Temporomandibular Dysfunction – A local problem with systemic effects David Hefferon BDS, Dip Hom Tox, FIAOMT,PGCE

Temporomandibular Dysfunction – A local problem with systemic effects.

As Nutritionists at Nadura we are firstly concerned with biochemistry and nutrition but we are aware of our scope of parctice and regularly refer and collaborate with other professionals who co-manage some of our client programmes. “Structure” of the body is one key area we would utalise the skills of other professionals, one of whom is Dr. David Hefferon BDS, Dip Hom Tox, FIAOMT,PGCE (Integrative Holistic Dentist) who give’s an insight into Temporomandibular Dysfunction and how it can effect more than just the oral cavity and the benefits of professional collaboration

Nadura Integrative Natural Health

Temporomandibular Dysfunction – A local problem with systemic effects.

The Temporomandibular joint is a unique joint in that it is the only reciprocal joint in the body. The right and left joints are connected to each other via the mandible and therefore directly affect each other as well as the rest of the body. Much time and effort is put into the anatomy of the temporomandibular joint and little is taught about the physiology and in particular the physiology of an internally deranged temporomandibular joint. An internally deranged temporomandibular joint can affect all aspects of

PsychoNeuroEndocrineThymicImmunology (PNETI). The main symptoms can present as headaches, migraines, neuralgia, bruxism, dizziness, tinnitus, preauricular pain etc. These are the obvious symptoms related to a direct trauma of the joint capsule. However due to the unique anatomy of the joint the temporomandibular joint can have systemic effects. Chronic sub clinical cases of temporomandibular dysfunction may actually be pain free as the body has compensated resulting in pain and tension in other areas of the body. This can result in stiffening of the Achilles tendon, anterior cruciate problems, hip and groin problems, upper body stiffness in the biceps, deltoids etc. There will be an associated compensation in the fascial planes.

The head of the condyle articulates with the base of the skull in the glenoid fossa, the teeth in occlusion and an internal derangement of the joint will change the position of the mandible which is influenced by, Temporalis, masseter, medial and lateral pterygoids, omohyoid, suprahyoid, infrahyoid, styloglossus, hyoglossus, chondroglossus, genioglossus muscles as well as nuchal, back and prevetebral muscles. The sphenomandibular and stylyohyoid ligaments also play a role in the positioning of the mandible. A retruded mandible or loss of vertical height will result in a forward head posture, increased cervical lordosis and a greater lumbar lordosis. There will be increased tension in the cervicothoracic transition zone, stretched iliopsoas muscle, stress on the iliosacral joint, tensed quadriceps and tensed anterior tibialis muscles amongst others. The reverse is true for a prognathic mandible.

As an internal derangement means that the cartilaginous disc is displaced, the resultant muscle tension means that it cannot self correct through the normal healing process and therefore the body remains trapped in this position until the joint is treated. This constant use of the musculature leads to hypoxia, acidosis and metabolic depletion. The body is kept in a sympathetic dominant situation and the HPA axis will be running continuously resulting in adrenal depletion. The sympathetic nervous system will also modulate the immune response. Peripheral nerve responses such as substance P will activate the pro-inflammatory cytokines.

If the proinflammatory cytokines Il1, IL6 and TNF alpha are not turned off they may result in the production of TH17, which is now being connected to autoimmune diseases.

The innervation of the temporomandibular joint is such that the locus ceruleus is also affected. This will affect the production of neurohormones such as Dopamine and noradrenaline etc. An internally deranged temporomandibular joint may present itself as depression instead of a painful joint.

An internally deranged temporomandibular joint will result in an adaptation occurring in the body. If this goes untreated the patient will have a 24-hour chronic inflammatory process and possibly even chronic infection depending on the extent of the damage. This may remain pain free and undetected as a person survives within their physiological adaptive capacity.

However, for a professional sportsman pushing the body to its limits it may result in constant recurrent injuries in the musculature that has compensated for this underlying condition. Good physiotherapy treatment and medication may put the footballer, athlete or martial artist back into their adaptive capacity. However, if the root cause is not treated then it is a matter of time before this injury reoccurs or a different injury occurs where the body has compensated for the previous injury due to the internal derangement.

An integrated approach would see the physiotherapist, doctor, dietician and dental surgeon working together for the benefit of the patients.

David Hefferon BDS, Dip Hom Tox, FIAOMT,PGCE 

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