notion that TMJ functioned through a specific hinging rotating behavior

Neuromuscular Dentistry Debate

You can find two rivaling philosophies of treatment methods through which clinical dentist are caring for their patients.

The initial and older philosophy is represented by Gnathology, which is structured on the opinion the temporomandibular joints is on an axis of rotation in the glenoid fossa of the skull. These clinicians believe occlusion is guided and brought together to a finally tuned order, determined by the axis of jaw joint rotation. The emphasis is on occlusion and joint position which is fundamentally called “centric relation”.
A second newer school of thought is represented by neuromuscular dentistry, established on the knowledge that the TMJ is in a physiologic resting position primarily based on direction provided by muscles and stabilized by an occlusional relationship between the upper and lower teeth. Here the focus is on a physiologic posture of the mandible correlated to the skull, along with physiology of the muscles in supporting a position of occlusion for stabilization of all involved entities: the TMJ, muscles and teeth.

Neuromuscular Dentistry: Gnathology Versus Neuromuscular

There is strong debated about both these philosophies are among clinicians that have been seeking the answers to the mysteries of occlusion. There are many challenges involved in treatment and management of the mandible, mastication muscles, hard and soft tissue structures that support the TMJ, as well as the physical and emotional elements that impact patients. The joint’s position is a major point of contention among the different philosophies, with many strong and opinionated feelings that support both views, past clinical experiences and instruction received.

What is Gnathology?

The word “Gnathology” was initially created by Dr. Harvey Stallard. The term originates from the Greek “gnathic” or “gnathos” referring to the jaw.
Gnathology pertains, in a broad or all-inclusive sense to the gnathic system measuring jaw relationship and function. Dentistry is the division of medical science that deals with teeth and the supporting tissues; while gnathology represents a dental specialization that focuses on the complete gnathic system and the whole patient.
Dr. Stallard as both a dentist and founding father of the gnathological principle stated, “Gnathology includes the exact relations existing between the teeth and the morphological border movements of the condyles: the lateral, the anterior and the rearmost positions… and most importantly, gnathology includes knowing how the nine various directions the condyles move laterally and medially in vertical chewing movements. How the chewing cycle of cusp points may be related to centrically related cusp-fossa occlusion, is wanted gnathological knowledge.”
Clinicians have emphasized gnathological treatment methods for many years to relate the teeth properly to each other in order to have cooperation between jaw motions and joints. Many have begun to realize through specialized medical practice that despite the fact that the concept and philosophy sounded good, it falls short on physiologic science and objective ideals.
Gnathological concepts originated during the 1930’s by very innovated physicians who desired to fully grasp mandibular movement by using a mechanical instrument known as articulators. These devices were designed using the notion that the TMJ functioned through a specific hinging-rotating behavior. These misleading concepts continue to persist as false notions still pervade the modern dental curriculum inherited from the early inventors.

Neuromuscular Dentistry: The Rise Science and Technology

Advancement of dental technology has greatly enhanced understanding of the mastication system and it accompanying structures. Dr. Bernard Jankelson led a new movement using scientific instrumentation to obtain objective, quantifiable data that can be documented to evaluate mandibular movements both during functional motion and at rest. A variety of systematic studies have been published in medical journals helping to reveal the dynamics of mandibular functionality, as well as muscle activity through both active and resting modes. Paths of mandibular motion can effectively be registered by neuromuscular dentistry in six different plains to distinguish pathological from physiological activity:

• Vertical
• Anterior/Posterior
• Frontal/Lateral
• Pitch
• Yah
• Roll

This innovate technology and data can successfully validate patient’s feelings and concerns. An optimal mandibular positioning can be realized without bias or opinion for every individual patient, which in turn gives rise to precision in treatment and predictable results. Distinct and reliable data can be compiled and analyzed to fully grasp the legitimate pathophysiology of mandibular activity, muscle action and function and the relationship to occlusion of the teeth and the TMJ for every patient in need of treatment.
No longer does treatment need to be based on subjective opinions and experiential guesses in order to attempt to care for patients. Doubt and questions disappear when those charged with treating patients dismiss outdated concepts and address the truth of scientific evidence.

Neuromuscular Dentistry: A New Approach to Treatment and Care

Dr. Maurizio Bergamini, M.D. stated “The field of neuromuscular dentistry has matured to adulthood. Over twenty years of study and research confirmed by clinical and experimental controls have enabled this special discipline to assume a respected role within the medical sciences. At last, it has achieved wide acceptance, is taught in the universities of several countries, is discussed at medical meetings and congress, and is considered an indispensable clinical method for an increased number of clinicians.”
Neuromuscular dentistry has asserted itself, through Dr. Jankelson’s examination on the fundamental role of the the neuromuscular system to involve all the components of the the head, neck, as well as mouth with its dysfunction. He helped to develop the ability to measure and regulate biophysical and biochemical elements that determine jaw movement. Dr. Jankelson’s motto elegantly summarizes the neuromuscular approach: “If it has been measured, it is a fact; if it has not been measured, it is an opinion.”
The neuromuscular approach should be welcomed in this modern era of dentistry among practitioners that seek to understand complexities of dental treatment. This is especially true of those working in the restorative realm of dentistry, focusing on musculoskeletal, myofacial pain, and TMJ problems. For those that witness the shortcomings associated with traditional dental teachings in clinical practice, it is inspiring and refreshing to fully grasp the manner in which stomatognathic systems truly function, supported by scientific instrumentation recording and verifying issues faced by patients in day-to-day clinical practice.

Neuromuscular dentistry is both scientifically and physiologically centered. Many health and medical disciplines support and confirm these views. Other professionals that understand the neuromuscular approach include osteopathic physicians, cranio sacral message therapist, chiropractors, physical therapists, as well as physicians that treat head and neck pain management. Diagnostic instrumentation discussed here is used in many different settings as part of scientific research and investigative study. This has answered questions, which allow neuromuscular dentists to investigate new possibilities that were never before believed to be in the realm of dental diagnosis and treatment.
There are many inroads that still need to be created in dentistry; organized dentistry, continuing education programs, dental school curriculum, medical health organizations and insurance companies. Yet, most established leaders are hesitant to make changes realizing the sacrifice that must be made both personally and professionally. Many years of habits and entrenched models must be altered, but change is difficult and career reputations are threatened. The system is presently well established, and change after many years is always unwanted.

Eventually the community will have no choice but to recognize the neuromuscular approach, which is confirmed by scientific instrumentation, addresses the lack of understanding in the border movements of the mandible, the determinants of occlusion and the physiology between occlusion, the supportive and functioning muscles, and the physiologic TMJ position.


A new and upcoming breed of forward thinking practitioners of neuromuscular dentistry are following in the paths of the innovative Dr. Bernard Jankelson and his son Dr. Robert Jankelson who have been opposed by the establishment for years. Responding to this call of rising to a “higher standard of care” for our patients is our professional obligation to reach this goal.