Wednesday, February 3, 2010

A Re-evaluation of the Meaning of NMD

by Clayton A. Chan, DDS, MICCMO

by Clayton A. Chan, DDS, MICCMO

 I am posting this to clear up confusion as to what Neuromuscular Dentistry and NM Occlusion is about. Because there are some who profess to be "Neuromuscularly" trained, but in reality have very little understanding and appreciation for the Gnathologic occlusal concepts which are the foundation to neuromuscular dentistry. NMD is not only about scans, EMGS and jaw tracking data, it is about occlusion and it’s relationship to the trigeminal system as it relates to postural system. Let’s not forget that it relates to CLINICAL applications of TMD, restorative/prosthetics and orthodontics. It’s not an academic exercise of knowledge, but rather it should be a display of how the teeth, muscles and joints are functioning (HEALTH not dysfunction) in relationship to the bio-physiology, neurology and their impact to the masticatory system.

 The concept of NMD is not new, neither should it relate to marketing exploits in the name of post graduate dental education. It is a "discipline" in dentistry that requires attention to detail to the core principles that every dental student has learned in their dental training. It is certainly not about an overuse of technological advancements for the learning student to convey to their patients that what they understand about EMGs, jaw tracking and orthotics is to over ride the actual patient responses of ill feeling bites, imbalance of musculature as it relates to restorative reconstruction. LEARNING THE BASICS IN OCCLUSION IS KEY!  The proper application of the GNM principles as taught at OC is key!

When doctors who begin to use these advanced techniques in manners and cannot properly interpret the EMG and jaw tracking data correctly or apply the micro occlusal management principles from a complete clinical perspective, even though in their mind that the data may appear to be normal or correct as per their understanding, it behooves all to assess their training and understanding of scan interpretation, especially when restoring patients through the various phase of reconstruction or restorations (phase I removables, phase I fixed orthotic, phase I porcelain orthotics and or phase II restorative). If the scans appear to be normally low EMGs and the trajectory looks like it is right on trajectory sagittally and frontally and the patient is complaining that they don’t have a bite, then perhaps a reassessment as to one’s understanding of scan interpretation is in order (Level 5 Advanced NM Bite Refinement/K7 Training and Interpretation).  If the EMG and jaw tracking data as per one's understanding shows a balanced occlusion, yet the central nervous system is not calm or neutralized then one's understanding of GNM (gneuromuscular) and or NM (neuromuscular) needs to be reassessed.

 If the patient is having a difficulty with the dentistry provided even if it was performed in the name of GNM or NM and one is not sure what to do….don’t tell the patient that all the scans appear normal and that there is nothing wrong with the dentistry. They are not whiners and complainers for no reason. They have a legitimate concern that needs further investigation, occlusal understanding and another level of skill sets may be required. It is wrong to tell the patient that there is nothing wrong when the Scans appear to be OK to cash this patient to the waste heap of “NM” failures. Let’s reconsider what we have been taught. (Of course the TMD patient must also realize there are no guarantees, when TMD involves multiple layered factors that involved not just structural/anatomical postural issues, but even more the emotional/psychological stressors as well as biochemical issues that often patients rarely want to acknowledge with their dentist).  Learn from those who really practice what they preach. Use your knowledge, skills and good judgment to help your patients and find a resolution to the problem. Be patient, compassionate, respectful of others work and listen to your patients carefully…sometimes they know more than the treating doctors…why because some of them are experienced and have read, learned educated themselves amongst the numerous practitioners they have visited, have been the recipients of many doctors treatments and therapies, yet continue to seek for real answers to real problems.

 As long as Neuromuscular clinicians continue to pretend to hide under the covering of their scans (not really understand OCCLUSION management principles and the importance that microns matter) not fully comprehending the GNM principles what they mean as they relate to CLINICAL TMD pain treatment, restorative occlusal therapy problems and orthodontic/orthopedic issues, then scan interpretation is only a lopsided perspective of what NMD and GNM really advocates.

 Orthopedic Dentistry, Orthopedic Occlusion, GNEUROMUSCULAR Occlusion or Gneuromuscular Dentistry is perhaps an updated means to convey the full package of what NMD originally intended. It shouldn’t convey something less than a complete understanding of both neuromuscular and gnathologics…it is really plain dentistry that requires self discipline.

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