Neuromuscular Dentistry

How do Neuromuscular Dentists Diagnose TMJ Dysfunction?

Initial evaluation will allow the neuromuscular dentist insight into the exact causes and symptoms of each case of TMD. Since there are many reasons for jaw pain, migraines, a popping jaw joint, or lockjaw, looking for each cause by thorough evaluation the best place to begin. The doctor will feel around the TMJ joint itself and different muscles around the TMJ to understand how they are interacting and if there may be specific areas of tension leading to symptoms.

Assessment of Jaw Alignment:

Since an estimated 85% of TMD cases are caused by a poorly aligned jaw position, a neuromuscular dentist investigates current resting location and motion of the jaw. It is important to understand how TMD sufferers’ teeth bite together, and if there may be an issue with worn teeth caused by symptoms of neuromuscular tension like night grinding. The jaw path during opening and closing will be analyzed as well.

If it is determined that more thorough diagnostic information is needed, a Bite Test including Sonography, 3D Advanced Imaging, 3D Computerized Jaw Tracking, MLS Cold Laser Therapy, TENS, EMG (Electromyography), and Computerized Bite Analysis is recommended so that the ideal neuromuscular position can be captured. In this position, patients’ symptoms often resolve. With this positional information, the best permanent treatment for each individual patient can be determined and presented.

The next step that a neuromuscular dentist may take to resolve TMD symptoms is to fit a patient for a customized “orthotic,” a device resembling an athlete’s mouthguard. These mouth guards hold the patients resting bite in the ideal neuromuscular position while symptoms are resolving. Many jaw pain patients report near-immediate relief of symptoms they have had for years, as soon as the orthotic is placed.

In order to prevent the jaw from returning to the previous bad jaw position that was causing all the painful symptoms, orthodontics or restorative dentistry (crowns/porcelain onlays) may be recommended. This is done to ensure that the teeth and jaw work together and allow the jaw muscles to permanently work in the correct position, leading to a lifetime of pain-free living.

Neuromuscular Night Guards

Do you notice having sore jaws or headaches after waking up? Have you noticed that your teeth look flat or worn down on the edges? If so, you are most likely grinding or clenching your teeth. This behavior, called bruxism, is very common and can cause serious damage to your teeth and mouth if it is not treated. Untreated clenching and grinding can lead to destructive results long-term.

What causes grinding?

Generally, anxiety and daily stress are the most common causes of isolated teeth grinding. Chronic tooth grinding is a neuromuscular condition that necessitates further evaluation. Tooth grinding, TMJ dysfunction, and sleep apnea are highly correlated. This is why we recommend a home sleep study and a bite screening for any patient we examine that has significantly worn down teeth, to determine what is causing your grinding and how we can stop it permanently.

How can we stop your tooth grinding?

In cases of worn teeth, after the cause of the wear has been isolated, we often recommend one of three types of oral appliances: a traditional night guard, a neuromuscular night guard, or the M2 Sleep/Snore appliance. Each type of guard is custom designed to fit your teeth precisely, and with a secure fit that you can comfortably sleep in. If you grind your teeth, let us help you stop this behavior now to prevent even more serious tooth problems down the road.

Neuromuscular Orthodontics

Neuromuscular orthodontics is an option for Phase 2 (making the joints healthy permanently) in our two-phase treatment for TMJ disorders. This revolutionary type of orthodontics enlarges the airway in the throat, helps align the vertebrae in the neck, and straightens the teeth, all while making sure that the jaw joints do not click or pop, and have enough space to remain decompressed and comfortable. Dr. Miller treats TMJ and airway issues with maxillary expansion appliances such as MARPE, MSE, AGGA, ARA, ControlledArch orthodontics, DNA, mRNA, and the Meridian appliance.

Jaw Surgery for Overbites/Underbites May Not be Necessary

Jaw surgery is now only recommended in very complex bite misalignment cases. In mild to moderate situations, new advances allow us to treat these problems without surgery! We are happy to provide a consultation to review options for non-surgical jaw development orthodontics.

Extraction of Teeth is Not Necessary for Successful Orthodontics

Often, traditionally-trained orthodontists will recommend extracting two to four bicuspids (premolars) to create space for straightening the teeth. The reason why some orthodontists recommend extractions in certain cases is because they see that there is currently not enough room in the dental “arch” to move the teeth into straight alignment without overlapping. At Advanced Dentistry of Amarillo, we use specialized techniques and appliances to create space for teeth alignment without extractions, by actually growing the arches instead of just working with what is there to begin with. Extraction of teeth and then moving the other teeth into their place does not solve the problems that can occur as a result of small dental “arches,” including airway issues and future TMJ joint problems. By utilizing orthodontics as a tool, we can accomplish a wider facial appearance, a broader smile, a fuller appearance of the entire smile line, better lip posture, better chin definition, and a more well-defined neck and jawline.

Extraction of Teeth is Not Necessary for Successful Orthodontics

Phase 2 TMJ therapy utilizing orthodontics maintains your correct bite position without the continued need for a Phase 1 TMJ orthotic appliance on the lower teeth. Often this involves bringing the upper teeth and lower teeth forward by growing bone in the upper jaw/midface. It was not thought possible to grow bone forward like this in adults until revolutionary changes have occurred recently in the field of orthodontics. This is upper arch development is accomplished with a fixed upper appliance called a FAGGA, or Fixed Anterior Growth Guidance Appliance. The ultimate goal of this appliance is to grow bone forward where it is needed, and to permanently move the teeth into the position that is physiologically correct for your head and neck and posture.

Anterior Guided Growth Appliances

Also referred to as AGGA, the Anterior Guided Growth Appliance accomplishes forward facial growth in adults and children alike. There are two different types of anterior guided growth appliances: fixed (FAGGA) and removable (RAGGA). Both growth appliances meet the same goal.

• Fixed: This growth appliance is the best treatment option for adults who suffer from TMJ and sleep apnea. The FAGGA is able to open the airways by expanding the upper jaw forward, allowing for a larger airway in your throat. FAGGA often improves facial appearance as well.

• Removable: This growth appliance is best for children who have not yet grown into their full set of adult teeth. This appliance fits much like a retainer, however instead of keeping the teeth in place, it expands the jaw forward and outward. This creates enough space in the mouth for the child’s adult teeth to erupt later without overlap. This can avoid extractions of adult teeth later during teenage orthodontics.

Who is a Good Candidate for an Anterior Guided Growth Appliance?

Of course, the best way to know if you are a candidate for AGGA is to schedule a consultation. However, if you have experienced any of the following, you may be suited for an AGGA: Sleep apnea Discomfort while chewing Jaw pain TMJ Bad posture/forward head posture Dissatisfaction with facial structure/appearance.

The Controlled Arch System

After proper growth is obtained with the FAGGA appliance, the Controlled Arch System is used to straighten the teeth into your physiologically balanced position, thus reducing pain and correcting your bite permanently. The Growth Guidance/Controlled Arch orthodontic approach develops the jaws forward first, and then moves the teeth to fit the jaw placement, rather than the reverse.

The Dangers of Old Style, Retractive Orthodontics

Watch this Video

How Long Does Neuromuscular/TMJ Orthodontic Treatment take?

Since we are working with your individual biology, there is no set duration for your orthodontic treatment. This is unique to every patient and depends on the distance we need to gain with the appliances. We usually accomplish everything within 14-and 24 months.

SphenoCath SPG Block

What is SphenoCath®?

A new patented device and method for achieving an SPG block (sphenopalatine ganglion block), the SphenoCath® device and procedure provides most patients with immediate relief of headache pain with a simple, gentle, comfortable in-office procedure.

How is SphenoCath® different?

The SphenoCath® device is a one-of-a-kind patented, soft, flexible, catheter through which a medical professional can deliver medication through the nasal passages to several difficult-to-reach ganglia (a group of nerve cells) in the face and head without needles, sprays, swabs or sedation for maximum patient comfort. This device allows a low risk, simple procedure that is a pain management game-changer for anyone who experiences four or more severe headaches a year.

Is SphenoCath® right for me?

SphenoCath®offers:

• Quick, simple and comfortable in-office procedure

• Higher success rates - immediate relief in majority of patients

• Low risk procedure

• Safe for adults, children and pregnant women

• Low cost - (covered by most insurance companies)

Is SpenoCath® safe?

SPG (sphenopalatine ganglion block) block procedures have been done for many years but, until the invention of the patented SpenoCath®, the procedure has been difficult, uncomfortable and offered only by a few practitioners. Now SPG blocks can be done quickly, easily and comfortably, and by a wide variety of practitioners.

What are the benefits of a SpenoCath® procedure?

SphenoCath® procedures provide prompt and often sustained relief of pain associated with headaches, facial pain, dental pain and neuralgia including conditions such as:

• Migraines

• V1 Frontal Lobe Headaches

• TMJ

• Occipital Neuralgia

• Post Concussion Headaches

• Cluster Headaches

• Ice Pick Headaches

Why will an SPG block help me?

The sphenopalatine ganglion is a collection of nerve cells located just under the tissue lining the back of the nose. By applying a local anesthetic to the area, nerve impulses can be temporarily blocked, providing relief from various types of pain. SphenoCath® is designed to deliver medication quickly and comfortably to the area of the sphenopalatine ganglion.

How long will it take?

SPG block using theSphenoCath® takes 2-3 minutes. Patients are encouraged to remain in a flat or reclined position for 10-15 minutes afterwards to maximize the benefit of the procedure.

What are the side effects or risks with the SphenoCath®?

The risks of using the SphenoCath® include irritation to nasal cavity or mucosa, nose bleeding; and/or mild pain.