Neuromuscular Dentistry and ICCMO: Barny Jankelson the Founder of Neuromuscular Dentistry founded ICCMO with the other great names of Neuromuscular Dentistry.

Neuromuscular Dentistry is one of the most powerful tools for treating TMJ, TMD and other CranioMandibular disorders tied to Chronic Headaches and Migraines.  If you are lookng for a Neuromuscular Dentist your first resource should be ICCMO, The International College of CranioMandibular Orthopedics.

The website of ICCMO has a "find a neuromuscular dentist" tab in the patients area.  I strongly reccomend that if you are looking for a Neuromuscular Dentist that you begin at the ICCMO website.  http://occlusiontmjauthority.com

Learn how neuromuscular dnetistry can treat a wide variety of TMJ disorders at the ICCMO site.

What is Neuromuscular Dentistry? How do I Find a Neuromuscular Dentist

WHAT IS NEUROMUSCULAR DENTISTRY?

If you are looking for a Neuromuscular Dentist dedicaed to the art and science of the field I strongly suggest a member of the International College of CranioMandibular Orthopedics (ICCMO) at their website
http://occlusiontmjauthority.com. That site has an extensive educational area for patients that is continually being updated.

My description of What is Neuromuscular Dentistry that was originally written for the American Equilibration Society and republished in the ICCMO anthology and by Sleep and Health Journal is considered one of the most succint and easy to understand descrptions of the basic principles of Neuromuscular Dentistry.  http://www.sleepandhealth.com/neuromuscular-dentistry

Neuromuscular Dentistry or NMD is a field of medicine and dentistry based on the work of Barney Jakelson.  There are many greats in the field including Norman Thomas BDS, PhD, Barry Cooper, Jim Geary and Barney Jankelson's son Bob Jankelson who wrote the tesxtbook on Neuromuscular Dentistry.  The International College of CranioMandibular Orthopedics is the organization devoted to the field of Neuromuscular Dentistry and is universalIy acknowledged as the primary organization representing Neuromuscular Dentistry.  There is an American Section of ICCMO representing Neuromuscular Dentists in North America, There is a South American ICCMO based in Argentina, There are large ICCMO chapters in Japa, Germany and a newly organized group in Russia. I have personally been working in the field of Neuromuscular Dentistry for over 35 years.been working in the field of Neuromuscular Dentistry for 35 years.

Dr Janet Travell famed for her work with Myofascial Pain and Dysfunction described in detail in her textbook the mechanism of trigger points, taut bands and myofascial pain.  She lectured at meetings in conjunction with ICCMO and much of her work is directly related to Neuromuscular Dentistry.  Her descriptions of how trigger points form is directly addressed by Neuromuscular Dentistry.


Neuromuscular Dentistry is the most physiological based approach to dentistry and treatment of TMJ disorders, TMD, Migraines, and  headaches.  There is more to Neuromuscular Dentistry than teeth, bones and joints which is where most of dentistry focuses.  Neuromuscular Dentistry looks at the entire nervous system including the parasympathetic and sympathetic portins of the autonomic nervous system and closely looks at physiological aspects of the somatic nervous system.  The stomatognathic must look beyond the jaws and teeth and look at how this interacts with the entire body.

Posture is a primary function of the masticatory system that is ignored by most of dentistry.  Airway maintenance is another  primary function of the the masticatory apparatus and associated systems. The Quadrant Theorem of Guzay explains from a mechanical engineering view how the TMJoint and head posture and the Atlas and Axis vertebrae interact.

Neuromuscular Dentistry utilizes objective data to measure how function and physiology work together.  Neuromuscular Dentistry utolizes EMG to measure muscle physiology and function (dysfunction).  The use of Ultra Low Frequency TENS in Neuromuscular Dentistry to create relax musculature was not discovered by Dr Barney Jankelson but was found during basic science research.  The genius of Dr Jankelson was utilizing it to relax the trigeminally innervated muscles that move the jaws.

The utilization of the Mandibular Kinesiograph now called computerized Mandibular Scans allow careful evaluation of jaw function is three dimensions in real time or in slow motion.  There are two companies that make equipment for Neuromuscular Dentists, Myotronics the company founded by Barney Jnkelson and BioResearch who also manufactures equipment for Neuromuscular Dentists.

http://www.sleepandhealth.com/neuromuscular-dentistry

Chicago area patients should visit my www.thinkbetterlife.com for more information

The Las Vegas Institute (LVI)  utilizes Neuromuscular Dentistry as the basis for its educational programs. I strongly suggest finding LVI dentists who are also members of ICCMO.   It is important to understand that not all LVI dentists are Neuromuscular Dentists.

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The Aqualizer Appliance, Neuromuscular Dentistry and Muscle Engrams

An important new article on Muscle Engrams was published in the October Cranio Journal (pubmed abstract follows).

This paper was written by my good friend and respected colleague Dr Martin Lerman who is also the inventor of the Aqualizer appliance. Dr Lerman has proven that the muscle engrams of neuromuscular dentistry as described by Dr Barney Jankelson exist. While Dr Jankelson utilized ULF TENS (ultra low frequency trancutaneous electrical neurostimulation) to eliminate the muscle activity of the Engram Dr Lerman utilizes an Aqualizer Appliance.

An interesting side note is that Dr Jankelson used to use Aqualizers with his patients on TENS prior to taking a bite. The Engram is the way the body masquerades bite discrepancies by correction thru conditioned muscle reflex. As Dr Lerman clearly shows eliminating the Engram is an essential step evaluating underlying neuromuscular bite discrepancies. The Aqualizer which utilizes Pascal's third law balances pressure bilaterally by fluid dynamics. Pitch Roll and Yaw are corrected.

Patients with TMJ disorders, headaches, facial pain, masticatory muscle pain or neck pain will all find that Engrams are an obstacle to healing. Elimination of the Engram and correction of the (engram free) bite will lead to healing and elimination of pain.

This is an important article and I will discuss it in more detail in the future.

Elimination of headaches, Migraines and facial pain by identifying and bypassing Engrams is the heart of Neuromuscular Dentistry. Read more about Neuromuscular Dentistry in Sleep and Health Journal online @

http://www.sleepandhealth.com/neuromuscular-dentistry

Cranio. 2011 Oct;29(4):297-303.

The muscle engram: the reflex that limits conventional occlusal treatment.

Lerman MD.

Source

Jumar Corporation, Prescott, Arizona, USA. lesboblyn@aol.com

Abstract

The engram (the masticatory "muscle memory") is shown to be a conditionable reflex whose muscle conditioning lasts less than two minutes, far shorter than previously thought. This reflex, reinforced and stored in the masticatory muscles at every swallow, adjusts masticatory muscle activity to guide the lower arch unerringly into its ICP. These muscle adjustments compensate for the continually changing intemal and external factors that affect the mandible's entry into the ICP. A simple quick experiment described in this article isolates the engram, enabling the reader to see its action clearly for the first time. It is urged that every reader perform this experiment. This experiment shows how the engram, by hiding the masticatory muscles' reaction (the hit-and-slide), limits the success of the therapist in achieving occlusion-muscle compatibility. This finding has major clinical implications. It means that, as regards the muscle aspect of treating occlusion, the dentist treating occlusion conventionally is working blind, a situation the neuromuscular school of occlusal thought seeks to correct. The controversy over occlusion continues.

Relief of 30 years of constant Headache: Brief relief may provide clue to long term relief.

KEN:I Have had headaches for 30 years going away only once when having a root canal done on an upper tooth. While everything was numbed up I had complete brain function and no headache. They are located directly behind my nose area and I feel a constant pressure.

Dr Shapira response: The anaesthetic relieved the pain probably confirming that it is from the trigeminal nerve. I would be very interested is a spenopalatine ganglion block could give more long term relief. It is a easy procedure that I have taught patients to do at home with a q-tip and anaesthetic thru the nose. There are also other diagnostic blocks that can be done to determine the cause of your headaches.

A diagnostic neuromuscular orthotic would be an excellent first step in treatment. If the headaches are eliminated or significantly relieved a permenant stabilization could be done. I have referred you to an excellent Dr who knows both of the procedures mentioned.

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.

Neuromuscular Dentistry, Neuromuscular orthotics, Neuromuscular Reconstruction all work by removing impediments to healing.

To understand Neuromuscular Dentistry you need to recognize the difference between ideal health,absence of overt disease and the presence of TMD symptoms including Migraines, Tension Type Headaches, Chronic Daily Headaches, Facial Pain, Sinus Pain and/or sinus headaches, temporal headaches, morning heaaches and hundreds of other symptoms of TMD (temporomandibular disorders).

We all recognize when we do not fel well but often we are subject to sub-clinical disease where there are neuromuscular adaptations that allow us to cover-up most symptoms but are still far from ideal health.

Is health the absence of Illness or is it optimum health a state where our physiological and anotomical processes function at their best.

The real beauty of Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) is that it produces idealized physiology of the trigeminal nervous sytem and idealization of the posture of the patient. Posturology is the science of ideal posture, Neuromuscular Dentistry combines idealized posture, physiology and neural function.

What is a diagnostic Neuromuscular Orthotic? A diagnostic orthotic allows the application of Neuromuscular Dentistry to idealize a three dimensional relation of the cranium to the mandible. Idealizing this relation starts a process of healing and postural corrections. The diagnostic orthotic is adjuste to match healing throughout the body. This is not magic though many patients report pain relief that seems magical.

In reality as we remove impediments to healing, the body heals itself. This is what holistic medicine and/or anti-aging medicine is about. Creation of a internal environment that idealies internal physiological processes. A Neuromuscular Reconstruction is a long term solution to long term stabilizing of the most important joints and systems in the body.

The trigeminal nerve is responsible for maintaining nutrition and respiration both necessary for life. The trigeminal nerve also is key to communication and central to romance and interpersonal relations. The trigeminal nervous system is key to almost all measures of health due to its autonomic functions and control of blood flow to the brain.

Wikipedia defines Neuromuscular Dentistry based on symptoms rather than underlying science. The current Wikpedia definitions are reproduced below. In future blogs I will point out shortcomings to these definitions.

"Neuromuscular dentistry is a dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry claims that "misalignment problem(s)" can be corrected by understanding the relationships of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion.
Symptoms of temporomandibular joint disorder (TMD) are claimed to include:
Headaches / migraines
Facial pain
Back, neck and shoulder pain
Tinnitus (ringing in the ears)
Vertigo (dizziness)
Trigeminal neuralgia (tic douloureux), a neuropathic pain disorder unrelated to TMD
Bell's Palsy, a nerve disorder unrelated to TMD
Sensitive and sore teeth
Jaw pain
Limited jaw movement or locking jaw
Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
Worn or cracked teeth
Clicking or popping in the jaw joints
Jaw joint pain
Clenching/bruxing
Tender sensitive teeth
Trigeminal sensitization of the brain and related Fibromyalgia
A limited opening or inability to open the mouth comfortably
Deviation of the jaw to one side
The jaw locking open or closed
Postural problems (forward head posture) Forward head posture is actually forward neck posture with rotation of the occiput an the atlas.
Torticollis
Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
Pain in the muscles surrounding the temporomandibular joints
Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
Pain behind the eyes
Swelling on the side of the face and/or mouth
A bite that feels uncomfortable, "off," or as if it is continually changing
Older Bells palsy
The basic premise of Neuromuscular Dentistry is to find a rest position that when the patient closes their mouth to swallow the muscle will return to a healthy rest position. There should be no muscle accomadation necessary to go from rest to Myocentric position. The Trigeminal Nerve is paramount in attaining this position. Swallowing is a neuromuscular resetting mechanism. A more complete explanation of the science behind Neuromuscular Dentistry is found in Sleep and Health Journal, and was originally published by the American Equilibration society. http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG) and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording. [citation needed]
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3-6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Because of the additional training needed and the complex computer systems and hardware required, neuromuscular dentistry is more expensive than conventional dentistry. The costs can range from $3,500 to $25,000 for usually four to six months, and up to one year or more of treatment for complex cases. (This does not include any additional orthodontics or restorative treatment)."