Neuromuscular Dentistry

In Gurnee, Illinois
Serving the Chicago metro area

The basic premise of neuromuscular dentistry is that healthy physiologic muscle function is basic to all of dentistry and medicine. A corollary to this is: Doctors do not heal their patients but rather they remove the impediments to healing and the body heals itself.

Dr. Ira Shapira is the founder of Ihateheadaches.org, a resource dedicated to educating and assisting those in need of headache diagnosis and treatment.

Neuromuscular dentistry is one of the most exciting fields of dentistry. The history of dental treatment has always been mechanical and primarily involved in repairing disease. This changed in 1934 when Dr. Costen, an otolaryngologist, in St Louis , Missouri described a series of problems in denture patients that eventually grew to become know as TMD or TMJ disorders. True to the mechanical background of dentists, they treated these problems as mechanical problems.

Dr. Barney Jankelson, a board certified prosthodontist (specialty dentist), changed all that. He realized that mechanics were important in treatment of these painful conditions, the underlying muscle physiology was most important. Dr. Jankelson (or Dr J) as his friends called him developed methods of relaxing muscles and measuring physiologic parameters . His work was done in Seattle, Washington now known world-wide as the birthplace of Neuromuscular dentistry.

Due to the Knowledge of Dr. J. and many other great innovators, neuromuscular dentistry became the preeminent treatment for TMJ problems.

There was a split in dentistry with many dentists clinging to their outdated mechanical views. These dentists still believe that the jaw joint or the temporomandibular joint is the most important aspect of treatment . They consider themselves to be Centric Relation dentists. Centric relation is the description of a joint position. The fallacy of this belief is reflected in the fact that the definition of centric relation continuously changes, and there are over 20 different definitions. The main belief of this group is that the muscles of the treating dentist's hands know better where the patients jaw should function than the patient's own relaxed healthy muscles.

There are other greats in Neuromuscular Dentistry.

Dr. Jim Garry was a pedodontist who described how airway and facial development affected the normal formation of the jaws and face. He was a great advocate of breastfeeding, and his work has changed the lives of tens of thousands of children.

Dr. Norman Thomas is an anatomist, physiologist and dentist who understood the science behind neuromuscular dentistry and how it related to total body health and posture. He is the brilliant man that still enables clinicians to integrate their clinical skills with the underlying basic science. He continues to do some of the most important work in all of dentistry at the Las Vegas Institute (LVI).

Robert Jankelson, Barney's son, carried on his father's work and wrote the first textbook on neuromuscular dentistry.

Janet Travell is one of the all time medical greats and is known for her textbook Myofascial Pain and Dysfunction: A Trigger Point Manual. She was President Kennedy's personal physician. He had severe chronic pain and walked with a limp and cane due to war injuries. Dr. Travell changed his life by letting him live without severe pain.

Jackie Kennedy built the Rose Garden at the White House in her honor because Dr. Travell loved Roses.

I am Dr. Ira Shapira and I was fortunate to be students of these greats of neuromuscular dentistry. I have been practicing the art and science of neuromuscular dentistry for over 25 years . My partner Dr. Mark Amidei, has been with me for over 16 years and also practices using neuromuscular dentistry.

The Las Vegas Institute, considered the premier learning institute, was founded by Dr. Bill Dickerson. His background was from the Centric Relation mechanical school of thought but 10 years ago he had the great courage to abandon the outdated ideas and teach cosmetic reconstruction using neuromuscular ideals. Thousands of dentists around the world are now embracing the science of neuromuscular dentistry. Bill is one of the great men in cosmetic dentistry but he will be best remembered for his work in making neuromuscular dentistry available to the world.

Traditional dentistry operates under the assumption that your jaw's acquired position is its optimum position. Neuromuscular dentistry, on the other hand is focused on finding the ideal position or range of positions for ideal health. This optimum position for your jaw is the basis for future work.

Our goal is not just to treat a single tooth to solve the problem. Instead, we examine the entire neuromuscular and anatomical system of the head and neck in order to treat the whole patient, alleviating pain throughout the mouth and body.

We strive to treat the whole problem and give our patients a higher quality of life by aligning your jaw in the most comfortable position possible. Posture throughout the body is affected by the jaw and jaw function. The lower jaw acts like a counter balance for the skull as it sits atop of the spine much like the weights that are used in a doctors scale. You set the 50 and the 10 pound weights and the when you get the 1 pound weight perfectly adjusted the scale rests perfectly centered. If you move that weight even slightly in either direction the scale does not go slightly out of balance but rather it goes clunk. That is the effect disruptions in jaw function has on the entire body's postural balance. I tell my patients, You've been clunked.

Neuromuscular Dentistry;

Diagnostic and treatment modalities

Warning!! All doctors that use these modalities do not practice neuromuscular dentistry. Some use the information as a baseline only!

MKG- Computerized Mandibular Scan

The mkg was invented by Dr. Barney Jankelson, DR. J, and it is designed to measure mandibular movement in 3 dimensions and track the jaw to understand both function and dysfunction. The name actually means study of mandibular movement. The name was changed to differentiate between neuromuscular dentistry and kinesiology, the study of movement elsewhere in the body. The scanner works by tracking a small magnet to the lower front teeth and tracking the magnets movement by sensors that do not touch the lower jaw. This allows the study of mandibular motion free of any interfering forces. Dr Shapira has been using an MKG for 23 years starting with an early model that utilized an ossciliscope to today's modern computerized scans. The understanding based on ossciliscope findings have been verified by today's computers. Clinicians who learned rd on the ossciliscope usually have a deeper understanding than doctors learning on computers today. Today's computers do give a wealth of information that was not available in the past.

EMG or electromyography is utilized in conjunction with the MKG or CMS to evaluate the physiologic state and function of the masticatory (jaw) muscles and neck postural muscles. The EMG can be used to evaluate bilateral symmetry of the muscles, the health during rest and function, and can be used for incredibly accurate adjustments to the bite.

Emg is also used to measure the effectiveness of TENS in relaxing muscles. Neuromuscular dentistry typically uses bipolar adhesive skin electrodes that measure activity only. There is no discomfort involved during EMG testing. Effectiveness of muscle relaxation can be determined by EMG following use of TENS.

TENS or transcutaneous electrical neural stimulation is at the heart of all neuromuscular dentistry. It is used to create a healthy relaxed state in unhealthy, diseased or spastic muscles. The Myomonitor is a specific type of TENS unit invented by Dr. Barney Jankelson that is used to relax masticatory and cervical musculature. The unit uses a very small electrical impulse to gently stimulate the muscles through a single synapse reflex (similar to the knee jerk done by physicians) repeatedly over an extended time. This action naturally relaxes the muscles. While some people don't think the process sounds natural I describe it as such because the repeated pulsing and relaxation pumps metabolic wastes out of the muscle cells and brings in blood with oxygen and nutrition, and the muscle relaxes as it heals versus the unnatural relaxation occurring by dumping chemicals or drugs into the system.

The pulses occur every 1.5 seconds and last only a 500th of a second. This time is set because it is the length of time it takes the cellular membrane to return to normal after stimulation. It is for this reason the muscles can be pulsed for an extended time without fatigue.

Borer associates have a similar TENS unit that is used for the same purposes but is slightly different in design. The slight differences usually do not matter, but for difficult long-term patients, each unit has its own peculiar advantages usually only appreciated by the very skilled and adept neuromuscular practitioner.

Both types of TENS are used in conjunction with the MKG and EMG to evaluate changes in mandibular position and function as the muscles are made healthier. Most problems are associated with long term accommodation pf muscle to less than ideal conditions. This results in a repetitive strain injury as the muscles must overcompensate for long periods of time.

The best way is to look at the diagnostic information gathered with these devices as aids that help the doctor make a more accurate diagnosis and plan effective treatment. If you go to the mall and look for a store, you will look up the store on the map and then look for the you are here arrow to figure out where you are in relation to where you are going. This information is vital to prevent treatment going in the wrong direction.

Transcranial neural transmitter modulation is a very unique type of TENS unit that is designed to stimulate the brain and create neurotransmitter changes in the brain similar to potent antidepressants without the chemical side effects.

Dr. Ira Shapira has been using this instrument as part of a diagnostic protocol to help understand and differentiate between peripheral disorders and problems arising from the CNS or central nervous system.

TENSing (Transcutaneous Electrical Neuromuscular Stimulation) muscles works out the lactic acid in your jaw muscles while working in fresh blood, oxygen, and nourishment for your jaw muscles. This helps relax your muscles and helps neuromuscular dentist Dr. Shapira to re-align your jaw to its relaxed neuromuscular rest position and establish an occlusion that lets the patients muscles return to a healthy state after use. The corrective alignment is usually done by a diagnostic orthotic. This allows initial treatment that is reversible until accurate diagnosis and successful phase 1 treatment is accomplished.

Phase 1 treatment is designed to find a functional position that stabilizes the jaw and allows healthy function in which the muscles naturally return to their relaxed state. Phase 2 treatment is long term stabilization with a more permanent orthotic cosmetic reconstruction orthodontic or surgical intervention. Avoidance of surgery is a top concern of Dr. shapira because there are so many complications related to surgery.

Neuromuscular dentist, Dr. Shapira, has been working with chronic head and neck pain patients for 23 years. His practice is dedicated to non-surgical alternatives to Temporomandibular Joint Dysfunction and drug-free pain management. He is certified to treat sleep apnea with FDA approved appliances as non-surgical alternatives to UP3 and Tracheotomy. He understands the relation of jaw position and sleep apnea to all of the physical and biochemical disorder patients deal with. He has successfully treated hundreds of patients with a multitude of TM Joint problems, TMD and the myriad of related conditions. As a former sufferer of chronic pain, Dr Shapira made it a personal crusade to not only relieve his pain but to give patients a quality of life they never thought was possible.

Dr Shapira trained with Dr Janet Travell, the world's expert on myofascial pain and dysfunction and uses the techniques he learned from her to alleviate pain and restore normal function to his patients. Many experts consider fibromyalgia and myofascial dysfunction to be different subsets of the same disorder.

For more information about Neuromuscular Dentistry visit Wikipedia's Neuromuscular Dentistry page

For information about Electromyography visit Wikipedia's Electromyography page

Click here for information on TMJ/TMD Treatment

Click here for TMJ/TMD FAQs

Click here to read more on Neuromuscular Dentistry in the Sleep and Health Journal

What Causes TMJ Disorder?

Note: Neuromuscular dentistry typically use non-invasive bipolar adhesive skin electrode

If you demonstrate any symptoms of TMJ and TMD disorder, you should immediately contact neuromuscular dentist, Dr. Ira Shapira and neuromuscular dentist, Dr. Amidei in Chicago, Illinois. Email us or call 847-623-5530 for a TMD treatment or TMJ treatment consultation. His practice is located in Gurnee, Illinois.

Many patients may remember Dr Shapira from his time at the Pain Relif Center in Racine Wisconsin, a multidisciplinary practice in pain medicine as well as from the TMJ center and oral facial pain center of Chicago where he practiced with a Diplomat Oral Surgeon as well as his dual tenures at Rush Medical School where he was involved in research and treatment of sleep apnea and snoring as a visiting assistant professor in the late 1980's and early 1990's and again as an assistant professor in the late 1990's and early 2000.