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Anthony J. Heibili DDS | Neuromuscular Dentistry in Rocky River

Anthony J. Heibili, DDS

20150 Center Ridge Road
Rocky River, OH 44116

T- (440) 331-8585
F- (440) 331-8672

Neuromuscular Dentistry

Cleveland, Ohio


neuromuscular_dentistry.jpgNeuromuscular dentistry is the evaluation and treatment of your overall oral health, by looking at how your muscles, teeth, and joints all work together.

TMJ stands for temporomandibular joint, which is the jaw joint in the temple, where the upper and lower jaws meet. As a commonly-used term, TMJ means temporomandibular joint syndrome and refers to a cluster of specific symptoms. In recent years, dentists have started using the term TMD (temporomandibular disorder), because the actual temporomandibular joint may or may not be part of the problem.

Other things besides the jaw joint that could cause neuromuscular or TMJ problems:

  • Posture

  • Head and neck muscle conditions

  • Your bite

Symptoms of TMD

  • Headaches

  • Jaw joint pain

  • Jaw joint noise or clicking

  • Limited mouth opening

  • Ear congestion

  • Dizziness

  • Ringing in the ears

  • Difficulty swallowing

  • Loose teeth

  • Clenching or grinding

  • Facial pain

  • Sensitive teeth

  • Chewing difficulties

  • Neck pain

  • Postural problems

  • Tingling in the fingertips

  • Hot and cold sensitivity of the teeth

  • Nervousness or insomnia

Your bite
Technically known as your Occlusion (the meeting of your upper and lower teeth), your bite is a central item to consider if you start having any of the TMD symptoms.

We all have a habitual, default bite. Our jaw muscles are programmed early in life to maintain certain positions. Even when we think our jaw is relaxed, there could well be tension there, but we're so used to it that we don't feel it as tension. However, we may well feel its consequences, in the form of any of the above symptoms.

How can a bite be changed?
A neuromuscular dentist can determine the position your jaws should be in if your muscles were relaxed, and can then adjust your bite to match.

How can this be done if your muscles are not relaxed when you think they are? By using a T.E.N.S. device (Transcutaneous Electrical Neural Stimulation). Dr. Heibili uses a Myomonitor.

    The Myomonitor
    The battery powered Myomonitor (muscle monitor) sends gentle electrical stimulation to your muscles on both sides.

  • It delivers the electrical stimulation through adhesive patch electrodes, which are attached over nerves that control specific facial muscle groups

  • There's virtually no pain

  • The affected muscles will twitch every one-and-a-half seconds

  • Blood flow to the area is increased

  • After about 45 minutes, this "exercise" of your muscles will have relaxed them

Once your muscles are truly relaxed, the neuromuscular dentist can record the position of your relaxed jaw.

  • He or she will place a fast-setting putty-like material between your teeth, and ask you to bite on it

  • This creates an impression in the material of your teeth positioning

  • The dentist can now evaluate whether your bite should be adjusted

Headaches are classified into 4 groups:

  • Sinus - behind the forehead and/or cheekbones

  • Cluster - in and around one eye

  • Tension - a painful band squeezing your whole head

  • Migraine - nausea and visual changes as well as head pain

    Tension headaches
    These are the most common.

  • If you get them only occasionally, you can probably alleviate them with over-the-counter medications.

  • If you get them often, and/or have had them for a long time, it would be wise to consult your dentist about them.

  • They can be caused by ongoing tension in the muscles around the temples that are part of moving the jaw. A mis-aligned bite can cause tension there, which leads to headaches.

  • When the bite goes uncorrected for a long time, the muscles remain tense, with no chance to rest, which impairs circulation in the area.

  • Impaired circulation is a lack of oxygen, which causes accumulation of waste products from your metabolism, which causes pain.

Dental treatment of headaches
If your dentist confirms that your bite is the cause of your headaches, he will then use an orthotic

    Use of an orthotic

  • An orthotic is a custom-made, plastic appliance that you can wear over your teeth

  • It holds your jaw in the new position based on relaxed muscles

  • You would wear this for a pre-determined period of time

  • If you find that during this time, your symptoms disappear, then you know that your old habitual bite was their cause

  • If you don't find that your symptoms disappear, then you know your bite is not causing them, and other options can be pursued

In practice, you will usually find the symptoms gone, because your dentist would only proceed with an orthotic if there were very strong indications that your bite was causing the headaches. The orthotic is a test. It doesn't permanently change your bite, but just ascertains whether it's causing your symptoms.

Permanent adjustment of your bite
After the orthotic has proved over time that your bite was causing your symptoms, whether tension headaches or other pain, your dentist can permanently adjust your bite, so as to prevent future such symptoms.
There are some options for doing this:

  • A more permanent orthotic

  • Dental treatment to alter your bite

  • Use of a Myomonitor device to relax your muscles when headaches are most bothersome.