Neuromuscular dentistry is inherently limited in effectiveness in treating bruxing due to its purely peripheral approach. Practitioners seek merely to manipulate sensory(afferent) inputs to the disordered part of the brain, the latter of which is the root cause of the problem. Yes, malocclusion and jaw positions can trigger bruxing in some, but they are only triggering the processes of a deranged trigeminal nucleus in the brain. And the neuromuscular dentists don't understand the neurological processes they are dealing with. Worse, neuromuscular dentists charge a great deal of money for services that all too often make patients much, much worse.
The best treatment approaches will focus directly on the trigeminal nucleus, which is the heart of the problem. There are various causes for derangement of these circuits, but medications such as Gabitril, along with Lamictal, Lexapro, or Welbutrin, can successfully reduce or eliminate bruxing for many. For the rest, find a good oral or plastic surgeon to administer Botox injections in the masseters to decrease the force of clenching and bruxing.
These treatments actually work and don't involve changes to your bite or other changes that communicate signals to your trigeminal nuclei that we as yet don't understand.
Remember that about 90% of people brux, but most do so lightly, without problems. A minority of us brux so hard that we damage teeth and our jaw joints. The former can sharpen teeth and even out bites. it makes adaptive sense. The latter does not and is due to the trigeminal circuits responsible for adaptive bruxing put into overdrive.
Those having trouble affording meds or Botox can contact the manufacturers and often get them for free.
So, the first lines of treatment are with your general dentist and a psychiatrist. Then, oral surgeon. Never, ever go to a neuromuscular dentist unless everything else has failed and suicide is plan B.
I indeed have a problem with the lack of neurological knowledge in the field of dentistry related to neuropathic/osteogenic pain, and the the ability to differentiate type of pain.
The amount that is being requested from the patients (3000 dollars what i was quoted)..
I wonder how did they come up with such a payment scale... Did LVI institute a recommended fee, so all the "graduates" would charge a similar amount.
Thank you again Zeldovich for your lucid explanation of this practice.
Botox/other muscular spasm inhibitors hold a promising future; would you mind sharing any articles that you might be aware of - from pubmed.com or elsewhere to back up the efficacy of such procedures?
I know this is quiet a recent practice, that's why I am interested in the peer reviews studies.
Unfortunately, linking to pubmed studies doesn't work, but if you type "botox" and "tmj" into the search field at pubmed.gov. you will find numerous papers published on the subject.
My oral surgeon offers these injections and says they are very, very effective.
I should clear something up though about neuromuscular dentists and the lack of understanding of the signals they are sending the trigeminal nucleus with their various manipulations. It is not only that they may not understand neuropathic pain, but changes to the jaw positions and teeth send signals which can change bruxing patterns, sometimes for the worse. In fact, sometimes the changes are nightmarish. So, beware dentists bearing peripheral treatments. (that is peripheral nervous system stimulation versus central)