“How can a dentist treat a TMJ patient without knowledge of EMGs, jaw tracking (positioning) understanding of where the jaw ‘should be’ and what the optimized occlusion should relative to standards of physiologic health in order to achieve happy muscles and the best distribution of even load?”
Almost 20 years has gone by and the dental profession has now recognized that the temporomandibular joints function better down and forward within the glenoid fossa. Previously this violated all reasonable thought at the higher levels of dental occlusal education which originally promoted an upper most and rear most TM joint position school of thinking which professed a centric position which was reliable, accurate and reproducible when establishing an occlusal position.
Well, any and all those who would support a more physiologic mandibular position other than what was previously promoted as sound reliable, “scientific” and proven occlusal teachings was effectively an “outcast” to traditional occlusal thinking – some would “disparage,” try to “degrade,” “demean” and “humiliate” those of a neuromuscular perspective. But to use the word “NM” or neuromuscular according to organization/institutional thought and based on the “majority” in the field of dental education also perpetuated the “disparaging,” “degrading,” “demeaning remarks often without logical bases of scientific thought. Mostly they feared the new terms and muscular focus of thinking regard the trigeminal system. Much bias and opinionated views against objective measuring technology, they knew little about in those earlier years defied classical rationale and thought of how the teeth, muscles and temporomandibular joints positioned themselves and operated.
Is it possible that in 20 years or less the North American dental profession, without saying so, is recognizing that the Myo-centric position is not so bad after all. They don’t dare use the term “myo-centric” because of the long history of politics…. because this term clearly conveys a historical thought and view many opposed regarding myo = muscles in a physiologic centric position. But now with the profession, many clinicians realized academia and what is theorized as a centric position has now changed, shifted and now moved from an upper most rear most joint position, moved to a mid most position and now has slowly but surely has been shifting over time toward a down and forward positional concept. Some may want to call it an adapted centric, a nuance in terms from “long centric”, or some may say they “bring the condyles in an anterior mid-superior position”. While others would say the mandibular position is similar to the Gelb 4/7 position, but they can’t say it exactly because they too are finding the terminology, words they are trying to find to describe this unique position without having to admit more optimal physiologic mandibular position.
Superimposed are 20 condyles and zygomatic arches
Nothing surprises me today, having observed within my dental profession the evolution of their understanding and appreciation of the neuromuscular concepts without admitting that it has had some very valid and compelling points that drove them to rethink their ways, and methods. No doubt this profession has been influenced by a greater thought to acknowledge other adjunctive supporting therapies what they now have been deeming proudly as a multi-disiplinary approach” to which in time the some clinicians will also recognize it too has its limitations as to results and outcomes.
Criticism of the neuromuscular concepts are definitely less, no longer at a high as it was years ago when I was bombarded and almost weekly challenged to prove and validate the NM science and approach. When I politely presented the factual evidence to those who challenged, and I would also ask for them in return to also show and present their physiologic science to prove the position, they often left me with no response in return.
Today, many have been influenced by the NM teachings and concepts that have evolved out from the United States. Now we seen these concepts seeping into all of UK, Europe, Asia, India, South America and abroad with a strong awareness and appreciation about airway, breathing, and the orofacial development.
Although I don’t openly profess to be a “Neuromuscular” dentist, many have come to know me as a dentist who appreciates the gnathologic concepts as well as the neuromuscular teachings to which I have mastered. Many are not sure how to brand me since some see me as an outcast of such from each of these prominent occlusal paradigms …perhaps an aberration of dentistry…being a serious student of dentistry. As many realize I continue to learn, pioneer and innovate the intricacies of occlusion, how it functions. TMD and all the associated issues of this problem definitely relate to occlusion – It is dentistry of the masticatory system.
Dentistry is a journey of learning and now I see great horizons for the future – a coming together of both the gnathic and neuromuscular principles. It is what many are calling a blended approach – GNEUROMUSCULAR (gnatho-neuro-muscular). It defines things that go beyond classical gnathic and classic NM….it brings the missing pieces together at another level.
“Insanity is repeating the same thing and expecting different results”.
– Albert Einstein
Perhaps one may say, that I see the profession is coming full circle back to a “Myocentric” without even saying what has been occurring within their thinking. Let’s admit it, our profession is now blending concepts, principles, technologies and even terms together. They themselves are not sure what is happening to the old schools they once held fast to, but realize the clinical realities of the challenging TMD case is pushing their views of occlusion to new levels of awareness, beyond the mechanical.
Truth is the truth. Science is science. Objective data is objective data. It doesn’t have a biase or an opinion. It is what it is. And so is gneuromuscular teachings. Some say it is NM while others say it is gnathic…even if you called it by another name it still is what it is….a gnathic centric, a centric relation, a bio-centric, an adapted centric, a neuromuscular occlusion, a long centric, or is it an adapted neuromuscular concept or is it really an optimized myo-centric?
We are living in a day of merging concepts and ideas with data and science that has been proven beyond a reasonable doubt. Let another 20 years go by and see if what we have stated still holds true.
- Whenever a new discovery is reported to the scientific world, they say first, “It is probably not true.”
- Thereafter, when the truth of the new proposition has been demonstrated beyond question, they say, “Yes it may be true, but it is not important.”
- Finally, when sufficient time has elapsed to fully evidence its importance they say, “Yes, surely it is important, but it is no longer new.”
- Montaign 1533-1592
“Truth is the truth. Science is science. Objective data is objective data. It doesn’t have a biase or an opinion. It is what it is.”