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Temporomandibular Joint (TMJ) Dysfunction
and
Emotional Stress
Comparison between osteopathic and traditional dental approaches to clenching and grinding relating to TMJ
Traditional dental approach to TMJ treatment is based on very rigid belief of fusion of cranial and facial sutures in adult skeleton. It offers TMJ treatments that emphasize bone remodelling as a result of application of strong compressive and destructive forces by means of tooth removal and splint application.
The most dramatic example of sutural remodelling is the result of rapid maxillary expansion, when a diastema is opened between the central incisor teeth. This technique uses a screw mechanism apparatus that produces a separation of the two halves of the maxilla. For this to be effective, the magnitude of the applied force must be strong enough to be transmitted beyond the periodontal joints; otherwise, the stresses will be absorbed within the alveolar bone, resulting in tooth movement alone.(Meikle, 2007)
Dental profession has provided convincing histological evidence that the influence of orthodontic treatment is not limited to the teeth, but extended to other parts of the mandible, causing remodelling of the glenoid fossa and condyle.
This approach is currently offering functional appliances that influence chondrogenesis and bone formation to correct malocclusions and thus eliminate the symptoms of TMD.(Meikle, 2007)
On the other hand, the study that compared various splint therapies with conservative physiotherapy approach concluded that patients of all groups improved equally over time, while traditional splint therapy offered no benefit over the athletic mouth guard splint therapy. Furthermore, splint therapy did not provide a greater benefit than did self-care treatment without splint therapy. (Truelove, Huggins, Mancl, & Dworkin, 2006)
In my opinion, these conflicting results are stemming from disregard for the multitude of interconnections between cranial, facial and the rest of the structures while solely focusing on the mechanical and biological stresses of the masticatory apparatus.
On the other hand, osteopathy provides a very different approach to TMJ treatment. Harold I. Magoun Sr. places the greatest significance on external and internal rotation lesions of the temporal bones that change the position of the temporal fossae to respectively posteromedial and anterolateral. He also noted that the bruxism is merely an effort on the part of the patient to correct the bony misalignments. He further expands the relationship of the whole body structural imbalances to TMD such as connection between short leg and proper dental occlusion; and autonomic nervous system function in connection with cervical spine lesions and their effect on TMD symptoms.
There is an interesting case of a woman coming to hospital with a heart problem and severe headaches after dental correction of her bite. Her “heart spell” was successfully treated after the osteopathic treatment of her cranial and cervical lesions. At the same time her headaches have persisted as a result of the changed bite.(Magoun, 1975)
This case particularly demonstrates the importance of communication between osteopathic and dental communities, and that dental equilibration should be done with respect to the cranial physiology as it is viewed by osteopathic profession.
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