1 / 47

NMD

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

halee-rocha
Download Presentation

NMD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NMD • THE SCIENCE

  2. The History & Evolution of Physiologic Dentistry 2

  3. 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 when it is not whole… 3

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. GROWTH AND DEVELOPMENT • MOST IMP THING O2 • FIRST YEAR GROWTH ADVERSELY AFFECTED WITH • ENVIRONMENT • NO FOSSA WHEN BORN • AFFECTED BY POSITION OF MANDIBLE

  10. THINGS THAT AFFECT FACIAL GROWTH • BREAST FEEDING • ORAL HABITS • ALLERGIES • AIRWAY OBSTRUCTION • DISHARMONY BETWEEN STOMATOGNATHIC FORCES

  11. 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

  12. CAVEAT: • WE ALL HAVE THE ABILITY TO EXIST IN ACCOMMODATIVE PATHOLOGIC POSITION

  13. WHEN THE PATHOLOGIC POSITION EXCEEDS OUR ACCOMMODATIVE CAPACITY PT BEGINS TO COMPLAIN EITHER OF PAIN DISCOMFORT OR ESTHETICS

  14. 90% OF PAIN IS DERIVED FROM MUSCLES - Dr Janet Travell

  15. TYPICAL PT • NECK PAIN • CAN’T TURN THE HEAD • CLENCHED OR BRUXED • HEADACHES • DOESN’T CONSIDER THEMSELVES A PAIN PT

  16. CO • CR

  17. PROPRIOCEPTIVELY PEOPLE CHOSE WHERE THEIR TEETH FIT TOGETHER CO=CR

  18. WHAT IS NMD

  19. NM DENTISTRY RESTORES TEETH WHERE THE MUSCLES ARE COMFORTABLE

  20. BECAUSE OF PROPRIOCEPTIVE CONTROL OF MABDIBULAR MOVEMENTS,THEY WILL ALWAYS CLOSE IN THAT COMFORTABLE POSITION

  21. 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.

  22. Six Dimensional occlusion • lateral • vertical • ap • pitch • yaw • roll

  23. lets discuss all the sign and symptom sheet

  24. pain in the joints • pain in the ear • pain around the eyes • pain in the jaw • pain in neck • shoulders

  25. Pain in forehead • temples • facial muscles • joint sounds

  26. Subjective hearing loss • Vertigo • ringing in the ears(tinnitus) • HEADACHES • fullness pressure in the ear • Difficulty swallowing

  27. Optimal Rx requires DD of the etiology of Ds process • requires primary or secondary stresses • Descending(primary TMD) • Ascending(sec TMD)

  28. Jaw position affects where cranium sits • Wax picture with condyle

  29. Transcutaneous Electrical Neural Stimulation TENS

  30. Myomonitor=Low frequency TENS

  31. Pumps waste metabolites and lactic acid from hypertonic muscles • Increases vascular flow • increases O2 • ATP • Glucose • Ca++

  32. TENS changes muscle metabolism from anaerobic (lactic acid) to aerobic ( Krebs)

  33. 8x more effecient • endorphin effect • produces antidromic refraction of the motor nerve

  34. 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

  35. now i have a difficult time getting her in the office • arizona • hawaii • utah • alaska

  36. Pt 39 years old • couldn’t sleep • diagnosed with fibromyalgia • jaw sounds • pain 9 out of 10 • ringing in the ears

  37. Pain almost gone 2 out of 10 • no longer on medication for fibromyalgia • sleep an average of 6-7 hours

  38. Forward Head Posture

More Related