New therapy allows predictable resolution of TMJ, Fibromyalgia and other related conditions

Townsend Letter for Doctors and Patients, June, 2005 by Farrand C. Robson

The NHLBI expands this even more and notes that Sleep Disordered Breathing (SDB), TMJ and "TMJ related conditions" may well be caused by abnormalities or impaired nervous system coordination of pain perception, motor output and sleep architecture. (1) These conditions include Fibromyalgia, Irritable Bowel, Chronic Fatigue, Restless Leg, and Migraine, as well as others.

SDB, TMJ and TMJ related conditions all share common symptoms of headache and other pain, on-edge (survival) feelings and disturbed sleep, along with postural breakdown, a nervous system relationship and a cardiovascular linkage. It is noted that TMJ patients may also be at increased risk of cardiovascular (CV) disease, hypertension, heart failure and stroke. (1)

The Oral Component of Swallowing, Speaking and Breathing

Functionally, the jaw takes part in swallowing, speaking and breathing. There are postural, physiological, neurochemical and pain management considerations in these functions, as well as the tongue that is at the center of the oral component of these oral functions.

The jaws have both voluntary and involuntary neuromuscular action that allows jaw functions to take place in harmony with each other. This is seen in the chewing and swallowing functions that can take place as head posture and respiration are maintained. Any interference with this normal muscular action and balance, that is necessary to allow swallowing, speaking and/or breathing, can be responsible for the elevated muscular contraction. This hyper contraction of the muscles must then take place to maintain the throat and, as a result, produces such symptoms that define TMJ.

The mouth and jaw hold the position and action of the tongue and thus maintain and define both the oral cavity above the tongue and the pharynx behind the tongue. The precise determination of which area is pharynx and which oral cavity depends upon the level of muscle contraction present. The position, tone and action of the tongue in the mouth and pharynx contribute to the ease of swallowing, speaking and breathing.

The Origin of TMJ Problems: A Working Hypothesis

The suggested origin of the great majority of TMJ problems is hypothesized to be an Impaired Ease Of Oral Functions (IOF). This is defined as a decreased ease of the oral and pharyngeal component of swallowing, speaking and breathing. These oral (pharyngeal) functions are maintained by the Autonomic Nervous System (ANS) mediated muscle contraction that is needed to maintain these functions.

TMJ muscular symptoms represent the elevated muscle contraction needed to maintain these oral functions. The presence of impaired oral functions is implied by the elevated muscle contraction that produces pain and TM Joint symptoms by overloading of the TM Joints. This then satisfies the NIH position that evaluation and treatment of TMJ problems should first address the cause of the underlying neuromuscular concerns.

Impairment of oral functions is then implicated in the origin of SDB, TMJ and TMJ related conditions. For this working hypothesis a protocol has been developed that allows the presence of IOF to be determined and tested by providing support for these functions and then monitoring changes in symptoms, postural correction and physiologic alterations. This patient centered treatment approach requires that care be supported by the diagnosis and modified by clinical outcomes. This is an essential part of the OSB protocol for management of these conditions.