NMD
THE SCIENCE
The History & Evolution of
Physiologic Dentistry
2
Perspective tells the story…
• We are still an in the infancy of our
profession
• Our understanding is growing and
increasing
• True of any evolution in science, the
bastions of the current view fight the next
evolution
• What we ‘know’ now compared to what
will be known in 100 or 1000 years is
miniscule!
• However, a system cannot be understood
3
Bilateral Balanced
• An approach to improve fit and function of
dentures ~ 1800s
• Occlusal scheme where all the posterior teeth
are in contact in all excursions
• Helped to keep dentures seated
• Chewing efficiency was terrible
• Tooth centered philosophy
4
Gnathology
• An approach to improve fit and function of
dentures ~1930s
• Tripodization of cusp/fossa relationship
• Stewart fully adjustable articulator
• ‘If only the cusp/fossa gearing is right, then
everything is right’
• Cusp interdigitation drives skeletal support
• Improved chewing efficiency but not patient
comfort
• Tooth centered philosophy
5
Centric Relation
• An approach to improve fit and function of dentures
~1950s
• Most Posterior-Superior position is occlusal nirvana
• Then another almost dozen specific single best places
and three dozen correct ways to get there
• Today those who teach it say most dentists won’t be
able to master it
• Thinking is that if the jaw relationship is idealized then
we can match the teeth to support that
• But… what happens when the condyle is bent – or
missing?
• Bone centered philosophy
6
Neuromuscular
• An approach to improve fit and function of dentures ~
1970s
• Accepts that tooth and bone relationships are critical –
but that in the end, muscle comfort reigns
• Only approach to look to objective data such as EMGs
• Reversible as it starts with orthotic wear to manage
symptoms
• Deals with all dimensions of space simultaneously
• Has significant literature to support therapy
• Decompresses joints like all other aspects of health
care – rather than compress the bone into the socket
• Eliminates grinding/bruxism ~85% of the time
7
Physiologic Neuromuscular
• An approach to improve fit and function of
patients
• Pioneered at LVI, a live patient and hands-on
Continuing Education facility
• Marries the ‘stomatognathic triad’ of teeth bones
and muscles with airway and the rest of the body
• Significant improvements in outcomes of care
• Manages night-time bite problems (airway) along
with daytime bite problems (headaches etc)
• Eliminates bruxism ~100% of the time!
8
GROWTH AND
DEVELOPMENT
• MOST IMP THING O2
• FIRST YEAR GROWTH
ADVERSELY AFFECTED WITH
• ENVIRONMENT
• NO FOSSA WHEN BORN
• AFFECTED BY POSITION OF
MANDIBLE
• THINGS THAT AFFECT FACIAL
GROWTH
• BREAST FEEDING
• ORAL HABITS
• ALLERGIES
• AIRWAY OBSTRUCTION
• DISHARMONY BETWEEN
STOMATOGNATHIC FORCES
• IN A HEALTHY CHILD T AND A BEGIN
TO ATROPHY BY AGE 2 AND GONE
BY PUBERTY UNLESS ALLERGIC
CHILD THEN THEY ARE
HYPERTROPHIED AIRWAY
BECOMES KEY
• CAVEAT:
• WE ALL HAVE THE ABILITY TO
EXIST IN ACCOMMODATIVE
PATHOLOGIC POSITION
• WHEN THE PATHOLOGIC POSITION
EXCEEDS OUR ACCOMMODATIVE
CAPACITY PT BEGINS TO
COMPLAIN EITHER OF PAIN
DISCOMFORT OR ESTHETICS
• 90% OF PAIN IS DERIVED FROM
MUSCLES
- Dr Janet Travell
• TYPICAL PT
• NECK PAIN
• CAN’T TURN THE HEAD
• CLENCHED OR BRUXED
• HEADACHES
• DOESN’T CONSIDER
THEMSELVES A PAIN PT
• CO
• CR
•
PROPRIOCEPTIVELY
PEOPLE CHOSE WHERE
THEIR TEETH FIT TOGETHER
CO=CR
• WHAT IS NMD
• NM DENTISTRY RESTORES TEETH
WHERE THE MUSCLES ARE
COMFORTABLE
• BECAUSE OF PROPRIOCEPTIVE
CONTROL OF MABDIBULAR
MOVEMENTS,THEY WILL ALWAYS
CLOSE IN THAT COMFORTABLE
POSITION
•
the atachment you will see pre bite change/post bite change/post coronoplasty of the rats.
•
Cranio. 2005 Apr;23(2):119-29. Links
•
The influence of an experimentally-induced malocclusion on vertebral alignment
in rats: a controlled pilot study.
Six Dimensional
occlusion
• lateral
• vertical
• ap
• pitch
• yaw
• roll
• lets discuss all the sign and symptom
sheet
• pain in the joints
• pain in the ear
• pain around the eyes
• pain in the jaw
• pain in neck
• shoulders
• Pain in forehead
• temples
• facial muscles
• joint sounds
• Subjective hearing loss
• Vertigo
• ringing in the ears(tinnitus)
• HEADACHES
• fullness pressure in the ear
• Difficulty swallowing
• Optimal Rx requires DD of the etiology
of Ds process
• requires primary or secondary stresses
• Descending(primary TMD)
• Ascending(sec TMD)
• Jaw position affects where cranium sits
• Wax picture with condyle
•
TENS
Transcutaneous Electrical Neural
Stimulation
• Myomonitor=Low frequency TENS
• Pumps waste metabolites and lactic
acid from hypertonic muscles
• Increases vascular flow
• increases O2
• ATP
• Glucose
• Ca++
• TENS changes muscle metabolism
from anaerobic (lactic acid) to aerobic (
Krebs)
• 8x more effecient
• endorphin effect
• produces antidromic refraction of the
motor nerve
• PT 65
• convinced going to die in 6 mnths
• severe migraines
• lots of medications
• never left house for 40 years
• would close herself in a room for days
• now i have a difficult time getting her in
the office
• arizona
• hawaii
• utah
• alaska
• Pt 39 years old
• couldn’t sleep
• diagnosed with fibromyalgia
• jaw sounds
• pain 9 out of 10
• ringing in the ears
• Pain almost gone 2 out of 10
• no longer on medication for
fibromyalgia
• sleep an average of 6-7 hours
Forward Head
Posture