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

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

Since the tongue moves away from the back of the throat as the jaw moves forward, stimulation of the JTR by grinding of the teeth also recruits the elevator muscles and adds the benefits of jaw position changes. This effect is tested by the demonstration that clenching in a forward jaw position has been observed to often provide even greater ease of breathing than clenching in the normal biting position of the jaw. Holding of rigid jaw positions has also been observed to initiate the JTR.

Bruxism is part of Sleep Disordered Breathing and TMJ problems that also share anterior temporal headache. Sleep bruxism is the third most common sleep disorder and has been related to other conditions, as have SDB and TMJ problems. In view of the JTR this relationship could be expected.

There is a central release of norepinephrine that occurs prior to or at the same time as catecholamine release from the adrenal gland. (24) The masseter reflex is increased by norepinephrine when the system is stressed. (25,26)

Norepinephrine allows for more rapid nerve conduction by lowering the nerve thresholds, which maintains the sympathetic tone, activates the Hypothalamic-Pituitary-Adrenal axis and stimulates the release of endorphins. The highest concentration of norepinephrine in the central nervous system is in the motor nucleus of the trigeminal. (27) Sleep bruxism appears to be neurochemically stimulated (28) and occurs at sleep stage transition with a 16.6% increase in heart rate that is indicative of elevated sympathetic activity. (29)

III. Dental Shapes and Contours

The JTR is seen to initiate neuromuscular control of the throat. We have also found that the contours and shapes of teeth and other oral tissues also initiate neuromuscular responses that alter the tongue position and volume in the mouth and pharynx. They can directly reduce areas of muscular pain and have major therapeutic implications.

Dental shape and contour alterations can stimulate muscle tone changes in the tongue that allow for a more open pharynx. These reflexes are used as a basic part of therapy. They often provide rapid reduction of jaw, head and other pain and appear to be maintained even in deep sleep.

Dental Shapes and Contours in Dentistry

Dental restoration has been demonstrated to produce the same alteration in head posture that occurs in upper airway disorders. (30) Similar head posture alteration has been demonstrated to be reflexly associated with respiration. (13,30,31)

Intraoral orthotics of other designs, such as mouth guards, night guards and TMJ orthotics involve mandibular and affect the airway. Any dental, dental occlusal, orthotic or facial skeletal changes will affect the upper airway. This should be considered as part of any dental care to avoid the risk of reducing the throat.

As dentists, we provide care that has an effect on the throat, even though it has not been apparent to us. Training of dentists in this area is critically needed.

IV. Fight or Flight Effects

Autonomic Nervous System effects, such as the Jaw Tongue Reflex, are associated with TMJ problems. This is not surprising since the maintenance of the throat is essential for survival and this is accomplished in the body by postural muscle mediated by the ANS.