Orthopedic/Neuromuscular Orthodontics

NYC Cosmetic Dentists Serving Manhattan and New York, NY

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When your teeth do not come together properly with the good fit that nature intended them to, the surrounding muscles and nearby joints will try their best to provide the fit. In other words, they will work overtime to accommodate the misalignment — until the stress of overworking leads to pain, or to improperly aligned jaw joints.

Successful treatment is dependent upon a complete diagnosis of the current status of your oral neuromuscular system. If you are in need of dental solutions for relieving headaches, jaw pain, and other symptoms of misalignment, please call the experienced dentists at NYC Smile Design: (212) 574-4660.

Comprehensive Neuromuscular Diagnosis

This is an area of dentistry in which technology has made tremendous strides in relating many problems that seemed to have no connection. A whole host of aches and pains, breathing difficulties, and general malaise can often actually originate in the musculature of your head, neck, and mouth, rather than in the areas in which you feel the discomfort — and it's all about misalignment. For instance: just as poor posture affects your spine, your limbs and organs, misalignment of the system of muscles that controls the movement of your jaws, cheeks, and tongue will stress and affect your body in many seemingly unrelated ways.

In addition, if you are a mouth breather because you have problems breathing through your nose, this too will affect your bite. What are the culprits to becoming a mouth breather and eventual bite problem? A deviated septum, swollen tonsils or adenoids—even asthma or allergies. Once you are accustomed to breathing through your mouth, your tongue will become accustomed to pressuring your teeth, provoking an outward movement of your front teeth until you develop an open bite -preventing your front teeth from touching, even though your back teeth do. These problems of restricted airway occurred when you were young and developing, which caused you not only to breathe through your mouth, but also develop a narrowed dental arch and crowding of your teeth, greatly affecting your adult facial structure.

The technology we use has made a real difference in that it enables us to go beyond what was previously studied and practiced in orthodontics. We are now able to evaluate the status of the muscles that control both the posture and the function of the jaw and study the role the upper airway has played. By determining the cause of crooked teeth we are able to correct your bite, determine what airway problems exist and make recommendations for their correction, and any abnormal muscle forces during your treatment.

What Is Neuromuscular Dentistry?

A neuromuscular dentist is concerned about how different systems work:

  • Facial muscles
  • Jaw joints
  • Teeth

Dr. Mello and Dr. Tabib design treatments that get these three systems working in harmony to create a balanced physiology. For every part of the system to function properly, the upper and lower teeth must be in alignment as the mouth opens and closes. If any one part of the system does not work properly — let's say your teeth don't meet properly in a misaligned bite — muscles that normally should be relaxed are now tired and overworked, ultimately leading to jaw joint problems.

Neuromuscular Tests before Any Complex Dental Treatment

As neuromuscular dentists at NYC Smile Design, we perform tests using computerized technology to provide detailed information about the status of the muscles and joints. With the aid of computerized jaw tracking, we are able to measure the pattern of jaw movement as the mouth opens and closes. With the aid of electromyography (EMG) tests we can see how the muscles function, where they should be, and how rested they are when they need to be. 

Another option available to us is sonography. With this test we are able to graphically represent the sound the jaw joints are making and determine whether the joints are healthy or not. This information helps us to diagnose the problem so we can create a treatment plan that not only affects the appearance of the teeth and smile, but also addresses the issues that can affect a patient's overall health and well-being.

As neuromuscular dentists, we are trained to carefully evaluate how the upper and lower teeth meet. This is called the bite, or dental occlusion. If the lower and upper teeth don’t meet together properly when the mouth is closing, the muscles will close the jaw in a path that will stress and fatigue the muscles over time. Because of this bad bite, muscles won’t be relaxed when they need to be. This will cause muscle spasm and pain in the forehead area and can produce tension headaches. In fact, a very high percentage of tension headaches can be the result of an improper bite. An improper bite can also cause painful clicking or popping of jaw joints, neck pain, swallowing problems, and snoring or sleep apnea.

How Do We Correct a Bad Bite?

As we mentioned earlier, if the teeth don’t meet properly, muscles of the face are in spasm and overworked, making it impossible to find the new, corrected position. Tense muscles will never relax by just asking a person to relax their jaw. In addition to spasm, tense muscles never have enough blood flowing through them, so they won’t have adequate amounts of oxygen and nutrients. 

As neuromuscular dentists we can achieve optimum muscle relaxation through the use of the Myomonitor-Transcutaneous Electrical Neural Stimulation (TENS). If the muscles of the face can be made to relax and avoid spasm, we have the ability to record the correct bite. A TENS unit delivers a very mild pulse stimulation to the skin over the muscles.  When the Myomonitor is applied, spasm and lack of oxygen and constricted blood flow are reversed. This may take anywhere from 30-60 minutes in order to achieve muscles at rest.

Once a position/bite has been confirmed, our goal for the first stage of orthodontic treatment will be the maintenance of this position. This can be accomplished with the use of removable or fixed orthotics.

Once your symptoms are diminished, and we are assured that our goal of establishing the most comfortable position has been accomplished, we move on to the second stage of treatment. During this second stage of your orthodontic/orthopedic treatment teeth are moved into a position that maintains the alignment established with the TENs and maintained with the orthotic.

A widening of constricted arches is done first, if indicated. This is called arch development. During this phase you will continue to wear your orthotic that will maintain your bite. Generally this is accomplished with a removable upper orthodontic appliance. Then the orthopedic verticalization process begins in which the lower teeth are moved to a height that maintains the proper jaw alignment.

Once your orthodontic treatment is completed, you will need to maintain your new bite and alignment with retainers just as you do for traditional orthodontic treatment.

Neuromuscular dentistry treatment can be complex, but our dentists have the experience and dedication to exceptional service to help you feel comfortable during each step of the process. Contact NYC Smile Design online or call (212) 574-4660 today for a consultation to discuss the steps of full mouth reconstruction.