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For more information about neuromuscular dentistry, contact:


James R. Harold, DDS

700 Exposition Place, #151
Raleigh, NC 27615
Telephone: (919) 848-3636

Finally! Years of Anguish Come to an End

For forty-seven of her sixty-nine years, a woman who prefers to be called Priscilla has lived with intense levels of pain and mental anguish, including severe depression, involving many different body parts and function.

Balancing muscles in the jaw is a key part of effectively treating TMJD—and Dr. Harold is a master at understanding the design and function of the muscles of the face and jaw.

“I have over the years seen at least 18 doctors,” she says, “had multiple CAT scans and MRIs, and every other kind of test you can imagine—I even at one point had my jaws wired shut and had surgery to fuse part of my cervical spine—all with no real or lasting benefit.

“Some years ago my health issues landed me on full disability from work, and I was pretty much resigned to living out my life in pain until I found out about Dr. James Harold in Raleigh, and the work he is doing with patients like me.”

More specifically, for the past decade and beyond Dr. Harold has become known in many venues—as a speaker, instructor, and practitioner—for his remarkable work in treating patients with TMJD—temporomandibular joint dysfunction.

“I knew this patient had TMJD issues when I first walked into the exam room,” says Dr. Harold. “Her severely overlapped bite (see photo) is a red flag signaling that her bite has virtually collapsed. I thought if we could give her even 80 percent relief from her suffering it would be a tremendous accomplishment. So we did a full workup, and referred her to Atlas Chiropractic for help with these many problems even as we continued with our TMJD work.”

The Healing Process

After a careful, four-hour initial exam to determine that Priscilla’s pain and function problems were really muscular in nature, and not, for example, a degenerating disk that might require surgery, Dr. Harold used an array of high-tech devices to properly align the jaw.

View of the patient’s “nearly collapsed bite.”

“We use sophisticated com-puter diagnostics in order to accurately measure muscle function and pain relative to the position of the jaw,” he points out. “What I often find is an imbalance in the position of the jaw as it relates to the muscles of the joint, and in the closing pattern of the jaw as it relates to the teeth.

“Most dentistry is concerned with occlusion—the normal spatial relation of the teeth when the jaws are closed. Occlusion is affected by the teeth, the muscles, and the temporomandibular joints.

“Traditionally,” he explains, “dentistry focuses on the teeth, while neuromuscular dentists add consideration of muscle and joint status when evaluating the occlusion—determining the optimal relationship between the mandible and the skull. To do this, we need to relax the muscles of the jaw to establish an optimal occlusal position.”

One valuable tool is a TENS unit, which, Dr. Harold explains, “is a very safe device that delivers a mild electrical stimulus to the muscles via neural pathways, and over a period of perhaps an hour or less, it brings the jaw to a position of maximum relaxation.”

Other tools of precision are used, as well, including surface electromyography and sonography “which is sometimes called joint vibration analysis,” notes Dr. Harold. “It utilizes computer-based vibration sensitive transducer technology that quickly and non-invasively records joint sounds and vibrations originating in the TM joints. This is invaluable diagnostic information.”

Orthotic for Relief

When this extensive testing is complete, Dr. Harold fashions a precisely designed therapeutic orthotic—made of tough acrylic plastic—for the patient.

Neuromuscular treatment, Dr. Harold reports, “often proves to be of great benefit in relieving a variety of issues, including headaches, facial pain, worn, shipping, or cracked teeth, cracking or chipping of dental restorations, neck and shoulder pain, jaw pain, ear congestion, ringing in the ears, clicking or popping in the joints, clenching or bruxing, limited opening of the mouth, loose teeth, and even tingling in the fingers.

“TMJD is not necessarily the root cause of these many problems, but in many instances it contributes to the discomfort in a direct way. Basically, the problem is often a lack of harmony between the joint, the muscles, and nerves, and is thus ideally suited for neuromuscular treatment.”

The patient reports, after three months of wearing her acrylic orthotic “24/7—I would never be without it”—that Dr. Harold has surpassed his goal of 80 percent relief of her pain and other symptoms. “Compared to how I was feeling when I first visited Dr. Harold, I would say right now I’m feeling between pretty good and great. I have mild numbness in the lower part of my face, but the intense pain is simply gone—for the first time in many, many years.”

Atypically, in this span of a few months, Dr. Harold has had to adjust Priscilla’s orthotic nine different times. Most commonly, patients need one or sometimes two adjustments to ensure that the orthotic is positioned to provide maximum benefit. “The issue with this patient,” says Dr. Harold, “is that she has a very small ‘window of comfort’ where her jaws and muscles are in balance and at rest. Our adjustments have been very, very tiny—but in each instance, they have been necessary and helpful.”

Many of Dr. Harold’s neuromuscular patients find they can function at a very high level, pain free, simply by wearing their custom-made orthotic device. Others choose to enter into Phase Two of the jaw-alignment process by undergoing reconstruction of their teeth and jaw as necessary, or with orthodonture. “The goal,” says Dr. Harold, “is to achieve optimal permanent benefits from this work.”