buzzing and evening and morning aches and pains."

The Sleep and Health Journal article on Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) explains many of the postural connections between the teeth, jaws, perioontal ligaments and how they ultimately effect and change total body function.

Curr Opin Neurol. 2010 Jun;23(3):254-8.
New therapeutic developments in chronic migraine.
Lovell BV, Marmura MJ.

Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. loveb9@gmail.com
Abstract
PURPOSE OF REVIEW: Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology. RECENT FINDINGS: Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. SUMMARY: This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.

PMID: 20442572 [PubMed - in process]