Temporomandibular joint dysfunction (TMD): Chiropractic approaches to temporomandibular joint dysfunction (TMD)

Journal of the American Chiropractic Association, Apr 2001

Twenty-five years ago, chiropractors knew little about temporomandibular joint dysfunction (TMD). They weren't alone. Medical doctors and dentists were equally unfamiliar with the disorder. Darryl Curl, DDS, DC, recalls those early years and shares personal stories that read like a timeline on the understanding and treatment of TMD.

It all started not long after he graduated from the University of California/San Francisco School of Dentistry in 1976. A patient asked him if he treated TMD. "And I remember sitting there in silence thinking, `TM-what?.' Dr. Curl says. "From that point forward, I promised myself I would not be stumped on this subject again. I took seminars, bought books, and studied everything I could get my hands on."

Over the next ten years, dentistry would begin to address the subject in its schools, research, and practices. Dr. Curl continued to pursue his own interest in TMD, devoting more than 2,000 hours to its study. So when his patient, Rick, came in with TMD, he was ready. Or so he thought.

"I made him a mouth splint and told him to come back in three weeks. He didn't come back for six weeks, but when he did, he came strolling into the office with a smile on his face. He showed me how his jaw moved straight up and down and didn't click anymore, and I was beaming from ear to ear. I had only seen him that one time and now he was so much better. I asked him how long he had to wear the splint before he got better, and he just looked at me. 'Heck, I didn't wear the splint hardly at all,' he said. 'I went to my chiropractor, who said that one leg was shorter than the other by an inch. So he corrected my leg length, adjusted my neck and back, and look,

Doc, my jaw's fixed!' As he told me more, I felt sick because I was indoctrinated in traditional medicine, and I just couldn't understand. But he was living proof, standing right before me." Dr. Curl visited with Rick's chiropractor, who explained how leg-length discrepancy would essentially throw off all the joints in the body and muscle tone in the leg. "While what he was saying made sense," he adds, "I was confused because nowhere in my training had I been introduced to anything like this. After that, I actively sought out chiropractors and talked with them. And I found out something interesting. If I asked dentists in those days what they would like their children to do, most would say they didn't want them to be dentists. But when I asked chiropractors, they said they would like their children to be chiropractors. That's when a light went on in my head. 'This is where I need to be,' I said to myself. 'Here is the answer to my prayers. I've been trying to invent the wheel, and it's already been invented."' Dr. Curl attended the Los Angeles College of Chiropractic (now Southern California University of Health Sciences), where he eventually served as full professor. He retired three years ago to go into private practice and currently teaches the orofacial pain residency program at UCLA. TMD is a collective term for a broad range of disorders displaying a variety of signs -- radiating pain in the face, neck, or shoulders; limited movement or locking of the jaw; painful clicking or grating when opening or closing the mouth; and a significant change in the way the upper and lower teeth fit together. Symptoms can also include headaches, earaches, dizziness, hearing problems, and difficulty swallowing.

"There are combinations of symptoms with TMD. It's a large topic, and even those at the National Institutes of Health agree there is no standard to diagnose this condition," says Jason Flanagan, DC, who serves as dean of Academic Affairs at Texas Chiropractic College. "And there's another catch. TMD symptoms can result from other areas of the body not only upper-cervical subluxations, but all the way down to the foot. If something were to happen to the medi al arch of the foot because of a stone bruise or trauma, that can cause the pelvis to torque and induce a functional scoliosis pattern of compensation in the spine that can cause problems all the way up to the temporomandibular joint."

Moreover, many TMD symptoms can mimic other disorders in that general area, such as congenital malformations, some kinds of arthritis, infections, and tumors. And some symptoms of TMD are similar to common conditions that do not require treatment -occasional discomfort in the jaw joint or chewing muscles, for example, or non-painful jaw clicking. In order to deliver the best diagnosis and care, many DCs and dentists are teaming up through referrals and partnerships to more effectively diagnose and treat TMD.

Harvey Getzoff, DC, began co-treating patients with Albert Chinappi, DDS, in the early 1980s. Dr. Getzoff uses the sacro-occipital technique (SOT) for treatment of jaw and dental-related problems. SOT divides the body into three functional but interrelated categories: cranial sacral respiratory mechanism; weight-bearing body system; and lumbar spine and its supportive tissue.