November 5, 2015
BY ELLIOTT J. ALPHER, BS, DDS
Many are unaware of the complexity and significance of how the temporomandibular joint (TMJ), cervical spine, and the autonomic nervous system are interrelated. The TMJ moves about 2,000 times in 24 hours (estimated to be the body’s most active joint). The major function of the spine is to support the head. The autonomic nervous system is responsible the body’s automatic functions, for example, breathing, heart rate, blood flow, digestion, etc. The nerves that travel through the vertebrae of the cervical spine serve all of the body’s organs, so any disruption may result in serious illness, disability, and even early death.
TMJ disorders involve the muscles that move the jaw and can involve the jaw joints as well. Many people clench and grind their teeth, but those experiencing severe stress, airway problems, or in chronic pain will clench and grind their teeth more than a healthy person. Two major causes of TMJ dysfunction are extensive clenching or grinding of teeth and whiplash injuries. Whiplash accidents that can injure the neck can also injure the jaw muscles and joints.
The fifth cranial nerve feeds directly into the limbic system of the brain, supplying all of the jaw movement muscles, joints, a portion of the throat, ears, back of the eye sinus cavities, and the side of the head. The fifth nerve is the communications center for all pain arising in the neck, head, jaw, eyes, ears, sinuses, and the cervical spine. These facts help explain why temporomandibular dysfunction (TMD) can have such a wide effect on the jaw, head, and neck and can be attributed to headaches and also explain how dysfunction of jaw muscles and joints could amplify problems in the limbic system. Symptoms of TMD can present with or without joint noise and can be accompanied by a restricted mandibular range of motion. Pain is usually localized in the muscles of mastication, the accessory muscles of mastication in the posterior cervical area, the TMJ joints, and the area of the ears. TMD may occur with or without sleep disorders. When breathing is obstructed, there is increased risk of developing high blood pressure, high cholesterol, diabetes, heart attack, stroke, and metabolic disorders in general.
Causes of spinal misalignment are varied and include accidental injury. They can happen slowly over time such that an individual will get used to the discomfort until it becomes too painful or disabling. One of the most common causes of spinal misalignment problems is poor sleeping posture. The spinal support of the head allows maximum mobility under normal circumstances. With only 8 ligaments, to maintain the occipital atlanto-axial joint complex, it requires maximum efficiency to protect the spinal cord, and most vitally, the brain stem. Cranial stability and righting reflex is of extreme importance to the maintenance and protection of the vital components of the brain stem. With displacement of this complex, the brain stem is compressed due to the rotation of the atlas. The compensatory changes of tilting of the head or forward head position, malocclusion of the jaws, and cervical spine displacement, create brain stem compression and vertebral artery compromise.
Any incoming nociceptive stimuli through C1, C2, C3, (facets, discs, muscles) as well as the vertebral and dural arteries, can cause the neurological pain phenomenon. Altered neuromusculoskeletal function caused by trauma or imbalance to the upper cervical structure causes noxious stimuli, referred to the trigeminal nerve divisions resulting in headache, found astudy by Bogduk published in 1992.
Atlas/Axis balancing, as well as neuromuscular dental techniques, are an effective combination for correction of biomechanical imbalances. A wide range of symptoms, including cervicogenic pain, migraines, disc compressions, craniofacial imbalances, neurophaties, palsies, fibromyalgia, Meniere’s syndrome, and tinnitus, are effectively managed by elimination of neuromuscular imbalances.
Without relief, symptoms can lead to long-term exhaustion, fatigue, and sleep disorders. Memory loss and cognitive problems may also arise. Feelings of irritability and restlessness from the body’s stress response rise as you respond to the lack of proper breathing. Many people complain of:
- chronic headaches
- morning headaches
- limited mandibular movements or locking open/closed
- TMJ sounds (clicking, popping, grating)
- dizziness
- ear fullness or pain with no apparent other etiology
- facial pain
- neck pain or stiffness
- loud snoring
- unrefreshing sleep
- dry mouth upon awakening
- in young children, chest retraction during sleep (chest pulls in)
- high blood pressure
- overweight
- irritability
- personality change
- depression
- difficulty concentrating
- excessive perspiring during sleep
- heartburn
- insomnia
- frequent nocturnal urination (nocturia)
- restless sleep
- nocturnal snorting, gasping, choking (may wake self up)
- rapid weight gain
- confusion upon awakening.
With the temporomandibular joint, cervical spine, and the autonomic nervous system so complexly interrelated, it is even more critical for healthcare providers to work together to start identifying the signs of TMD or obstructive sleep apnea and to get their patients screened.
Elliott J. Alpher, BS, DDS, FAGD, FASCD, DAAPM, MICCMO, DABFE, FADI, DBCP–DABC–SM, one of the Washington DC’s most experienced specialists for sleep and jaw disorders, on staff at George Washington University Hospital and Georgetown University Hospital, has been known as a leader in the treatment of sleep disorders and jaw pain for more than 25 years. Alpher has pioneered a conservative, non-invasive approach utilizing computerized and verifiable diagnostic methods to treat TMJ, snoring and sleep apnea.