Medical History: Patient referred to our Epoche Centre who reports Orofacial Pain and intense bruxism day and night. The medical history reveals a persistence of bruxism phenomena since adolescence which has been treated by dental colleagues by using a biteplane with the intention of limiting the tooth damage and wear caused by grinding. The patient, however, continued to report the persistence of the bruxism phenomena, which in recent times has been accompanied by intense types of headache. Following a classical dental and gnathological approach, the patient is subjected to a series of specific tests to analyse the masticatory system from a biomechanical point of view, via an axiographic examination of the neuromuscular system using an electromyographic examination of the masseters. A test that we will describe in detail below.

Axiography:  The axiographic traces shown in the figure were performed with a para-occlusal bite to better describe the mastication cycles. Both the right and left side show a physiological curvature and kinematic development of the masticatory area is medio-trusive and latero-trusive, with no meniscal and/or tooth interference. The axiography report was negative, and therefore the cause of the clinical phenomenon could not be referred to a specific joint.

Electromyography: The patient was then subjected to a routine electromyographic investigation at the dental laboratory, which examined the "Interferential patterns" of the masseter muscles. The figure shows the EMG responses when the patient is asked to clench their teeth, and can be quantified using very complicated Fourier transforms, and other algorithms which however, are indicated by an asymmetric trace. An asymmetry verified in this way however does not mean anything, because in the general population there is a certain neuromuscular side asymmetry anyway, but the fundamental idea is that the interferential EMG is a stochastic phenomenon, which is thus considered a random signal and is therefore not predictive of organic and/or functional damage, at least not until the damage itself becomes disabling.

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Conclusions: The only possible diagnosis using the current view of a generic dentist is: patient suffering from "Bruxism" , and the only treatment advisable would be to use a gnathological Biteplane

Functional Neuro Gnathological Diagnosis:  When the same test was performed on the patient in question, it showed the presence of the second silent period (SP2), and delivery of the second electrical stimulus (S2) which showed an inhibitory intensity exaggeratedly more intense than the previous SP2 from S1. The clinical and scientific merit of this test is irrefutable, because it indicates a hyper-excitability state in the Central Nervous System, similar to what happens in people with basal ganglia disorders (Parkinson). From a Functional Neuro Gnathological perspective, the patient was suffering from a serious neurological disorder, and bruxism was absolutely not the cause, but ratherthe result of this pathology.

Diagnosi Neuro Gnatologica Funzionale: Lo stesso test eseguito al paziente in questione mostrò la presenza del secondo periodo silente (SP2) all'erogazione del secondo stimolo elettrico (S2) che si presentava di intensità inibitoria esageratamente più intensa del precedente SP2 da S1. Il contributo scientifico clinico di questo test è inconfutabile perchè indica uno stato di iperccitabilità del Sistema Nervoso Centrale in modo simile a ciò che accade nei soggetti affetti da patologie dei nuclei della base ( Parkinson). Da un punto di vista Neuro Gnatologico Funzionale il paziente era affetto da un grave disturbo di tipo neurologico ed il bruxismo non era assolutamente la causa ma il risultato di questa patologia.

Radiological Diagnosis: An MRI brain study, performed before and after intravenous administration of contrast medium in TSE, FLAIR and GE sequences on axial and coronal planes, highlighted the presence of a round area, about 1.5 cm in diameter, located at the cistern of Galen in the pituitary gland. This area did not change after administration of contrast medium, appearing mildly hyperintense on T1-weighted images and markedly hyperintense on T2-weighted images, with the presence of a fluid-fluid level inside it. In the T2 images, around the area described, one could see the presence of clearly hypointense area (magnetic susceptibility), like haemosiderin deposits. The fourth ventricle was normal and in its normal position. At the same time, a fair dilation of the supratentorial ventricular system was apparent on the same axis, most noticeably at the temporal horns, with a periventricular skirt due to transepidimal liquor resorbtion phenomena. The characteristics of the training signal gave a diagnostic suspicion of pineal cavernoma. The images did not show any signs of organic impairment of the mid-brain structures.

Bruxism reported by the patient was not the cause, but the result of vascular brain disease that was quickly resolved via an endoscopic neurosurgical intervention. Diagnostic delay, at present, is considered a criminal offence, especially if it comes from a failure to update existing and already accredited methods from the international scientific community. But beyond the legal aspects, what is concretely visible is the added value to professional ethics that would be acquire if the member made a diagnosis of this type and saved the life of a patient. There would then be: