Positive Health Online

In my early years of practice I was fortunate enough to work in the same building as an holistic dentist. He specialized in correcting malocclusion. He is the only dental practitioner I have come across who used Applied Kinesiology to check the results of his work. He introduced me to the work of Harold Gelb and his pioneering book Killing Pain Without Prescription”[1] which is about the relationship between TMJ dysfunction and the rest of the body.

Whilst at the practice a fourteen-year-old girl came for a consultation presenting with pain on the spine between the shoulder blades. On examination there appeared to be very little wrong with the spine in the area of pain. It was observed however that she was wearing a fixed brace on her upper teeth, which caused a clicking in the jaw. I sought the advice of my dental colleague who loosened the brace, explaining that the tightness across the midline between the maxillae had been restricting the motion of the bones. I followed up by treating the jaw  using craniosacral techniques; her pain subsequently resolved.

The brace had restricted movement of the maxillae (cheek bones) altering the subtle relationship between the teeth and jaw setting up an imbalance through the jaw joint (TMJ) and indirectly causing the back pain.

Tight braces result in contraction of the neck muscles causing the head to move forward in relation to the body resulting in poor posture. This can be readily demonstrated by placing the thumb and first finger either side of the upper teeth and applying a medial compression whilst at the same time palpating the neck muscles. It will be observed that the neck muscles contract as the force is applied by the fingers.

Fig 1 TMJ Ligaments

The TMJ is an extraordinary structure located at the junction of the temporal bone and mandible. The joint contains a synovial articular disc that is designed in such a way as to allow a pivotal motion as the first movement on opening the jaw followed by a subsequent forward motion or translation. The joint is stabilized by the capsular, sterno-mandibular and stylo-mandibular ligaments [Fig 1].

Movement is achieved by the muscles of mastication, masseter and temporalis also the medial and lateral pterygoids with attachments principally to the sphenoid bone but also the maxilla and palatines. Between them these muscles allow for complex movements involved in chewing and vocalisation.

Fig 2 Pterygoid Muscles

The distal part of the mandible houses the lower teeth. Tensions in the TMJ are largely influenced by  the occlusal relationship between the upper and lower teeth. This creates the bite; if the bite is in any way misaligned, abnormal tensions are created through the facial and cranial structures that will lead to variety of symptoms including head pain, sinus dysfunction dental problems and much more.

In addition the TMJ is the most used and most complex joint in the body and therefore has a massive proprioceptive influence on the central nervous system. Any inaccurate information resulting from misalignment will have knock on effect in the rest of the body with implications for balance and coordination.

Adjacent structures such as the temporal bones with the vestibular apparatus, the atlas vertebra influencing vagus nerve, and the sphenoid forming a large portion of the eye socket with it’s relation to the pituitary gland and optic nerves can all be influenced by TMJ dysfunction.

The complexity of the joint arises from its structure. Complex musculature allows the joint to be moved in a variety of ways. These muscles are extremely powerful being used in mastication. They are capable of subtle movements in vocalization. Copious nerve activity is required to control all its functions.

TMJ dysfunction can be caused by many factors including retained moulding of the cranium as the result of stresses experienced during birth, trauma such as blows to the head, dental surgery and poor nutrition. Breast feeding too affects structure and function of the palate and occlusion. In an age where fewer mother are breastfeeding this can be implicated in aetiology of TMJ dysfunction.

Dental procedures such as braces will influence tensions in the TMJ.

The complex of physical and anatomical relationships with the TMJ is almost unlimited within the human structure. In addition to the direct muscular and ligament connections with the neck and cranium as described above there are many indirect associations such as the sternocleidomastoid muscles from the sternum linking the temporal bones and thus TMJ with the clavicle and sternum as well as leg length via the pelvis spine and neck. Similarly TMJ dysfunction can create some unlikely seeming symptoms such as low back pain or digestive ones.

Just to illustrate this a patient seen at the Dental practice was a young executive who had regular episodes of acute low back pain with no pathological signs which occurred roughly every 6 weeks or so. Examination showed some muscle spasm in the mid lumbar spine that was easily adjusted. One treatment per episode was sufficient to keep him out of pain until the next episode. There were no other identifiable triggers. However he did have a deviated mandible. I referred him to my dental colleague. He was fitted with a device to balance tensions in the TMJ. Subsequently his visits to me occurred every 18 months or so!

Another patient a female in her late 50s developed acute low back pain after commencing treatment with a dentist, which included the fitting of a brace. She responded only temporarily to my ministrations, needing to be seen every fortnight. Fortunately I was able to predict that the back would stabilize once the dental treatment ended. This turned out to be correct.

Examination of joint function can be through observation as the jaw opens and closes, through palpation over the joint as it moves. It is also important to observe the bite as an abnormal bite will be constantly stressing the jaw.

Craniosacral therapy works through palpation of the cranial rhythm, better known as the involuntary mechanism (IVM). This motion is expressed by all structures in the body. If the motion is not expressed efficiently this can be corrected by careful balancing of the tensions within the disturbed structure and related structures. Adjustment takes place through a cessation of movement, a still point followed by an improvement in the expression of the IVM.[2]

Craniosacral examination will be via palpation of the temporal bone using three fingers. The fourth finger is stationed on the mastoid process; the middle finger rests lightly on the external auditory meatus and the second finger just on the TMJ. With this contact temporal motion can be palpated along with a sense of the response of the involuntary motion of the ligaments and if necessary the condyle of the mandible below.

In addition there are associated bony structures especially the sphenoid, maxilla, palatine and vomer as well as the soft-tissue tentorum cerebelli. The latter is part of the reciprocal tension membrane system including the falx cerebellum and the falx cerebrum that is also continuous with the dura mater of the spinal cord to the distal attachment in the sacrum.

Craniosacral technique can correct many TMJ problems by gentle manipulation of the temporal bones and the mandible too. Bite problems can be addressed through manipulation of other facial bones such as the maxillae. Working with a holistic dentist may be necessary to achieve permanent change in some cases.

Fig 3 Craniosacral Adjustment of TMJ

Treatment of children with overcrowded teeth and poor bites can often reduce or even prevent the need for dental intervention. As many problems with the bite result from birth patterns set up by compression, forceps or ventouse deliveries, Craniosacral treatment of babies is therefore a very important preventative measure.

Increasingly Health Sciences are recognizing that the body is not just a Cartesian molecular biological machine[3] but an organization of interrelationships and complexity. Via it’s great functionality and structural flexibility, the TMJ exerts a great influence on the body economy both in its locality and at a distance, something not only ignored by conventional medicine but by complementary health practitioners too.

References

1. Gelb, H. and Siegel, P. Killing pain without prescription. Wellingborough: Thorsons. 1987.
2. Upledger, J. and Vredevoogd, J. Craniosacral therapy. Seattle: Eastland Press. 2002.
3. http://natureinstitute.org/txt/st/org/comm/ar/2014/machines_18.htm