Monthly Archives: September 2008

Who needs a seat belt? Part 2

It is common for the chronic TMD sufferers to have over stretched the ligaments of the TMJ.  This results in the joints being too loose.  When sleeping, the jaw often falls back and interfers with breathing.  There are studies that link bruxism ( clenching and grinding) to Sleep Disordered Breathing. 

Gilles Lavigne, a researcher in the Faculties of Dentistry and Medicine at Université de Montréal, explains that “the development of neurobiology has enabled us to better understand the structure of sleep in clenchers and to define bruxism clearly as one of many cyclic phenomena that are characteristic of sleep.” The researcher and his team at Sacré-Cœur hospital in Montréal have now gained international recognition for establishing criteria to identify nocturnal bruxism.

Many medications that are classified as Selective Serotonin Reuptake Inhibitors (SSRI) have been shown to induce clenching especially during sleep. 

Drugs in this class include (trade names in parentheses): (source: Wikipedia)

  • citalopram (Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram)
  • dapoxetine (no trade name yet; not yet approved by the FDA)
  • escitalopram (Lexapro, Cipralex, Esertia)
  • fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR), Fluox (NZ), Depress (UZB))
  • fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
  • paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)
  • sertraline (Zoloft, Lustral, Serlain)
  • zimelidine (Zelmid, Normud)

These medicines are used so commonly for a long list of indications, this is definitely something to be aware of.

When I wear my seat belt before driving my car on the street, it does not show a lack of confidence in my driving ability.  There are other drivers on the road that may be impaired or inattentive.  There may be a mechanical problem such as a blown tire from a nail on the street.  So wearing a seat belt is a sensible thing to do.

If we prescribe a sleep appliance such as Somnomed MAS after finishing a Neuromuscular Reconstruction, it shows prudence.  Not a lack of belief in our ability.  Just like wearing a seat belt.

Who needs a seat belt? – Part 1

Neuromuscular dentistry is based on these fundamentals: 

  • measured, objective data is fact; while all else is just opinion
  • start with unstrained jaw and neck muscles that move the mandible
  • allow the lower jaw to move through a trajectory which is determined by the simultaneous contraction of all of these unstrained muscles and optimal TM Joint conditions
  • freedom of entry in to and exit from, a stable bite position
  • address ascending posture factors with co-treatment from physical therpists and AO (Atlas Orthogonal) chiropractors

 

 

With this level of attention to muscles, posture and joints as well as micro occlusion of the bite, most of the usual reasons for breakage of restorations (crowns, veneers etc.) are successfully addressed.  As such the usual cause of breakage, interferences when chewing and bruxism is resolved to a great extent.

Should a NM dentist then prescribe a “seat belt” for his restored patients? If he or she gives a sleep appliance or night guard, after NM full mouth resotrative treatment, does it exhibit a lack of confidence in the priciples of Neuromuscular dentistry?

Let us look at this more closely in the next post!