Diagnostic and Treatment Protocol for Jaw Joint and Neuromuscular Disorders

After Doctor Westman performs a screening for jaw joint and neuromuscular disorders, he offers further diagnostic testing and therapeutic treatment options if the screening results are affirmative.

Jaw joint and neuromuscular disorders can have emotional, biochemical and/or structural components. A structural problem is almost always present. State-of-the-art instrumentation makes it possible to accurately diagnose structural problems and establish a correct, muscularly balanced jaw posture that meets the physiologic parameters of the individual patient.

The first goal of neuromuscular dentistry is to find the position of the jaw where the muscles are relaxed and at rest. From there, an optimal biting position for the jaw is determined where the teeth, muscles and jaw joints can operate in harmony. The optimal position is a three dimensional position in space that is often very different than the position where the teeth currently cause the jaw to close.

Dr. Westman uses the Myotronics K-7 system of sophisticated instruments in his practice of neuromuscular dentistry to diagnose malocclusion and find an optimal biting position for the jaw to eliminate symptoms and maximize the comfort, stability and longevity of the teeth and dental restorations. With the K-7 system, valuable information is gathered via four main testing modalities: jaw tracking, electromyography and sonography; and ULF-TENS.

MYOTRONICS K-7

Computerized Jaw Tracking

Multiple sensors in an extremely light weight (four ounce) spectacle-like array, track the motion of a tiny magnet attached with adhesive to the lower front teeth. The procedure is completely non-invasive and does not interfere with natural posture or function. Computerized jaw tracking records the position and movement patterns of the jaw, including range of motion, border movements, habitual centric occlusion, chewing patterns, resting positions, freeway space and relaxed neuromuscular closure path.

This is gives Dr. Westman a detailed "map" of the jaw’s position and allows him to record an optimal occlusal position.

Surface Electromyography (sEMG)

Electromyography precisely measures and records the electrical activity in the face, jaw and neck muscles, which shows the amount of tension versus relaxation in individual jaw muscles, and whether or not the muscles are healthy or fatigued. Simultaneous jaw tracking and electromyography provides Dr. Westman with objective measurements verifying that the new bite will place the jaw into a position that will result in relaxed and comfortable muscles.

Ultra-low frequency TENS (ULF-TENS)

Different than the high frequency TENS commonly used to reduce pain, ultralow frequency TENS increases blood circulation, improves muscle metabolism, decreases muscle tension and fatigue, increases range of motion and produces physiologically healthier muscles. Dr. Westman uses ULF-TENS to produce relaxation in tense, hyperactive muscles, and close the jaw to a position in line with the relaxed muscles.

Sonography

Sonography simply and non-invasively reveals jaw joint noises that occur during jaw movement. Such noises are a sign of distress.

A set of sensitive microphones that look like headphones are worn over the joints. These measure jaw joint noises such as clicking, popping and grinding. Subtle vibrations are recorded as well as loud sounds. Vibrations are analyzed with respect to frequency, which allows evaluation of joint damage. Timing of noises with jaw position is also measured and recorded when sonography is performed simultaneously with jaw tracking.

For more information on neuromuscular dentistry, please contact our office.

TREATMENT

If Dr. Westman diagnoses a structural imbalance in your bite, you may have several options to correct the problem. He might recommend orthotic therapy, coronoplasty, orthodontics, dental restorations or a combination of these modalities to allows your jaw to close to an ideal muscularly balanced position that gives proper length to the muscles to avoid muscle spasm, allow muscles to heal and pain trigger points to go away, and joint capsules to heal. With all of these options, patients usually experience a range of benefits, from reduction or elimination of pain and discomfort, to better overall health and longer lasting teeth and dental restorations.

Orthotic therapy

An orthotic is an appliance that fits on the teeth to align the jaw and facilitate muscle relaxation and joint decompression. It can be made removable so the patient can place it on and remove it from the teeth, or it can be made to stay on the teeth without being removed for several months. A neuromuscular orthotic is much different than the commonly made nightguard or splint.

Our orthotics are designed to be comfortable to wear while awake, eating, speaking, and while sleeping. The best results are achieved with full-time, 24 hour per day use. Symptoms usually begin to improve immediately. Jaw and neck posture often continues to improve for several weeks, making it necessary to rebalance the bite on the orthotic to keep up. After maximum comfort is obtained and posture has stabilized, which commonly occurs within three months, then coronoplasty, orthodontics and/or dental restorations can be done to maintain the orthopedic position established by the orthotic. Or the orthotic can be repaired, relined or replaced as necessary to allow long-term orthotic use.

Coronoplasty

Coronoplasty is reshaping the biting surfaces of the teeth with heavy polishing in order to remove interferences that deflect the jaw as it closes to its optimal biting position. When there is a minimal difference between the pre-existing bite and the desired bite, then coronoplasty may be the treatment of choice.

Orthodontics (braces)

The neuromuscular approach to orthodontics establishes proper alignment of the jaw muscles and joints before moving teeth into their correct positions. This is much different than the common approach to braces where teeth are moved without regard to proper jaw joint and muscle alignment. In addition to providing comfort, neuromuscular orthodontics tends to provide better long-term stability of the teeth resulting in less need for retainers.

Orthodontics can often align the teeth and jaws without the need for any dental restorations. In some cases restorations are a better choice than braces because restorations can replace old leaking fillings, eliminate decay and improve the color and shape of unsightly teeth; all while instantly aligning the teeth and jaws without having to use any braces at all. Sometimes a combination approach of orthodontics and then restorations is recommended.

Dental restorations

When there is a major difference between the pre-existing bite and the desired bite, then veneers, onlays, crowns, fixed bridges or removable dentures may be recommended to construct a naturally comfortable bite. Some cases require restoration of only a few teeth, while other cases involve several or even all of the teeth.

If dental restorations are needed to replace old leaking fillings, eliminate decay and/or improve the color and shape of unsightly teeth, then the restorations can be made at the same time to create the proper bite.

Surgery

Surgery is seldom recommended, because non-surgical therapy is usually very effective.