Temporal mandibular disorder (TMD) is one of the most overlooked causes of chronic disease. Many people have a hard time making the connection of jaw health to systemic overall health. This article is meant to be a general summary of how TMD can cause chronic disease throughout the body, the causes of TMD, and how to treat it.
HOW JAW HEALTH RELATES TO OVERALL HEALTH
There are many theories of how TMD can cause chronic disease. Here I will highlight the ones that hold the most credibility or plausible methods of action. I don’t think that it is one single theory, but rather a combination of all of them.
1) Basic chiropractic theory: Structural dysfunction and subluxations pinch nerves which then cause dysfunction of the organs connected to those nerves. This is the basic theory of why chiropractic adjustments help overall body function.
In TMD disorder, for reasons I will get into later, typically causes a head- forward posture. This in turn causes kyphosis, lordosis, and sometimes scoliosis, creating misalignment throughout the spine.
2) Airway obstruction: TMD patients commonly have their jaw too far back. This can cause airway obstruction (which forces the body to compensate by moving the head forward as mentioned above). Obstructive sleep apnea is a risk factor in almost every chronic disease.
3) Substance P: Substance P is a neuropeptide involved in pain signaling. When you have chronic pain from TMD, substance P rises. Substance P can increase cell membrane permeability, making cells more susceptible to infections and toxins.
4) General nervous system overload: 60% of nerve input comes from the trigeminal nerves in the face (think about all of the different sounds and facial expressions that humans use to communicate). TMD causes a lot of stress to the trigeminal nerve. Even more important is that the trigeminal nerve does not connect to the spinal cord; it actually goes directly to the brain. TMD has the potential to cause massive amounts of nervous system stress. This is commonly seen in elderly people. Over time, their proprioception is so messed up that they can’t keep their jaw still. This can cause the shaking of the jaw seen in the elderly, and sometimes in Parkinson’s disease.
5) TMD can (indirectly) cause cavitations: TMD is typically caused by poor facial bone development (I will get into this more in the next section). Underdeveloped facial bones are the reason why people do not have room for the wisdom teeth to erupt properly. The wisdom teeth can then become impacted and infected themselves. More commonly, when people have to get their impacted wisdom teeth removed, standard oral surgeons leave the periodontal membrane, and the bone cannot heal causing infection.
6) TMD can cause CCSVI: TMD causes tightness in the muscles of the neck, which can then constrict the veins in the neck, causing impaired blood flow to the brain. Right below your thyroid gland are two boney points at the ends of the collarbones. The tendons that connect here can be very tender if you have TMD.
7) Impairment of the glymphatic system: The brain has two main methods of detoxification. One is melatonin, and the other is the glymphatic system. When you sleep, the brain shrinks, and gets “washed” with CSF. The glymphatc systems physically moves by the pumping action of the jaw every time you swallow. With TMD, this pumping action is inadequate due to lack of vertical height of the molars, and thus toxins are unable to be cleared by the brain. The body will sometimes try to compensate by grinding or clenching the jaw at night (though this can also be a symptom of parasites).
8) Gall bladder problems: The gall bladder meridians run along the side of the head, across the temporal muscle. The temporal muscle is responsible for opening and closing the jaw. The theory is that when you chew food, the temporal muscle stimulates the gall bladder meridian, signaling the gall bladder that food is coming and that it needs to produce bile. TMD disrupts this communication, leading to gall bladder problems.
CAUSES OF TMD:
There are three main causes of TMD:
1) Direct injury or trauma to the head
2) Standard orthodontics: Your run of the mill orthodontist is only concerned with aesthetics, and not function. Orthodontists erroneously believe that an overbite is the human norm. They typically push the jaw too far back, which can cause TMD. Even worse, they sometimes use headgear to push the maxilla even farther back to match the jaw, when it really is the jaw that needs to come forward to match the maxilla.
3) The most common cause of TMD; poor development of the facial bones: When the maxilla is underdeveloped, the mandible cannot fit with the jaw joint in its ideal position. One of two things can happen. 1: the mandible will jet out and down, creating a classic “under bite” (Think Jay Leno), or 2: the mandible will be forced backwards (Freddie Mercury) into an overbite, jamming the jaw joint back too far, and preventing the molars from erupting to their proper height. Note: if you have an under bite, standard orthodontists will force you into and overbite, which actually makes the situation worse.
Underbite (Top), and Overbite (Bottom)
A quick way to tell if your jaw is too far back is to put your finger in your ear and open and close your mouth. If you can feel your jaw joint to a significant degree, it is too far back. Ideally you should not be able to feel much movement. Also, bite down slowly and notice which teeth touch first. If your front teeth touch first, that is a good indication of a bite problem. This constant clashing of the front teeth causes massive amounts of stress to the trigeminal nerve, and causes pain and substance P to rise.
Normally the jaw should track on a fair arc when opening and closing. When the jaw is too far back, it has to jet out every time you open, and slide back when you close. When this happens, the jaw slides backwards off of the disk it is supposed to sit on, and “pops” back into place when you open. This causes the popping and clicking noises associated with TMD. Video Representation: https://www.youtube.com/watch?v=jFhxtehAbqw&t=168s
Another sign you can look at is the nasal labial angle. It should be less than 90 degrees. Men will be more acute than women. If it is obtuse (like in the picture of Freddie Mercury above), your maxilla is underdeveloped.
Common symptoms of TMD:
-Jaw pain and facial pain
-Popping and clicking of the jaw joint
-Unexplained sinus problems
-Loss of sense of smell
-Hypersensitive smell (multiple chemical sensitivities)
-Jaw locking, or trouble opening the jaw
-Unexplained vision problems
There are a few reasons why the vast majority of people today in developed countries have poorly developed facial bones. Weston A. Price showed that nutrition is very important in proper facial development. His findings showed that a compound that he called “Activator X” was necessary for proper development. We now know that this compound is actually vitamin K2. When the diet lacks K2 during childhood, the growth plates in the maxilla fuse too early, and the maxilla cannot grow to its maximum potential size. The drug warfarin (a vitamin K antagonist) is contraindicated during pregnancy because it will cause the baby to have an underdeveloped maxilla.
Skull of the famous Kennewick man. Note how the teeth line up tip-to-tip, there is no over or under bite, and the maxilla is fully developed.
NFL hall of famer Shannon Sharpe
It is not a coincidence that most professional and Olympic athletes have well developed facial bones.
Another major cause of underdevelopment of the face is lack of jaw use. Hunter-gatherers used to eat upwards of 100 grams of fiber a day. This required a lot of chewing of fibrous roots, leaves, and other plant foods, as well as game meat, which is considerably tougher than the meat from domesticated animals. It is a case of use it or lose it, and the measly 20 grams or so of fiber in the standard American diet is not enough use.
Improper tongue posture can also lead to maxilla underdevelopment. Your teeth are held into position by the opposing forces of your tongue, and your lips. Normally the tongue sits on the roof of the mouth. If it doesn’t, the lips push back on the maxilla, and with no opposing force from the tongue, it gets held back from growing. Breast feeding is important for developing good tongue posture, and bottle feeding encourages poor tongue posture. Allergies can also cause bad tongue posture. When the nasal passages are clogged, the person is forced to mouth breath, and the tongue cannot rest on the roof of the mouth (lack of breast feeding is also a risk factor for allergies).
(Note: Many people claim that dental injections can cause TMD. While they can cause pain and inflammation to the trigeminal nerve and the surrounding tissues, they don’t cause true TMD, or mechanical dysfunction of the jaw joint itself.)
Developmental problems can be prevented with proper perinatal health care, and good nutrition and breast feeding during childhood. Even later in childhood, but before puberty, proper development can be had with certain appliances that teach proper tongue posture (myobrace being one example). Once the growth plates of the maxilla are fused during the teenage years, treatment is more complicated, but can still be successful and completely eliminate TMD.
Myobrace can promote proper myofunctional habits.
Treatment of TMD is done by a dentist who specializes in neuromuscular dentistry. The main diagnostic method is done with a myotronics k7 jaw tracking device. It tracks the jaw in 4 dimensions (forward-back, left-right, up-down, and time). X rays are also used to assess the position of the mandible in the joint. Electrodes are used to measure the firing of different facial muscles. Using the tracking device as a guide, some type of appliance (typically referred to as an orthotic) is placed on the teeth, and sculpted to put the jaw into its ideal place. This is done over time, and it can take around a year for the jaw to move into its proper place. Once the jaw is in its ideal position and tracking in a fair arc, orthodontics can be used to fix the jaw in this position without an orthotic. This usually involves expansion of the maxilla with a growth appliance, and erupting the molars to make up the lack of vertical height of the teeth.
Myotronics k7 tracking equipment
Example of a commonly used plastic orthotic that sits on the lower teeth.
If you want to find a practitioner for treatment (there are not a lot out there), look for someone who uses the equipment and methods described above. There can be slight variations in the appliances used, but they all generally do the same thing.
Q: How can I find a dentist that does this type of treatment?
A: Finding someone who does this properly can be a challenge. iccmo.org is a good place to start. Look for someone who uses the myotronics k7 tracking device. You will have to do some digging to find someone. I do not know every single dentist who does this.
Q: How much does this type of treatment cost?
A: Usually anywhere from 5-10k, plus more for orthodontics if necessary.
Q: My dentist uses muscle testing as a diagnostic tool for bit correction. Is this adequate?
A: In my opinion, it is not. I am a big proponent of muscle testing in general, but not for this application. Jaw movement and position needs to be measured precisely and mathematically, we are talking fractions of a millimeter. Muscle testing is not sensitive enough, and there are objective tools that are better.
Q: How long will it take before I feel better?
A: Some relief will be instant, but there will ups and downs with gradual, overall improvement. If you have had TMD for a long time, there can be damage to the joint that may require additional treatments to fix.
Q: Will this cure all of my health problems?
A: If your health problems are related to TMD, than this treatment can help.
Q: Why is this treatment not more popular?
A: Because it is based on common sense, is highly effective, and not covered by insurance. It is not a good business model because after 1-3 years, the patient is cured and does not need to come back. On the other hand, you could charge the patient more than triple the amount for jaw surgery and bill it to insurance. After a year or two, the patient will be back to square one. Now you can get them hooked on pain medication, and regularly have them come in for visits to monitoring. Over time the patient will get worse, and you can put them on more medications. This is the big, stupid dumpster fire of American health care.
Q: My dentist wants to use an appliance that has metal in it. Will this be a problem?
A: It depends. If there is only one type of metal in your mouth, it will probably be fine. If there are two or more types of metal, it can create a galvanic effect. In general, I think that the long-term benefits of this treatment out weight the short-term risks of a temporary appliance.
Q: What about the ALF appliance?
A: ALF is an appliance that expands the maxilla. This is good, as it will allow the jaw to move forward. However, it won’t add vertical height to the teeth, which is the main problem. You have to correct jaw position first. After the jaw is in its ideal position, then you can move the teeth to fit this position without and appliance.
Q: What about the DNA appliance?
A: It will expand the maxilla and allow the jaw to move forward, but again, it won’t add height to the teeth.
Q: My dentist says he can fix my bite by shaving down high spots on my teeth. Will this work?
A: The main cause of TMD is LACK of vertical height of the teeth, not too much height. The jaw typically needs to be corrected in all 4 dimensions. There have been extremely inhumane experiments done on dogs where researchers ground down one side of the dog’s teeth. They became severely ill and died prematurely.
Q: Can I just add composite or crowns to build up the height of my molars?
A: You could, but depending on how much height you need to add, it will likely make you look like a big doofus with horse teeth.
Q: Will cavitation surgery fix my bite?
A: Cavitations can cause inflammation and pain in the jaw. However, they don’t change the position of the jaw. Cavitation surgery won’t change the physical position of the jaw.
Q: Will bite correction treatment fix my cavitations?
A: No. Once the jawbone becomes infected, the only effective treatment I know of is surgery. I do believe that bite correction can help the sites heal properly after surgery, and that bite correction early in life can make enough room for the wisdom teeth to come in, and prevent cavitations in the first place.
By Bryant Rubright
Resource for finding practitioners: http://iccmo.org/
Link to the jaw tracking equipment: http://www.myotronics.com/products/k7-evaluation-system/
More general information: