75% of the population is affected with TMD signs & symptoms, such as headaches, vertigo, ringing ears, neck pain, shoulder pain, sleep apnea or sleep disturbance, and a lack of libido and cognitive focus. Most people do not associate the ailments with TMD or are misdiagnosed. Our Central New York area was lacking a center dedicated to the comprehensive evaluation and non-surgical treatment of TMD, such as myofascial pain, TMJ pain, and secondary conditions such as vertigo, ringing in the ears/tinnitus, neck pain back pain, and headaches. Dr. Dorothy Kassab has taken a special interest in the area of orthodontics early on in her general dentistry career.
The science of orthodontics has evolved over the past 30 years to broaden smiles similar to the famous "Julia Roberts smile", with a huge shift away from extractions and retractions to expansions and advancements. During this education, Dr. Dorothy Kassab took it upon herself to study TMD, the joint, case management, and develop a comprehensive multidisciplinary approach to treatment that has proven a success for her patients.
The bite acquisition for the treatment with appliances is now patented in the OneGuard Solutions TM kit product. Dr. Dorothy Kassab also leads a small group online TMD study club and periodic TMD Academy lectures where teaches other colleagues this successful modality. At the same time, Dr. Dorothy Kassab understood the void in our local area and being the visionary opened up the first Central New York TMD Pain Center dedicated to the diagnosis and comprehensive non-surgical treatment of TMJ pain & conditions.
The 2 most significant, yet misunderstood and unknown factors to other providers and patients are that TMD results in a displacement of the disc, dislocation of the mandible, or dysfunction of the joint, which in turn results in 2 things a weight shift of the entire head AND a corresponding agonist/antagonist muscle group response down the entire body. Over time, unbalanced muscle group function produces pain and injury. The second factor is that it produces an altered vertical measurement of the mandible to the skull causing a head-forward posture and affecting physical structures such as the airway, tongue space, sinuses, compression of nerves, and spasms of muscles.
The head weight shift AND the head-forward posture are the sequelae of this debilitating condition that typically physicians or patients DO NOT associate with TMD but have profound signs and symptoms in patients that can be improved by treating the cervical head alignment. Neuromuscular oral appliance therapy has been studied over decades and has proven to be a reliable modality to improve patients' signs and symptoms in the TMD Headache Relief Solutions.
• Sleep Apnea & •Upper Airway Resistance Syndrome
• Facial pain
• Back, neck, and shoulder pain
• Tinnitus (ringing in the ears)
• Vertigo (dizziness)
• Trigeminal neuralgia (tic douloureux), a neuropathic pain disorder unrelated to TMD
• Bell's Palsy, a nerve disorder unrelated to TMD
• Sensitive and sore teeth
• Jaw pain
• Limited jaw movement or locking jaw
• Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
• Worn or cracked teeth
• Clicking or popping in the jaw joints
• Jaw joint pain
• Tender sensitive teeth
• A limited opening or inability to open the mouth comfortably
• Deviation of the jaw to one side
• The jaw locking open or closed
• Postural problems (forward head posture)
• Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
• Pain in the muscles surrounding the temporomandibular joints
• Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
• Pain behind the eyes
• Swelling on the side of the face and/or mouth
• A bite that feels uncomfortable, "off," or as if it is continually changing
• Older Bell's palsy
This report considers the entire spectrum of disorders related to Temporomandibular disorders.
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG), and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMGs are used to verify pre-, mid-, and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording. 
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3–6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as an "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Neuromuscular Dentistry is generally provided in two Phases. Most commonly, the first phase is performed for patients that are symptomatic, usually with acute pain such as headaches, etc. Some Phase One patient does not have symptoms, but rather their occlusion or bite needs to be corrected prior to restoring their mouths with crowns, veneers, or NM Functional Orthodontics (often termed an Esthetics case). Phase Two treatment is preferably decided upon PRIOR to embarking on Phase One treatment by the NM Dentist and the patient. Phase Two treatment can be: 1. Continuing to wear the lower orthosis with the knowledge that replacements will need to be fabricated over time (at patient expense) 2. Restorative Dentistry to the new bite position 3. Neuromuscular Functional Orthodontics 4. Combination of any of the above. There are separate fees for Phase One and Phase Two treatment options. Phase Two Dentistry options are "conventional" dental procedures such as crowns, bridges, implants, and partial or full Dentures.
The treatment plan involves utilizing low-frequency TENS (transcutaneous electric neural stimulation) prior to a passive bite registration in her resting mandibular neuromuscular position to create a medically necessary orthopedic repositioning appliance. This device is used to position the condyles in the fossa in a less pathological, more true anatomical position, reduce stress to the jaw joint, increase joint space, allow remodeling of the condyle, heal retrodiscal tissue, re-capture the dislocated articular discs, provide proper alignment of the mandible to the skull, reduce myospasm and pain, and maintain the muscles of mastication at their proper physiologic resting length. Please note that all treatment is neuromuscular and orthopedic in nature and necessitated by a medical condition resulting in head and neck pain and should be considered a medical necessity. At this time, the treatment does not involve the teeth, periodontium, or surrounding structures, but is for a structural, orthopedic, neuromuscular problem that must be stabilized (Phase I). The teeth will be treated at a later date (Phase II) to hold this new, stable orthopedic position using methods.
Neuromuscular dentistry is a dental treatment philosophy recognized by the International College of Craniomandibular Orthopedics (ICCMO) and the International Association of Aesthetic Dentistry (IACA) and The American Academy of Craniofacial Pain has a Neuromuscular Section these professional associations consider the health and welfare of temporomandibular joints, masticatory muscles, and central nervous system mechanisms a follow the same physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting the physiologic "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry can correct the relations of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion.