04/13/2025
The DNO™ Appliance or Diagnostic Neuromuscular Orthotic is the ideal start to treatment of TMD utilizing Neuromuscular Dentistry. It is a Removable Mandibular Orthotic that is used intially both as a Diagnostic Appliance and the first step in the treatment of TMD.
There is a great deal that goes into initial diagnosis including CBCT, Review of Health History and history of subjective patient symptoms. The goal is always to bring the patient relief as soon as possible.
This is not a stand-alone appliance but utilizes Ultra-Low Frequency TENS. In my office, a home unit is included in initial treatment.
The use of Travell Spray and Stretch can often quickly relieve referred Myofascial Pain so it is only logical to teach patients proper use of the Vapo-Coolant Spray and to teach the techniques for home use and not just in the office.
Sphenopalatine Ganglion(SPG) Blocks can address the autonomic nervous system's contributions to TMD pain. Patient live their lives and control of Pain and Anxiety is key and it is ideal for patients to learn how to Self-Administer SPG Blocks at home with cotton-Tipped Catheters and 2% lidocaine through the nose without injections.
TMD is a Rpetitive Strain Injury (RSI) similar to other Repetitive Strain Injuries, the DNO™ Appliance gives the body a chance for the Repetitive Stain Injury to heal, not just the TMJoints but also the Muscles and Fascia of the head and upper cervical areas.
The compensations of the head and neck spread through the entire body. Ideally, at the start of treatment the hip height at the level of the illiac crest is evaluated prior to start of treatment. If they are uneven it makes sense to determine if this is a ascending or descending issue. An Aqualizer Aplliance can be utilized to determine if uneven hip heights can be corrected before taking a neuromuscular bite.
In my office a "blank orthotic" is made before starting treatment and the bite is added after evaluation and/or correction of hip height discrepancies.
Tongue Reflexes and function are always important considerations as are Tethered Tongue or Tongue Ties.
It is always important to consider the quality of Sleep as part of treatment including Apnea, Hyponea, UARS and also insomnia, restless legs and Circadian Rhythm Disruptions.
Ira L Shapira DDS, D,ABDSM, D,ABPM, FICCMO, MICCMO
Neuromuscular Dentistry Section Editor: Journal of Advanced Dental Technologies and Techniques
Editor in Chief: CRANIO..Journal of Craniomandibular and Sleep Practice. (12/2021-12/31/2023)
Past Chair, Alliance of TMD Organizations
Diplomat, Academy of Integrative Pain Management
Diplomate, American Board of Dental Sleep Medicine
Diplomate, American Board Sleep and Breathing
Vice-President Regent, Master & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Professor Neuromuscular Orthodontics and CranioMandibular Orthopedics University of Castellon
Dental Section Editor, Sleep & Health Journal
Past CranioFacial Pain Section Editor, CRANIO: Journal of Craniomandibular and Sleep Practice
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
Member, Academy of Cosmetic Dentistry
Life Member, American Dental Association
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.NorthShoreSleepDentist.com
www.IHateCPAP.com
www.iHateHeadaches.org
www.SleepandHealth.com
www.SphenopalatineGanglionBlocks.com
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg
OVER 100 VIDEO TESTIMONIALS Dr. Ira L. Shapira, of Chicagoland Dental Sleep Medicine and Think Better Life, is an experienced TMJ and Sleep Apnea Dentist who has earned recognition as a Diplomate of the American Board of Dental Sleep Medicine, a Fellow of the International College of Cranio-Mandibul...
