- Top of page
- Anatomical Preconditions
- Conclusion and Summary
- Competing Interest
The current development of computer technologies, as well as new examination methods, enables the linking of relatively distant fields of medicine. For this reason, the term ‘integrative medicine’ is now becoming more widely used in specialised literature. Recently, the functional connections between the structures of the maxillofacial region and other systems of the human body have been thoroughly studied and some articles published in scientific literature describe the influence of different pathological states of the maxillofacial region on orthopaedic problems. Modern research conducted in the field has proved the positive influence of a correctly performed reconstruction of occlusion on such important indices such as carriage, stable balance, aches in muscles, headaches, physical state, eyesight and some others. A dentist should not now be perceived as someone whose job is merely to treat people's teeth, but as a physician of the maxillofacial region. In the framework of this concept a new direction of dentistry has appeared: maxillofacial dentistry or integrative dentistry. The field of maxillofacial dentistry has been widely recognised by the professional community, and this is reflected in its inclusion in the syllabuses of the world's leading universities.
In neuromuscular dentistry the following principles are applied:
- Direct connection with classical physiological concepts and application of its terms. According to physiology, the central nervous system, muscles, joints, teeth and jaws are one functional unit. Pathological changes appearing in any part of this complex have an influence on other parts. Therefore, successful treatment has to be applied to the whole system, not only its most diseased part. This is the core assumption of modern neuromuscular dentistry, which is focused on the detection of physiological mechanisms determining the reciprocal influence of the maxillofacial region on other parts and systems of the human body
- During treatment a neuromuscular dentist seeks the proper balance between the work load and relaxation of the masticatory muscles. The aim of neuromuscular therapy is to create the proper conditions for muscle relaxation of the maxillofacial region as well as for the reverse movement of condyles mandibulares to the rest state, which would be optimal for a patient
- To establish a diagnosis and to provide further treatment sophisticated equipment is used. Technical equipment and computer programs enable the analysis of the state of muscles, temporomandibular joints (TMJs) and occlusion. The received biometric data are essential for establishing an accurate diagnosis. The saying of Dr Bernard, the founding father of neuromuscular dentistry, can be applied in this instance ‘If it has been measured, it is a fact; if it has not been measured, it is an opinion’.
A modern dentist is required to have not only knowledge of the maxillofacial region, but also general morphological and physiological awareness of the human body.
According to the orthogonal concept applicable to both organic and inorganic units, the resistance to any loading is the strongest when the resistance axis of the structure is parallel to the axis of loading.
From the point of view of neuromuscular dentistry, the orthogonal concept of regulating anatomical structures is a necessary condition for the natural functioning of the maxillofacial region. In the physiological head position, Camper's plane, the HIP-plane (Hamulus–Papilla incisiva), the occlusal plane, and the ANS-Porion line should be parallel to the horizontal plane as well as perpendicular to a vertical axis[1, 4] (Figure 1a). Should these planes not be parallel, imbalance of the maxillofacial system could occur, which would result in a number of interconnected neuromuscular reactions (Figure 1b).
Figure 1. Parallelism (a) and disruption (b) of main anatomical planes in human body. Ivo Klepáček, based on an original drawing by James E. Carlsson, DDS.
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The masticatory muscles play a significant role as various pathological processes in the maxillofacial region influence them. As masticatory muscles are loaded unevenly, muscle strain in its different parts is unequal, which leads to the alteration of the mechanical trajectory in the jaw joint. As a result of the uneven loading of their fascicles, the bone will adjust its attachment points to the muscles, and even its own structure. For example, the chronic spasm of m. pterygoideus lateralis could cause a deformation of the condyle. The alteration of the mandibular mechanical trajectory could be also connected with repeated premature contact between opposing maxillary and mandibular teeth. As a result of iatrogenic injury it could occur accidently. A premature contact stimulates a response of the nervous system (efferent impulses). With the help of head and cervical muscles, this response is intended to repeatedly return the mandibular joint to its physiological position. Furthermore, chronic and asymmetric overstrain of individual muscles and their groups could deform the bone structure and influence their growth. Muscle hypertonus could cause pathologies such as headaches, orofacial pain, different orthodontic anomalies, teeth abrasion and fractures, cervical teeth defects and TMJ disorders.
From the position of modern dentistry the determination of any mouth cavity condition is essential for diagnosing diseases, which at first sight appear not to be connected with dental pathologies. Both the loss of a tooth and the aforementioned premature contact could initiate a chain of reactions causing various disorders. In serious cases, for example loss of a molar and significant height reduction of the bite, there is a high risk of the emergence of different symptomatic complexes as a result of heightened pressure on chorda tympani and n. auriculotemporalis (tinnitus, ear congestion, non-specific facial and neck pain, glossalgia, xerostomia, herpes meatus acusticus externus)[6, 7].
There is now clear evidence that the atypical relations between anatomical structures of the maxillofacial region could be connected with structural deformations of the cervical spine. Accompanying mouth opening and closing, the minor displacements in cervical, thoracic and lumbar spine also contribute to this interconnection.
Occlusion dysfunctions could cause sleeping apnoea, myofascial pain syndrome, column diseases, leg-length inequality, abnormal pelvis obliquity and incorrect head posture. They affect equilibrium, craniospinal fluid circulation and physical condition, among other parameters[6, 10].
- Top of page
- Anatomical Preconditions
- Conclusion and Summary
- Competing Interest
Occlusal forces are the greatest of all forces acting on the bone structures of the head, reaching a value of up to hundreds of Newtons per one square centimetre. This is why the angle (slope) and position of the occlusal plane play a significant role in determining the vector of action of the occlusal forces transmitted onto the skull. In the case of the previously mentioned deformation of the dental cone, the occlusal forces are transmitted through the bony structures differently, resulting in imbalance and shifting of the power centre of the cranial base. Permanent asymmetry of pressure distribution can result in gradual deformation of the skull and tension and ‘contortion’ of the dura mater.
The activity of the muscles participating in restoring the cranial balance is spreading far beyond the maxillofacial region. There is little doubt about the redistribution of muscle activity caused by occlusal dysfunction. What may be disputed is the question of the character, extent and consequences of these compensatory dysfunctions. Recently, the problems of the interdependence of the orofacial pathology and functional and structural dysfunctions in other parts of the body have been discussed in the scientific literature. In addition to the considerable research proving this interconnection there is also some scepticism, with opponents pointing to a lack of scientific evidence and the imperfect methods of examination.
The research conducted in this field is of great value as it enables the working out of new progressive principles of both prevention and methods of treatment. In particular, the dental component of complex rehabilitation can make a significant contribution to the treatment of pathologies of carriage, stable balance, eyesight, tinnitus, ear congestion and herpes meatus acusticus externus. Moreover, normalisation of occlusion and of the condition of the muscles should thus be regarded as an important component of therapy in all patients with pain of the cervical or maxillofacial regions. Unfortunately, this stomatological component of therapy in these patients is usually neglected as a result of the one-sided view of neurological and postural problems. This is compounded by the insufficient knowledge of dentists themselves. However, a number of important studies provide conclusive evidence about the beneficial effects of normalisation of the stomatognathic system[7, 41]. As an example, bite-plan splints correcting the mandibular position according to neuromuscular criteria are used in various sports disciplines.