Dentomandibular sensorimotor dysfunction

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Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible (lower jaw), upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas.

Contents

There is a concentrated nerve center in this area called the trigeminal nucleus. This major pathway of nerves controls pain signals from the teeth, face, head, and neck, and carries them to the brain. DMSD refers to a condition in which an individual experiences chronic pain or stiffness from these nerve inputs as a result of dental force imbalances. [1]

Signs and symptoms

There are many symptoms associated with DMSD conditions. The most commonly reported are: [2]

This condition affects all ages and both genders. However, females are more likely to suffer from DMSD. Individuals who have experienced chronic headaches and/or migraines without finding lasting relief through traditional medicine can be assessed for DMSD through a combination of objective tests, evaluations, and a comprehensive discussion of their symptoms, medical history, headache history, pharmacological background, and head health. Research used in sports medicine and rehabilitation allows dentists to address the population with DMSD symptoms.

Dental foundation

The dental foundation consists of teeth, muscles, and joints in the dentofacial (head and neck) area. The dental foundation is considered to be out of balance when one or more of the following conditions apply:

Diagnosis

The protocol for assessment of the condition is typically done in several stages:

Digital portion

Tekscan's T-Scan

This tool is used for digital force analysis to measure the presence and amount of imbalance at closing of the mouth, during closure, and during mastication (chewing). The computer displays the results of how the forces in the mouth spread along the arch, the center of force, the center of force trajectory, and the left/right force balance. This means the dentist can show patients which teeth are generating the most force, and facilitates the dentist’s knowledge of what adjustments need to be made to teeth and soft tissue to create a stable dental foundation.[ citation needed ]

Range-of-motion (ROM) assessment

This test digitally measures an individual’s cervical range of motion from a standing position and displays the results in terms of flexion and extension, left and right lateral flexion, and left and right rotation. Limited cervical range of motion is a disability, and being able to understand what is normal—and where their own mouth, head and neck are during the examination—helps people see how this disability is affecting their condition.

This is also when the amount a person can open their mouth is measured. Along with normal opening movement, the jaw should slide symmetrically from left to right at least 25% of the total mouth opening distance.

Finally, during the range of motion assessment, a record of jaw joint vibrations and sounds are made. Normal jaw joints glide without noise or vibrations.

Depending on the assessment findings, patients are classified as needing 1 of 4 levels of care (see Table 1: Levels of Dental Headache Care) to treat and manage their pain and balance their dental foundation. Every level has a regimented therapy protocol designed to provide the most effective, long-lasting care for each individual.

Once the type of headache pain and extent of dental foundation imbalance is determined, treatment options are discussed. Historically, the treatments for headache pain included one or a combination of herbal remedies, stress-reduction exercises, massage, acupuncture, non-steroidal anti-inflammatory drugs (NSAID), narcotic pain relievers, anti-seizure medications, chiropractic adjustments, anti-depressants or sedatives.

The combination of advanced dentistry techniques and sports rehabilitation-derived therapies used in treating dental force imbalances in dental headache care has resulted in a dentist reported 93% success rate in providing patients with real, lasting relief from their DMSD symptoms. The methods used control muscle force and force balance, restore proper function and range of motion, and change the way the brain perceives stimuli, so pain levels, dysfunction, and improper muscle activity return to normal. By balancing the muscles, joints, and teeth, and controlling the way the body feels pain in the head and neck areas, long lasting pain relief can be achieved.

Once the individual has had the proper dental adjustments to restore normalcy to the dental foundation, and has been prescribed and fitted for their at-home orthotic (worn in the mouth for the short term, typically only during the 4- to 12-week rehabilitation period) for muscle re-training, the sports rehabilitation-derived components of therapy begin.

Treatment

Therapeutic ultrasound

The goal of therapeutic ultrasound treatment is to restore circulation to sore, strained muscles through increased blood flow and heat. Another objective is to break up scar tissue and deep adhesions (areas where connective tissue fibers have formed over muscle) through sound waves. Therapeutic exposure to ultrasound reduces trigger point sensitivity and is considered a useful clinical tool for managing myofascial pain. Moreover, the ultrasound has also been shown to lessen the stiffness and discomfort of trigger points. [4]

Transcutaneous electrical stimulation

Sub-threshold micro-current stimulation reduces muscle spasms and referral pain through a low electrical signal that decreases lactic acid buildup and encourages healthy nerve stimulation. Micro-current electrotherapy is known to significantly aid in increasing mouth opening. [5]

Low-level laser (light) therapy

Low-level laser therapy, sometimes called light therapy for short, decreases pain and inflammation, accelerates the healing of muscle and joint tissues by 25%-35%, and reconnects the brain stem’s neurological pathways, effectively inhibiting pain. Low-level laser therapy combined with electrical stimulation improves mouth opening in patients diagnosed with TMJ/D. The musculoskeletal system's natural healing ability decreases pain and promotes TMJ stability. [6]

Manual muscle or trigger-point therapy

Manual trigger-point therapy, also known as manual muscle therapy, decreases and eliminates pain and tension in the trigger points by breaking up muscle knots and increasing blood flow. This decreases inflammation and pain in the muscles. [7]

As part of their in-office treatment, a dentist-monitored homecare system/deprogrammer and intraoral orthotic device are given to patients for their own personal use on their own time.

Table 1: Levels of dental force imbalance and dental headache care

Patients will typically need: [8]

  1. A rehabilitation orthotic and some occlusal adjustments
  2. A rehabilitation orthotic, and some occlusal adjustments
  3. In-office treatments, rehabilitation orthotic, a basic at-home care kit, and occlusal adjustments
  4. A greater number of in-office treatments, a rehabilitation orthotic, a basic at-home care kit, a micro-current stimulation kit, and occlusal adjustments.

See also

Related Research Articles

Temporomandibular joint dysfunction

Temporomandibular joint dysfunction is an umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints. The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life; this is because the symptoms can become chronic and difficult to manage.

Bruxism Disorder that involves involuntarily grinding or clenching of the teeth

Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; reports of prevalence range from 8% to 31% in the general population. Several symptoms are commonly associated with bruxism, including hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition.

Temporomandibular joint Joints connecting the jawbone to the skull

In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the mandible below; it is from these bones that its name is derived. This joint is unique in that it is a bilateral joint that functions as one unit. Since the TMJ is connected to the mandible, the right and left joints must function together and therefore are not independent of each other.

Trismus

Trismus, commonly called lockjaw, is reduced opening of the jaws. It may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with the patient's ability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful for the patient. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself.

Whiplash (medicine)

Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquialism. "Cervical acceleration–deceleration" (CAD) describes the mechanism of the injury, while the term "whiplash associated disorders" (WAD) describes the injury sequelae and symptoms.

Torticollis

Torticollis, also known as wry neck, is a dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus for twisted and collum for neck.

Tension headache

Tension headache, also known as stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

Toothache

Toothache, also known as dental pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

Mouthguard

A mouthguard is a protective device for the mouth that covers the teeth and gums to prevent and reduce injury to the teeth, arches, lips and gums. "An effective mouthguard is like a ‘crash helmet’ for teeth and jaws. It also prevents the jaws coming together fully, thereby reducing the risk of jaw joint injuries and concussion." A mouthguard is most often used to prevent injury in contact sports, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as tooth bleaching or sleep apnea treatment. Depending on application, it may also be called a mouth protector, mouth piece, gumshield, gumguard, nightguard, occlusal splint, bite splint, or bite plane.

Ear pain Pain in the ear

Ear pain, also known as earache, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.

The Nociceptive trigeminal inhibition tension suppression system, is a type of occlusal splint that is claimed to prevent headache and migraine by reducing sleep bruxism. Sleep bruxism is purported to lead to a hyperactivity of the trigeminal nerve, often triggering typical migraine events. The hyperactivity of trigeminal neurons during trigemino-nociceptive stimulation is a proposed cause of migraine and is correlated with imaging of migraine sufferers. The objective of the NTI-TSS is to relax the muscles involved in clenching and bruxing, thus supposedly diminishing the chances for migraines and tension headaches to develop through the reduction in nociceptive stimulation normally caused by parafunctional activity. It is sometimes used for temporomandibular joint dysfunction (TMD).

Pericoronitis Inflammation of the soft tissues surrounding the crown of a partially erupted tooth

Pericoronitis is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods. The hyponym operculitis technically refers to inflammation of the operculum alone.

A dental emergency is an issue involving the teeth and supporting tissues that is of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.

Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial constrictions. It can appear in any body part. Symptoms of a myofascial trigger points include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

Myotherapy is a form of physical therapy which focuses on the assessment, treatment and rehabilitation of musculoskeletal pain and associated pathologies. The term myotherapy was originally coined by Bonnie Prudden to describe a specific type of trigger point therapy which she developed in the 1970s based on the earlier work of Travell and Simons who researched the cause and treatment of pain arising from myofascial trigger points. While based on rational principles, there is little scientific research regarding the efficacy of this therapy, so it remains controversial within the medical and academic disciplines.

Cracked tooth syndrome

Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.

Dislocation of jaw

Dislocations occur when two bones that originally met at the joint detach. Dislocations should not be confused with Subluxation. Subluxation is when the joint is still partially attached to the bone.

Atypical facial pain (AFP) is a type of chronic facial pain which does not fulfill any other diagnosis. There is no consensus as to a globally accepted definition, and there is even controversy as to whether the term should be continued to be used. Both the International Headache Society (IHS) and the International Association for the Study of Pain (IASP) have adopted the term persistent idiopathic facial pain (PIFP) to replace AFP. In the 2nd Edition of the International Classification of Headache Disorders (ICHD-2), PIFP is defined as "persistent facial pain that does not have the characteristics of the cranial neuralgias ... and is not attributed to another disorder." However, the term AFP continues to be used by the World Health Organization's 10th revision of the International Statistical Classification of Diseases and Related Health Problems and remains in general use by clinicians to refer to chronic facial pain that does not meet any diagnostic criteria and does not respond to most treatments.

iHunch

iHunch, also called iPosture, forward head posture, poking chin posture, wearsie neck, computer neck, upper crossed syndrome, text neck, and dowager's hump, is the common spinal problem of an excessively kyphotic (hunched) thoracic spine driving neck pain and cervicogenic headache. It is clinically recognized as a form of repetitive strain injury. The term text neck was first coined by Dr. Dean L. Fishman, a US chiropractor.

References

  1. ↑ Sessle, B. J. (2006). "Mechanisms of oral somatosensory and motor functions and their clinical correlates". Journal of Oral Rehabilitation. 33 (4): 243–261. doi: 10.1111/j.1365-2842.2006.01623.x . PMID   16629880.
  2. ↑ Junge, D. (1998). Oral Sensorimotor Function. Medico Dental Media International.
  3. ↑ Koolstra, J. H. (2002). "Dynamics of the human masticatory system". Critical Reviews in Oral Biology & Medicine. 13 (4): 366–376. doi: 10.1177/154411130201300406 . PMID   12191962.
  4. ↑ Srbely, J. Z.; Dickey, J. P.; Lowerison, M.; et al. (2008). "Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: A randomized controlled study". Pain . 139 (2): 260–266. doi:10.1016/j.pain.2008.04.009. PMID   18508198. S2CID   31340642.
  5. ↑ Dijkstra PU, Kalk WW, Roodenburg JL. Trismus in head and neck oncology: a systematic review. Oral Oncol.2004;40(9):879-89.
  6. ↑ Fikackova, H.; Dostalova, T.; Vosicka, R; et al. (2006). "Arthralgia of the temporomandibular joint and low-level laser therapy". Photomedicine and Laser Surgery. 24 (4): 522–527. doi:10.1089/pho.2006.24.522. PMID   16942435.
  7. ↑ Quinn, C.; Chandler, C.; Moraska, A. (2002). "Massage therapy and the frequency of chronic tension headache". American Journal of Public Health. 92 (10): 1657–1661. doi:10.2105/AJPH.92.10.1657. PMC   1447303 . PMID   12356617.
  8. ↑ DiMatteo, A. M.; Montgomery, M. W. (2012). Understanding Assessing and Treating Dentomandibular Sensorimotor Dysfunction. Fort Lauderdale, Florida: Dental Resource Systems.
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