Neuromuscular dentistry: developing optimal jaw harmony

Neuromuscular Dentistry

Developing Optimal Harmony

“Determine a Correct Jaw Position”

What is Neuromuscular Dentistry and does it differ from common dentistry?

Traditional dentists concern themselves with only the hard tissues- teeth and joints. Neuromuscular goes beyond not only the hard tissues but also the soft tissues – muscles and nerve. It addresses the dynamic relationships related to the physiologic range of motion and body posture. This is based upon the ability to objectively measure muscle function and correlate it to a proper jaw posture and it’s movements in function.

When the harmony of the teeth, the facial muscles, and the temporomandibular joints no longer exists. Symptoms of what has identified as TMJ/TMD (Temporomandibular Joint Dysfunction) arise.

Some of the CLINCIAL TMJ SIGNS are:

• Headaches
• Sensitive and sore teeth
• Facial pain
• Neck and shoulder aches
• Ringing in the ears
• Jaw Pain
• Ear Congestion
• Clicking/popping in the joints
• Worn down teeth
• Clenching/bruxing
• Limited opening of the mouth
• Cervical/neck problems
• Loose teeth
• Tingling in the fingertips
• Forward head position

The focus

In our office Neuromuscular Dentistry emphasizes the need to establish and occlusion based upon:

• The optimal position and function of the temporomandibular joints and
• The optimal resting posture and function of the masticatory muscles.

This approach differs greatly from the common dental approach that treats the teeth and assumes the teeth, active muscles, and the jaw joints will accommodate to the treated occlusion. Treating teeth by restorative procedures (crown, bridges, and fillings) or common orthodontics (straightening teeth) are often done without accurately determining a correct jaw posture and a proper vertical dimension.

A Neuromuscular Dentist can determine a proper resting jaw position that effects the facial head and neck muscles, the teeth as well as the joints. A physiologic resting position and body posture is often overlooked and not even considered as an important part of the whole dental system

Our success is in the philosophy of taking a neuromuscular approach in all facets of our dentistry including orthodontics, TMD/myo-facial pain problems, occlusal (biting) problems, and all areas of restorative and aesthetics treatments.

Computerized Diagnostics

In this day of technology and computerization, Dr. Harding and his team use state of the art technology to find a correct and accurate jaw posture substantiated by objective data of the muscles in function and rest. Computerized diagnostics make it possible to accurately find a physiologic position that meets the parameters of each individual patient.

Those patients that are seeking state of the art care and treatment, especially those that find themselves in the difficult to complex category (top 5-15%) should seriously consider this approach. Those patients that are tired of educated guesses, trial and error treatment protocols and having experienced splints that are not effective should stop and re-evaluate by what philosophy you would like your care and treatment.

Computerized jaw-tracking instrumentation: is used to record jaw movements, range of motion, path of closure, rest positions, habitual centric occlusion and determine freeway space.

Electromyography: is used to monitor the muscles in function.

Sonography: records jaw joint sounds and helps detect abnormalities.

Myo-monitor (low frequency TENS): is used to relax the hyperactive facial muscles.

Tomography: are special x-rays of the jaw joints to evaluate the jaw joint condition and position.


Finding your neuromuscular jaw position is paramount before a final restorative/orthodontic phase is started to prevent muscular imbalances that would lead to instability of the teeth, supporting bone and compromised posture.

A comprehensive analysis and evaluation is highly recommended to assist the doctor in accurately diagnosing and developing a treatment plan that can best meet your needs for long term optimal dental health and posture.

Subjective feelings and educated guesses when treating the mandible, masticatory muscles of the head and neck, and the temporomandibular joints will not produce cost effective results and treatment times.

Are your joints healthy?

The temporomandibular joints (the TMJ’s) are the two joints that are a part of the chewing and swallowing functions. They are important in supporting the mandible to the skull by means of many muscles. Without these two joints our ability to open and close the mouth and move the jaw from side to side would be greatly diminished.

The TMJoints are often overlooked and not seriously considered, since on routine exam the joints are hidden behind tissue. The oral cavity, the gums and the teeth are mostly seen since those are the parts that we see the easiest. Routine x-rays are taken of the teeth to check for cavities. Pocket probing measurements around the teeth and gums are recorded regularly to check for gum disease. But the jaw joints are rarely considered as important. Most dentists, physicians, chiropractors, osteopathic physicians, etc. consider these two joints in their overall evaluation since most of the health professionals have had very little training in this area.

Should we dentists continue to ignore the joints and just continue doing our "Tooth Dentistry?"

The condition of the temporomandibular joints must certainly be considered, especially when any form of dentistry is being considered!

If any restorative work is being considered such as fillings, crowns, bridges and implants, the health of the joints should seriously be considered. Most jaw joints do not give the patient pain directly, but many symptoms that are indirectly related will affect the occlusion (the bite), the comfort of the teeth and the overall comfort of the supporting muscles.

It is obvious that if the joints are not stable and have to compensate in the opening and closing paths of mouth movements, it will later impact the stability of the teeth and overall comfort of the supporting muscles. For the “occlusion” (the bite) to be stable, the jaw joints must be stable and healthy.

Let us not forget that the TMJoints are connected to the same jawbone (mandible) at one end and at the other end of the jaw are our teeth. They do affect one another! Muscles are the driving forces to move them together.

Do most dentists realize this? Do they realize that vertical dimension, posture and unstrained muscles at a physiologic rest position plays a major role in treatment outcomes? Or do they ignore these important body parts (oblivious to the facts of muscle physiology, joint pathology and teeth)? The teeth and joints function together as a unit and are not independent one from the other.

Advances in science and technology exist today to assist any clinician in the diagnosis and treatment of TMJ, occlusal and jaw orthopedic problems.

Dr. Harding owns Harding Dental Center in Avon, Colorado. He is a Clinical Instructor at The Las Vegas Institute for Advanced Dental Studies and is a Medical Provider to the US Ski and Snowboard Teams. He can be reached at [email protected] or 970-845-9980