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Neuromuscular Dentistry

Neuromuscular Dentistry – The Holistic Approach to Treat Facial Pain

How long have you been suffering from headaches? For how many years have you been popping those anti migraine pills? Does your snoring disturb those sleeping with you or even those in the next room? The field of medicine has always involved reasoning. For every problem that you suffer from - the headaches (HA)/ neckaches (NA)/ pain while chewing/ facial pain/ neck pain/ migraine/ snoring/ interrupted sleep/ excessive daytime sleepiness - there is a cause. Treat the cause; instead of being dependent on medicines for a lifetime. Once the cause is removed, so is your problem.

80% of all uncured headaches/neckaches/disturbed sleep is caused due to a simple malpositioning of your lower jaw, the mandible. The malpositioning happens as a result of erratic chewing habits, such as single side eating (due to missing teeth on the other side), failed prostheses, wrong breathing habits or even failed dental treatment. These would lead to an error in the way our lower teeth are supposed to occlude with the upper teeth. This causes a shift in the mandibular position as the body has to find a solution so that the person can chew his food.

This faulty positioning, changes the way the mandible articulates with the skull; more often than not, pushing it upwards and backwards. This puts pressure on the tissue that lies between the 2 bones that form the joint. The articulation or joint is known as THE TEMPORO MANDIBULAR JOINT (TMJ) AND THE ERROR IN IT IS CALLED TEMPORO MANDIBULAR JOINT DISORDER (TMJD OR TMD). The tissue wears away due to this constant pressure. Through the sheath of this joint travel important nerves that supply a variety of muscles in and around the head and neck region. Hence, any constant stimulation of these nerves keeps those muscles in a hyperactive state for long periods, thus causing pain in the area. This neuromuscular pain ends up as the HA/NA that you suffer.
TMD is treated most successfully by NEUROMUSCULAR MEDICINE/DENTISTRY(NMD). NMD is done in 2 phases. The first phase is splint therapy. A lower splint is constructed by filling the space between the teeth that is created by the use of a TENS device that relaxes your facial muscles and then the use of a highly sophisticated mandibular tracking device that determines the actual position of your mandible. After a period of 5-6 months, the tissue that has eroded will form back automatically. Once the symptoms are nil, the splint is removed and the 2nd phase is started, wherein the space is permanently closed by either crown/bridges or orthodontic therapy.

Chronic TMD results in the silent killer, OBSTRUCTIVE SLEEP APNOEA (OSA) (Or vice-versa) a lifestyle disease which is very prevalent in India but commonly ignored. Do you know that almost 90% of all sleep deaths we attribute to cardiac arrests are actually caused due to long term untreated OSA? In India, snoring (which is a symptom of OSA) is mocked upon. OSA is a breathing disorder during sleep caused by a backward displacement of the mandible (90% of the time caused by TMD) and the tongue that is attached to it. Hence the tongue presses upon the airpipe reducing its size,thus causing an imbalance in the oxygen level in our body. So the heart struggles to pump out rich oxygenated blood. The body thus struggles for air, disturbing our sleep quality, finally ending up with frequent awakenings, snoring, exertional breathlessness, tiredness, high blood pressure, cardiac disease, etc.

A suspected patient is advised a sleep study which would indicate, among other parameters, your AHI (Apnoea – Hypopnoea Index), which should ideally be below 4. There are 2 methods of treatment. One is the popular but cumbersome and costly method of using a C-PAP machine, which is a ventilator like device that straps to your face, like a mask, and pushes in air at a high pressure; enough to push your tongue and jaw forward. Patient compliance and cost is a big issue, especially now when we compare with the pocket friendly smaller oral appliances.

If your AHI is below 20, oral appliances should be the choice. It basically holds your mandible in a forward position with the support of your upper jaw. It needs to worn only during your sleep and costs only a third of a C-PAP machine. It is that simple. But we should not forget the cause, which is more often than not the TMD. So, as long as the TMD persists, the OSA would never go away, or vice versa; in spite of whatever treatment you opt for. Also, other airway blockages need to be addressed.

Currently, in India, TMD is treated by surgeons. Yes, the pain would go away post-surgery, but the patient would become dysfunctional. However, NMD cannot treat patients who have reached the ankylosis stage, where the 2 bones of the joint have fused, for which surgery is the only option. NMD is a holistic approach with no pain during any part of the treatment.

Sadly, there are only a handful of NMD specialists practicing in India and an even fewer number who possess the technologically-advanced equipment.  Dr. Rajesh Raveendranathan, who has done his training and education in NMD and sleep medicine from Italy and USA, is a pioneer of sorts. Even though NMD was invented in the 60’s and shot to prominence in the 90’s, in India, there is still lack of awareness among patients and doctors alike. So if you are suffering from any of these symptoms, contact your doctor and ask for the nearest NMD specialist.

Dr. Rajesh Raveendranathan currently visits The Right BiteTM centres in Bangalore, Kolkota (Dental World) and Cochin. He also consults at Crystal Dental (Delhi), Smilecare (Mumbai) and Korambayil Hospital (Manjeri).


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Mrs. Shani

I used to have constant headaches for nearly 20 years. I've met lots of ENT surgeons and neurologists and have been consuming their medicines until I heard about Dr. Raj's NMD therapy from a friend of mine who got cured by him. I am really thankful to him for freeing me from my aches. I never realized my tiredness during any physical activity could in any way be related to my snoring.

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