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Anyone in NM Orthotic Phase 1 ?

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Old 11-07-2008, 12:40 AM   #1
Join Date: Mar 2007
Location: Ireland
Posts: 255
pipdog HB Userpipdog HB User
Anyone in NM Orthotic Phase 1 ?

Hi people,

I got my new LVI neuromuscular orthotic last week, after a lot of time, money, false starts and diagnostics it looks like my problem is muscular and not in the joints.

The dentist took the bite registration after TEN'sing me and my bite was very different. I'm down and forward with an increase of 6mm in vertical dimension. This position feels very 'right' compared to before.

But so far not much change except now for the first time I get the tingling in my right hand, before it was always in the left. The pain/headache is in the left side of my face especially around/behind my left eye.

The dentist says old muscles 'engrams' (memory) are causing the symptoms and it takes 3 - 4 months of TEN'sing and adjustment to the orthotic to retrain them to the new NM position.

He TEN'sed me for around an hour and this really did the business in terms of pain relief, lasted for around 12 hours or so. If TENS works is this diagnostic that it is in fact a muscular problem?

Is anyone here in Phase 1 treatment right now who can swap notes with me on what to expect, the ups and downs, whatever? Or anyone who has moved on to Phase 2?


Last edited by pipdog; 11-07-2008 at 02:19 AM.

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Old 11-08-2008, 04:37 AM   #2
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Join Date: Apr 2003
Posts: 31
nirmal HB User
Re: Anyone in NM Orthotic Phase 1 ?

hi pipdog

I am glad to see that you are making progress. Much like yourself, I am confused with regard to treatment options and who to pursue. I have now identified several doctors that i could potentially seek treatment from, but am unable to tease them apart and make a final decision as to who to see.

from what i can infer, you are obviously quite experienced at this, would you have any idea how i can overcome this problem.

Thanks for your help in advance

Old 11-11-2008, 10:58 PM   #3
Join Date: Mar 2007
Location: Ireland
Posts: 255
pipdog HB Userpipdog HB User
Re: Anyone in NM Orthotic Phase 1 ?


You need to arm yourself with good baseline information about what your actual problem is. First get MRI scans of your mouth in open and closed positions, these will show the position of the disc. Then get them reported by somebody you can trust. There is a radiologist in London called Kevin Lotzof who only looks at TMJs, he's even written papers on the subject. If you do have a displaced disc you will probably be advised to wear a Gelb appliance which will bring your mandible down and forward and allow space in the glenoid fossa for the disc to recapture. Grossmann in London is the man for this kind of work.

X-rays don't show soft tissue so won't help except to show position of the condyle in the glenoid fossa which can be diagnostic as well. Most people with TMD have condyles which are too far up and back, caused by our bites becoming overclosed over time.

However if the MRI shows no pathology in the TMJs but you have all the classic TMD symptoms then you could take it that the cause of the problem is spasming muscles. This is around 90% of cases.

Because men have stronger facial muscles I was told we destroy our teeth first so look in your mouth:
  • Is there dentin exposed along the tops of the lower incisors?
  • Do you have notches at the gum line of the incisors?
  • Are there any fracture lines running down the teeth?

These are all signs of serious grinding and need immediate treatment even it this is only a bruxing guard to wear at night. Otherwise you will loose the teeth. I lost one, it started with the notches at the gum line which got bigger over time, destabilized the tooth and then it just started to splinter away.

The jury seems to be out on the question of why people grind, the most common explanation is stress but another theory is that grinding is our sub-conscious way of trying to find the correct bite. I'd be inclined to believe the latter because children grind and they don't suffer from stress the way adults do and their bites are in development.

For the muscular form of TMD you could try a neuromuscular dentist. If you read their theories and methods they make a convincing case. They record objective data on joint sound, jaw tracking and muscles activity.

When I had my work up it was illuminating to see the pathologies on the screen, i.e. I have pain on the left side and thats the side where my temporalis and masseter are in a state of total fatigue trying all the time to maintain a badly positioned mandible (too far back and with a distinct yaw). Also they put a magnet on your lower teeth and track the opening and closing route you take. It should be a smooth slightly curving line. Just before closing mine suddenly makes a big detour back to get under the top teeth.

Once you get information on the exact nature of your problem it will be easier for you to make a treatment decision. Its like a jigsaw puzzle, at the beginning you will have only little pieces of information but gradually a better picture will emerge and you will know what is right for you.

Last edited by pipdog; 11-12-2008 at 04:37 AM.

Old 11-12-2008, 01:54 AM   #4
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abond0073 HB User
Re: Anyone in NM Orthotic Phase 1 ?

how well is your NM treatment working?

Last edited by abond0073; 11-12-2008 at 01:55 AM.

Old 11-12-2008, 03:07 AM   #5
Join Date: Mar 2007
Location: Ireland
Posts: 255
pipdog HB Userpipdog HB User
Re: Anyone in NM Orthotic Phase 1 ?

Its two weeks since I started wearing the NM orthotic.

The only changes I've noticed so far it that my neck is less stiff and my smile is symmetrical again. Before treatment I had a crooked smile, it just didn't curve up on the left side at all.

Other than that the tightness / pain is still there in the left side of my face. The dentist says it will take a couple of months of ULF Tensing to retrain the muscles into their NM position.

Have you been down the NM route? Any feedback?

Last edited by pipdog; 11-13-2008 at 01:30 AM.

Old 11-12-2008, 10:26 AM   #6
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abond0073 HB User
Re: Anyone in NM Orthotic Phase 1 ?


i havent been down NM route - i was about to - but decided against

i have bad experience down repositioning route - and am very wary about trying any splints

i hope your treatment is successful

Old 11-12-2008, 12:20 PM   #7
Join Date: Mar 2007
Location: Ireland
Posts: 255
pipdog HB Userpipdog HB User
Re: Anyone in NM Orthotic Phase 1 ?

Can you explain what you mean about a bad experience with a repositioning splint?

I wore a Gelb for 6 months this year to reposition my mandible. It was flat plane so I was sliding around on it a lot at first but for the first three weeks I felt a big improvement. The he built up the vertical dimension more and I think he got a bit carried away because it felt way too high and then he built it up some more and I was in agony. He ultimately increased the vertical to around 8mm. It doesn't sound like much but you really notice it.

He is a well known US TMD specialist. He was trying to recapture my left disc. Later on I had my MRI scan re-reported and it turns out my TMJs are ok, the problem is muscular.

The point I want to make is that too much vertical can be as bad as too little. There is a 'correct' level for your bite to be at. The way all the facial muscles work is like a finely balanced mechanism. Maybe you were built up too high?

Last edited by pipdog; 11-13-2008 at 12:02 AM.

Old 11-12-2008, 02:40 PM   #8
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Join Date: May 2007
Location: mountain view, ca
Posts: 109
loudawg HB User
Re: Anyone in NM Orthotic Phase 1 ?

Thank you for updating us Pipdog. I sometimes think about returning to the NM treatment - I started with NM, then went to a Phonetic approach and now am using an approach similar to your last one - increased vertical dimension and flat pivot splint.
If you are looking for past stories of success with the NM approach, try searching either for 'Phase 2' or 'Phase II' or 'braces' on this site.

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