Neuromuscular Dentistry/ Facial Pain Cure

The Holistic approach to pain relief

Neuromuscular dentistry is the holistic approach of creating a balance between teeth, gums, facial muscles, nerves and temperomandibular joint (TMJ), whereas traditional dentistry focuses only on the teeth and gums. The main objective of neuromuscular dentistry is to correct the alignment of the jaws in co-ordination with the teeth and jaw muscles, in order to maintain the proper functioning of the oral cavity(swallowing, breathing and chewing).

The jaws are kept in the most comfortable position, which helps to relieve the temperomandibular joint (TMJ) pain and the facial pain.

How does a problem in the oral cavity lead to neuromuscular pain elsewhere in the body?

Stress, mutilated occlusion, improper bite, sleep disorders along with asymmetrical usage of muscles(chewing on only one side) may lead to change in the jaw position (TMJ). This in turn alters the seating of the skull in the cervical vertebrae leading to spasm and pain radiating through the neck, shoulder, back, hip muscle and the calf muscles in the leg.   Neuromuscular dentistry ensures and manages the functions of the jaws in correlation with skull positions and orienting the skull positions to the entire body. 

How does chewing on only one side affect the body posture?

Chewing on only one side can lead the teeth to migrate and form cant(tilt)  in the occlusal plane. This leads to pain in the muscles of chewing. These small groups of muscles of chewing, in turn, have a strain on the larger group of muscles that is neck and shoulder muscles (sternocleidomastoid muscles and trapezius muscles). .Both these large muscles are involved in positioning the skull and the lower jaw to the cervical vertebrae. 

Changes in postures and disorientation can cause pain in the neck, shoulder, L4, and L5 (center of the body), sciatic muscles, leg, and foot.

Neuro muscular orthodontist  can help provide coordination between the joints, muscles, teeth orientation by correcting the bite and making the patient chew bilaterally. With this, the teeth position will be made stable, and body posture is improved and pain will be relieved.

What are the symptoms of neuromuscular / oro facial pain?

• Neuromuscular disorders manifest as sprain or muscle stiffness anywhere in the body.
• Jaw pain/ temperomandibular joint pain
• Clicking or popping sound in the jaw joint 
• Difficulty in mouth opening
• Ringing in the ears (tinnitus)
• Headaches and migraine
• Neck pain
• Shoulder pain
• Numbness in the fingers
• Back pain (L4,L5)
• Sciatic pain
• Leg pain

Smile and glow diagnostic protocol for Neuromuscular disorder

• Detailed case history taking
• Clinical examination
  • Intra oral and extraoral examination
  • Postural examination
• Intra oral and extra oral photos
• Radiology
  • Full mouth x-ray (OPG)
  • Lateral Cephalogram
  • TMJ view (open and close, right and left)
  • Airway CBCT 3D Volumetry
  • MRI scan
  • Whole body scan
• Sleep study (HST –Home Sleep test or PSG – Polysomnograph)
• Equipment such as Ultra Low-Frequency Transcutaneous Electrical Neural Stimulation (ULF-TENS),  jaw tracker, and MAT Scan will be used to diagnose the exact problem.

T-Scan(Digital occlusal analysis)

Almost all dental procedures performed have an impact on occlusion(bite). A bad bite can adversely affect the quality of life of the patient. T-Scan is a device  that helps to analyse the bite precisely and reveals the amount and timing of force on individual teeth and the occlusal stability of the overall bite. 

Transcutaneous Electrical Nerve Stimulation (TENS) 

Ultra low frequency Transcutaneous electrical nerve stimulation is a technique to relieve pain using an electrical current. Low-voltage electrical impulses are sent to a particular nerve through electrodes placed on the skin.

Functions of the TENS machine

• Helps to relax the muscles of chewing 
• They prevent the pain signals from reaching the brain.
• They help in the production of endorphins (natural painkillers).
• They improve blood circulation.

After the muscles are relaxed using the TENS machine, the actual jaw position is recorded.

Neuromuscular disorders can be classified as 

• TMD (Temporal Mandibular Disorder)
• OSA(Obstructive Sleep Apnea)
• CCMD (Cranio Cervical Mandibular Disorder)

Treatment for neuromuscular disorders

The treatment for neuromuscular disorders like TMD (Temporal Mandibular Disorder), OSA(Obstructive Sleep Apnea), and CCMD (Cranio Cervical Mandibular Disorder) are done using the same holistic approach.

The expert neuromuscular dentist and orthodontist at Smile and Glow would diagnose your problem and treat it. He will use a ultra low frequency transcutaneous nerve stimulation device (J5 TENS machine-Myomonitor or muscle monitor) to relax the muscles in your face in order to relieve muscle strain that results in signs and symptoms. Some patients will require a removable dental splint or mandibular orthopedic repositioning appliance (MORA). He may treat you using orthotics, braces or restorations to  ensure that  your teeth, muscles, and joints work harmoniously, thus relieving you of the pain.  In some cases surgical treatment may be required.

Most often the neuromuscular disorders are treated by a team of specialists including a neuromuscular orthodontist, physiotherapist, yoga and breathing specialist, ENT, Pulmonologist and a psychologist.

The longer the condition has existed, the longer would be the time required for  treatment . Hence every child should be examined at the age of seven years. Anyone with chronic pain in the jaws, jaw joints, head, face, neck, shoulder, legs  should be examined as soon as the signs or symptoms are noticed.