Migraine, Headache and Jaw Condition Treatment Through Neuromuscular Dentistry
(Neuromuscular Dentistry in Sutton Surrey and London)

What is Neuromuscular Dentistry (NMD)?
The way that your upper and lower teeth come together ( your bite or occlusion) is part of a system of teeth, muscles and joints. If your teeth do not fit together properly, the muscles and joints accommodate work to get them together. A misaligned bite often leads to muscles that are overworked when they should be relaxed, leading to various painful conditions. The Neuromuscular dentist considers the entire system that controls the positioning and function of your jaws to establish a jaw position based on harmonious relationship of the three main factors affecting occlusion- the teeth, muscles and joints. The resulting jaw position is called the neuromuscular bite.

How is NMD Performed?
Your dentist may be considering various types of dental treatment to improve your smile, to correct a misaligned bite or to relieve a painful condition. To achieve an optimum bite your dentist will have to evaluate the complex relationships between your teeth, jaw joints and muscles.

NMD begins by relaxing the muscles around the jaw with the use of a TENS (myomonitor) device. It delivers a mild electrical stimulus to the muscles of the facial/jaw area and the neck/shoulder area, to “exercise” these muscles and cause them to relax.

Your NM dentist may also perform tests with computerised technology that provide very detailed information about the status of your muscles and joints. These tests give your dentist a “picture” of what is happening with your muscles and joints.

Computerised Mandibular Scanning
or Jaw Tracking allows to measure and study the pattern of the jaw opening and closing through it’s full range of motion. Electromyography (EMG) tests provide information on the activity
of key muscles that control the jaw during various functions as well as at rest.

Sonography is a way to assess the status of the articular disc which is within the joint and joint function. This information is used in assisting the diagnosis and to help determine the precise point at which your jaw should be in relation to your upper teeth. Rather that relying on your present jaw position as being the best for you, this additional objective information is used to determine if your bite should be left as is or be adjusted to a more optimal occlusion.

Once the dentist has determined where your new bite should be, you will be given a plastic appliance called an “orthotic” to keep your bite in its new position. You may wear this orthotic as an interim step to a more permanent treatment

Muscles in Dentistry
How muscles affect your occlusion- Your jaw posturing muscles may be overworked in attempting to maintain your present “programmed’ position, even when you think they are relaxed. Head posture can also affect your occlusion and muscles that control the head posture are primarily in the neck and the upper back. Taken together, these conditions can lead to a variety of problems including a less than ideal bite, muscle pain or dysfunction, or jaw joint problems.

How the Muscles are Relaxed
Because the muscles controlling the jaw are subconsciously “programmed” by the brain, most individuals have difficulty consciously reaching a truly relaxed state.

To help your muscles reach that relaxed state, a device called a Myomonitor is used is used to deliver gentle electrical stimulation to your muscles. It is battery operated and the mild stimulation is delivered through adhesive patch electrodes attached over nerves that control specific muscle groups. The virtually painless stimulus will cause your facial and jaw muscles to twitch once every one and a half seconds and after 45-60 minutes your muscles will overcome their programming and go to a relaxed state.

Getting Your Bite Right
Now, that your muscles are relaxed, we record the relaxed jaw position of you jaw by placing fast setting putty between your teeth. The dentist can now compare your usual occlusion (bite) with the relaxed jaw position to evaluate if your jaw is presently in a near optimal position and determine whether the occlusion should be adjusted.

Headaches
Headaches are generally classified into several basic types:
Sinus, Cluster, Tension and Migraine. While headaches are typically treated by your doctor, improper occlusion (bite) may play a significant role in certain types of headaches as well as other head and neck pain.

Headaches and Your Bite
The muscles of the temple area of the forehead are muscles that play an important part in the posturing and closing of the jaw. If your occlusion (bite) is not right, it can lead to abnormal tension in these muscles- one of the several possible causes of tension type headaches. If the bite is not corrected, the muscles may remain tense for long periods of time. The contracted muscles does not get a chance to rest and soon suffers from poor circulation- thus a lack of needed oxygen and the accumulation of waste products of metabolism. The result can be pain (headache).

Determining if the Bite is the Cause
Based on a physical examination and new technology that allows your dentist to evaluate the state of these muscles, your dentist can rule in or out if your bite is a possible cause of headache pain with a high degree of confidence.

Dental Treatment of Headaches
If the indications are that your bite is a major factor, your dentist may recommend provisional or interim treatment. This involves fabrication of a custom made orthotic. An orthotic is a plastic appliance that is worn over your teeth to adjust your bite to a correct relationship. At this point, nothing permanent is done to alter your teeth or your bite. You would wear this appliance for a period of time to make sure the new bite position is correct before any consideration would be given to permanently altering your bite.

After having worn the provisional appliance for some time, both you are your dentist will know for sure if the new bite position has resolved the headache problem. If it has, you will have several options open to you for long term treatment.

Some of the options may include dental treatment to permanently alter your bite to the new position, fabrication of a more permanent type of orthotic, or using a TENS device tto relax the muscles at times that the headaches are most bothersome.

Temporomandibular Joint Disorder
What is TMD? The temporomandibular joint is the hinge that the lower jaw moves on. Therefore, TMD stands for tempormandibular disorder. Today it is widely believed that most joint problems are commonly a result of problems elsewhere in the bite (occlusion) or muscles. Dentistry is still not in consensus on the causes and treatment of TMD. However, the profession does largely agree that the condition should be treated in the most conservative manner (surgery is a last resort) and without drugs whenever possible.

Signs and Symptoms of TMD
Pain or dysfunction of the head and neck is a very common condition and one that might be resolved very simply or might be very complex and frustrating to treat, depending upon the circumstances.

Since there is a relationship between the teeth, jaw joints, head and neck muscles, and head posture, a problem in any one of these areas may affect others. These can include headaches, jaw joint pain, jaw joint noise or clicking, limited mouth opening, ear congestion, dizziness, ringing in the ears, difficulty swallowing, loose teeth, clenching or grinding, facial pain, sensitive teeth, chewing difficulties, neck pain, postural problem, tingling of the finger tips, hot and cold sensitivity of teeth, nervousness or insomnia.

In addition we look for a number of signs in your posture, appearance and condition of your teeth, and existing bite that might aid in diagnosis. An imperfect bite often plays a significant role in these conditions. However, diagnosing these problems problems can be very difficult at times and may require the collective efforts of your dentist and other health care professionals. These may include your doctor, ENT specialists, chiropractors, to name just a few.

The Dentists Diagnosis
We consider all of the information gathered by taking your history and doing a physical examination of your teeth, head and neck. When indicated, we may conduct a series of tests using non invasive electronic instruments. Data from these tests will indicate whether your bite is a major factor to your problem and will help rule in or out your bite as the cause of, or major component of, your condition.

If these tests show that your bite is a probable cause of your condition or pain, we then identify a jaw position while the jaw muscles are in a relaxed state. This jaw position and corresponding new bite is called neuromuscular occlusion.

Treatment
An orthotic is a custom made appliance fabricated of plastic that can be worn over the teeth to maintain the neuromuscularly derived bite position. At this point, nothing is done to permanently alter your teeth or your bite. You typically wear this plastic appliance for a prescribed period of time to verify that this new jaw position solves or reduces the problem. If it does, it has proven that the imperfect bite was the cause of the problem and you elect to go on and have your natural teeth treated to permanently maintain that new bite position.

If the symptoms are not substantially alleviated, the bite position is most likely not the cause of the problem. Your natural bite has not been altered and other causes may then be further explored. (Although this latter circumstance is possible, it is not likely since the dentist will only proceed with an orthotic if there are strong indications that the bite is a major factor in your problem).

Cedar Dental - Aesthetic and Implant Centre.