Neuromuscular dentistry is an approach to dental treatment that focuses on the correction of jaw misalignment. Neuromuscular dentists determine the optimal position of the jaw in order to correct misalignment and adjust how the upper and lower teeth come together (occlusion). By realigning the jaw joint through the use of cosmetic dental restorations, tooth recontouring (equilibration) or orthodontics, neuromuscular dentists strive to alleviate stress from the jaw muscles and eliminate painful symptoms of temporomandibular joint disorder (TMJ or TMD).
A neuromuscular junction (or myoneural junction) is a chemical synapse formed by the contact between a motor neuron and a muscle fiber. It is at the neuromuscular junction that a motor neuron is able to transmit a signal to the muscle fiber, causing muscle contraction.
Muscles require innervation to function—and even just to maintain muscle tone, avoiding atrophy. Synaptic transmission at the neuromuscular junction begins when an action potential reaches the presynaptic terminal of a motor neuron, which activates voltage-dependent calcium channels to allow calcium ions to enter the neuron. Calcium ions bind to sensor proteins (synaptotagmin) on synaptic vesicles, triggering vesicle fusion with the cell membrane and subsequent neurotransmitter release from the motor neuron into the synaptic cleft. In vertebrates, motor neurons release acetylcholine (ACh), a small molecule neurotransmitter, which diffuses across the synaptic cleft and binds to nicotinic acetylcholine receptors (nAChRs) on the cell membrane of the muscle fiber, also known as the sarcolemma. nAChRs are ionotropic receptors, meaning they serve as ligand-gated ion channels. The binding of ACh to the receptor can depolarize the muscle fiber, causing a cascade that eventually results in muscle contraction.
Neuromuscular junction diseases can be of genetic and autoimmune origin. Genetic disorders, such as Duchenne muscular dystrophy, can arise from mutated structural proteins that comprise the neuromuscular junction, whereas autoimmune diseases, such as myasthenia gravis, occur when antibodies are produced against nicotinic acetylcholine receptors on the sarcolemma.
Symptoms of TMJ disorders can include facial or ear pain, jaw soreness, clicking or popping noises upon opening or closing the mouth, jaw stiffness, headaches, or neck discomfort. Symptoms can range from mild discomfort to debilitating pain.
Diagnosis of TMJ disorders can be difficult, as jaw pain is often related to other conditions, such as poor sinus drainage, arthritis, or facial injury. A qualified and experienced dentist can make a TMJ diagnosis and recommend an appropriate course of treatment to relieve some or all of the symptoms. A thorough physical exam and X-rays may be necessary.
Dr. Gonzales may utilize several methods for treating TMJ, depending on your particular needs. Mouth guards, muscle relaxants, and stress reduction techniques can help.
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