English
When it comes to the diagnosis or treatment of temporomandibular joint (TMJ) problems, there is frequently more than just one thing going on, and you will find that in order to have the best chance of success you need to work with a) a specialist dentist and b) an upper cervical chiropractor. In this article, we will explain why.
Temporomandibular disorders come in a variety of flavors with many associated symptoms:
- Clenching
- Grinding (aka Bruxism)
- Clicking
- Sleep Apnoea
- Temporal Headaches/Migraines
- Dizziness
- Fibromyalgia
One of the most common underlying causes of disorders of the TMJ is craniofacial or mandibular disorders that occur during the process of growing up. As a consequence, the way that your teeth come together starts to put abnormal stress on your TMJ, which in turn leads to premature degeneration, pain, and other neurological symptoms later in life. In these cases, it is frequently necessary to work with a specialist dentist who may need to prescribe a splint/orthodontic therapy, braces, or other procedure to decompress your TMJ so that you can get long-lasting relief. Of course, no one wants braces (and treatment can be damn expensive), but the alternative is oftentimes much worse.
Now, we are not going to present that we are dental specialists because we are not. However, we know to call a spade a spade! So when it comes to diagnosing TMJ disorders, we know what we can and what we cannot help and when we need to make the appropriate referral. Note: We mention this right here and now because if you do experience a TMJ disorder but your dentist says that everything is okay, maybe you haven’t seen the right person yet, and we may be able to offer you a second opinion to get you to the right person.
How your neck affects your TMJ
Now, we mentioned that a dentist may be the only person on your team to help with your TMJ disorder. The other person is an upper cervical-specific chiropractor. Upper Cervical is a special division of general chiropractic that focuses on the relationship between the two vertebrae in your neck - the atlas (C1) and axis (C2) - and how they affect your spinal nerves and brainstem, which is the master control system of your body.
The key to understanding how your neck affects your TMJ is by understanding the neurology of the upper neck. We are not going to punish you with all the technical details. However, we would like to point out a few interesting things. First, the sensory processing centre for the muscles that control how your jaw moves are located in your brainstem and descend into your upper neck. This processing centre (aka spinal trigeminal nucleus) also receives sensory input from the upper cervical nerves, which supply your head, face, and neck. Thus, if the processing centre receives a huge amount of abnormal input, it can cause a sensory processing disorder (aka dysafferentation) that ends up affecting not only the muscles in your neck but also the muscles that control your jaw position and movement.
The hallmark finding that signifies abnormal jaw movement stemming from your neck is that when you open or close your mouth, you see that your lower jaw zigs and zags slightly sideways. You can go do this simple test for yourself by looking in a mirror. Second, your C1 and C2 vertebrae actually assist with your ability to fully open your mouth. Place your fingers lightly across the base of your skull, and start opening and closing your mouth as wide as you can. You will feel the muscles contract and relax as you do so.
Your jaw is actually designed to be flexible, and part of its normal flexibility comes when the C1 and C2 vertebrae are free and capable of gliding as they shoulder. However, if you should have a problem locked up in your upper neck (even if it isn’t causing you pain there per se) it can restrict your normal TMJ movements as well. A very recent report found that people who suffer spinal cord injuries are more likely to experience TMJ disorders than the general population. Now, we aren’t necessarily talking about the same level of injuries. However, we may still recognise that it is the exact same neurology involved that can produce accumulative effects over a long period of time that ultimately leads to the development of a TMJ disorder.
Third (and most interesting in my observations) is that when people experience TMJ pain, they frequently do not actually point to their TMJ, but to the tip of their C1 vertebrae … and they don’t even know it! Try this for a moment. If you experience pain or clicking, point to where you feel it coming from. Your TMJ is located just in front of your ear at that little nub called the tragus. Your atlas, on the other hand, is actually located 1cm backward from there behind your jawline and just under the base of your skull on the side of your neck. So, which one did you point to? One way or another, we like to point out that these two important areas are separated by only a single finger width. Thus, one truly can and does affect the other.
Blair Technique, Upper Cervical Care and TMJ Treatment Brisbane
Upper cervical chiropractic has a long history and has helped many people find relief and resolutions from the TMJ conditions. Unfortunately, it is still a very rare procedure here in Australia. Upper cervical refers to a collection of methods including the NUCCA and Atlas Orthogonal techniques that were developed and researched in the USA but are not currently taught in the chiropractic universities in Australia (a long story). The particular method that we employ in our practice in Brisbane is known as the Blair Technique.
The Blair Technique is founded on the principle that all human beings are unique not only on the outside but also on the inside. Therefore, it is important to take these individual differences into account in order to provide the most accurate care possible. The Blair Technique uses a series of precision diagnostic tests including paraspinal thermography and articular diagnostic imaging in order to identify the exact location, direction, and degree of any misalignments in your neck that could be affecting your TMJ. (We are also sure to look for TMJ conditions where we may need to refer to the appropriate dental specialist). When we identify a problem with your neck, we then put together a personalised plan in order to help restore the normal motion and function through this important area of your spine so that your body is better able to do what it is designed to do: heal itself.
We hope that this article has been informative and valuable. Our practice, Atlas Health, located in North Lakes (north Brisbane) sees people from across Australia with a variety of health conditions including TMJ disorders. Our purpose is in helping people find long-term solutions so that they can enjoy the things in life that matter most to them. Dr. Jeffrey Hannah is an advanced certified Blair chiropractor with over 15 years of experience. He is a published author, international lecturer, and recognised leader in the field of upper cervical specific chiropractic.
If you would like to schedule a complementary 15-minute phone consultation with Dr. Hannah so that you may be able to discuss your individual case and ask any questions so that you can decide if care is right for you, click the contact us link on this page, or call us direct at 07 3188 9329.
References
Calixtre LB, Oliveira AB, de Sena Rosa LR, Armijo-Olivo S, Visscher CM, Alburquerque-Sendín F. Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women with TMD. A randomised, controlled trial. J Oral Rehabil. 2019;46(2):109-119. doi:10.1111/joor.12733. https://pubmed.ncbi.nlm.nih.gov/ 30307636/
Chinappi AS Jr, Getzoff H. The Dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction. J Manipulative Physiol Ther. 1995 (Sep);18 (7):476–81. https://www.ncbi.nlm.nih.gov/pubmed/8568431
Delgado de la Serna P, Plaza-Manzano G, Cleland J, Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial. Pain Med. 2019 Oct 29. pii: pnz278. doi: 10.1093/pm/pnz278. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31665507
Cuenca-Martínez F, Herranz-Gómez A, Madroñero-Miguel B, et al. Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta- Analysis of Observational Studies. J Clin Med. 2020;9(9):E2806. Published 2020 Aug 30. doi: 10.3390/jcm9092806. https://pubmed.ncbi.nlm.nih.gov/32872670/
Ferreira MP, Waisberg CB, Conti PCR, Bevilaqua-Grossi D. Mobility of the upper cervical spine and muscle performance of the deep flexors in women with temporomandibular disorders. J Oral Rehabil. 2019;46(12):1177-1184. doi:10.1111/joor.12858. https://pubmed.ncbi.nlm.nih.gov/ 31292981/
Giacalone A, Febbi M, Magnifica F, Ruberti E. The Effect of High-Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review. Cureus. 2020;12(4):e7682. Published 2020 Apr 15. doi:10.7759/cureus.7682. https://pubmed.ncbi.nlm.nih.gov/32426194/
Greenbaum T, Dvir Z, Reiter S, Winocur E. Cervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects. Musculoskelet Sci Pract. 2017 Feb;27:7-13. doi: 10.1016/j.msksp.2016.11.010. Epub 2016 Dec 11. https://www.ncbi.nlm.nih.gov/pubmed/28637604
Grondin F, Hall T, von Piekartz H. Does alter mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people. Musculoskelet Sci Pract. 2017 Feb;27:85-90. doi: 10.1016/j.math.2016.06.007. Epub 2016 Jun 15. https://www.ncbi.nlm.nih.gov/pubmed/27847242
Häggman-Henrikson B, Rezvani M, List T. Prevalence of whiplash trauma in TMD patients: a systematic review. J Oral Rehabil. 2014 Jan;41(1):59-68. doi: 10.1111/joor.12123. Epub 2013 Dec 30. https://www.ncbi.nlm.nih.gov/pubmed/24443899
Kim JR, Jo JH, Chung JW, Park JW. Upper cervical spine abnormalities as a radiographic index in the diagnosis and treatment of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Oct 25. pii: S2212-4403(19)31536-6. doi: 10.1016/j.oooo.2019.10.004. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31780398
Knutson GA, Moses J. Possible manifestation of temporomandibular joint dysfunction on chiropractic cervical x-ray studies. J Manip Physiol Ther. 1999 (Jan);22(1):32-7. https:// www.ncbi.nlm.nih.gov/pubmed/10029948
Losert-Bruggner B, Hülse M, Hülse R. Fibromyalgia in patients with chronic CCD and CMD - a retrospective study of 555 patients. Cranio. 2017 Jun 5:1-9. doi: 10.1080/08869634.2017.1334376. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28580880
Westersund CD, Scholten J, Turner RJ. Relationship between craniocervical orientation and center of force of occlusion in adults. Cranio. 2016 Oct 20:1-7. doi: 10.1080/08869634.2016.1235254. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/27760504
Rangel M, Ferreira MV, Dos Santos MTBR, da Silva CBG, Romano MM, Guaré RO. Temporomandibular disorder in individuals with spinal cord injuries [published online ahead of print, 2022 Mar 29]. J Spinal Cord Med. 2022;1-7. doi:10.1080/10790268.2022.2046421. https://pubmed.ncbi.nlm.nih.gov/35349395/
Leave a comment