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Neuromuscular Positioning

The first phase in TMJ treatment is based on finding a comfortable position for the lower jaw that is dictated by the major jaw-closing muscles and the nerves that innervate them.  This "neuromuscular positioning" is accomplished by using a custom-fit mouthpiece that is constructed so that the lower jaw is free to assume a position produced by the relaxed muscles rather than the teeth.

In cases where the muscles will not spontaneously relax, non-invasive, physical modalities such as specialized stretching techniques, electrode stimulation, and ultrasound therapy may be used.  The idea behind these treatments is to relax the jaw-closing muscles and allow them to comfortably position the lower jaw.  

The goal of this first phase of treatment is to eliminate muscular aches and joint pain by allowing the lower jaw to assume a relaxed neuromuscular position.  This new position can then be documented by a computerized scanner so that it can be reproduced.

In the next phase of treatment, an acrylic mouthpiece is fabricated which directs the lower jaw to the previously documented "neuromuscular position."  

Once the patient has reached his or her optimum level of improvement, patients enter the management phase of treatment.  In this phase, the new jaw position is stabilized in one of three ways:  (1) long term mouthpiece wear, (2) orthodontic treatment to allow the natural teeth to serve as a mouthpiece, or (3) full mouth rehabilitation to allow dental prosthetics (crowns, bridges or partials) to serve as a mouthpiece.


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