By Kevjonesin - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=26222892
Disclaimer: nothing in this article constitutes medical advice. This article is offered for informational purposes only. Medical decisions are yours to make together with your healthcare providers.
Preface
I assume that if you’re reading this, you fall into one of three categories:
You have a dystonia diagnosis and are curious about TMJ balancing treatment;
You have TMJ disorder (TMD), are experiencing neurological symptoms, and are trying to understand how those two are connected;
You have been diving deep into TMJ therapy for years and perhaps walk around with 3-5 different splints to help manage your symptoms.
Whichever of these (or other) categories you fall into, there is something in this article for you.
So here it goes!
The basics on TMJ-based approaches to neurological symptoms
If you suffer from dystonia and have searched for treatments that can actually help you reverse the disorder rather than just trying to ‘freeze’ the muscles that are spasming with botox injections, you have perhaps run into the TMJ balancing approach.
This may have shown up as “TMJ dentistry”, “splint therapy”, “TMJ decompression” or other more specific, proprietary nomenclature such as Dr. Youngjun Lee’s “Functional Cerebro-Spinal Therapy” (FCST) in South Korea.
You may have also looked into TMJ dentistry if you don’t have a dystonia diagnosis, but suffer from neurological symptoms related to malocclusion, TMJ disorder (TMD), cranial imbalances and other trouble in the head and neck area. These symptoms can include pain and spasms in the face and throughout the body, difficulty breathing, sleep apnea and more.
This approach can be quite effective in reversing symptoms, at least in the short run. At the same time, the TMJ balancing approach is not nearly as comprehensive as it would need to be in order to truly allow a person with dystonia to reverse the disorder and create a long-lasting, functional equilibrium - a eutonic homeostasis, if you will.
Moreover, the level of understanding of the link between TMJ balance and nervous system health by TMJ specialists, dentists, osteopaths and other providers is more often than not severely lacking, which leads to treatments that can provide some relief initially but actually produce greater damage in the long run.
It is therefore crucial that if you are considering such a treatment, you have all the information you need in order to make an educated decision, protect yourself against unnecessary harm, and use this type of treatment in the service of whole-person healing.
This article looks in detail at the anatomical and biomechanical bases behind this approach and its efficacy, the different ways in which healthcare practitioners adopt it, and helps you understand how you can figure out if this approach is right for you and if so, how to actually guide the right practitioner to create the TMJ balance that works for you.
What is TMJ balance and why it matters for nervous system health
The temporomandibular joint, or TMJ, is an extremely complex and refined mechanism. It is the joint where the ends of the jaw bone, or condyles, meet the cranium in a concave space called fossa; between them sit the discs that help the jaw move smoothly as we chew, speak, and open and close the mouth.
The crucial thing to know about the importance of the TMJ for the health of the nervous system is that several cranial nerves travel through the TMJ area and are compressed more or less depending on the position of the condyles in the fossa.
When the jaw is displaced in such a way that the left condyle is further away from the fossa than the right one, for example, the cranial nerves on that left side will be compressed less than the condyles on the right. This leads the nerves on this less-compressed left side to work less than their counterparts on the right, leading to a pattern of a hypotonic (underworking) left side and a hypertonic (overworking) right one. This is a key causal factor in dystonia for many people.
The cranial nerves are really fundamental parts of the nervous system: they help us with such fundamental things as seeing, hearing, breathing, speaking, finding our place in space and so on. They also mostly connect directly to the brain stem, a very fundamental and primordial part of our brain. When the cranial nerves are disturbed, the health of our nervous system can be severely compromised, and our quality of life can deteriorate rapidly.
Among other things, when the brain stem constantly receives messages of instability and asymmetry through the cranial nerves, there is a persistent level of stress in the background that can manifest as a chronic trauma response such as fight, flight or freeze patterns. (But there is a way out, read to the end!).
How the TMJs get out of balance
The temporomandibular joints get out of balance for a variety of reasons: malocclusion (an imbalanced bite), bruxism (grinding teeth), cranial asymmetries, harmful orthodontic or dental interventions, viral infections (herpes family viruses, including shingles and Epstein-Barr Virus or EBV), heavy metal toxicity (including from everyday environmental exposure), misalignment of the upper cervical vertebrae, physical and psychological trauma, and more.
It is important to remember that occlusion (the way the teeth meet) guides the position of the condyles in the temporomandibular joints, therefore determining the relative pressure in each one of the TMJs (TMJ balance) and impacting the health and balance of our entire nervous system.
This simple fact is not at all taken into account by the vast majority of dental and healthcare practitioners, who have no way of measuring the impact of their interventions on the nervous system and therefore dismiss these life-changing effects altogether. Almost the entirety of today’s orthodontics and dentistry at large, with very few exceptions, are based on an understanding of occlusion as a matter of geometry that exists in a vacuum: as long as the teeth look good and match well, all must be good elsewhere.
This approach disregards the fact that one’s teeth may match perfectly when looked at in isolation, but may actually be guiding the condyles into an imbalanced position in the two temporomandibular joints, and destabilize the whole cranio-mandibular-cervical complex.
Several Hope for Dystonia clients suffered from such imbalances when they first began their recovery journey, sometimes unbeknownst to them and the healthcare professionals that followed them. One client had all his teeth on the left of his mouth ‘shaved off’ to reduce their length; his dentist thought this would be a good idea because it created an apparently symmetrical bite. This dentist ignored the fact that his patient’s cranium was asymmetrical, and therefore was oblivious to the disastrous consequences that inevitably ensued when his patient’s new bite pushed his left condyle deep into the TMJ, compressing the cranial nerves there, causing an endless list of symptoms including tinnitus, pain, spasms and more that ended up forcing an early end to a promising musical career. (This client has since then made incredible progress with Hope for Dystonia coaching and a holistically-minded dentist whom he learned to guide based on the inputs from his nervous system).
TMJ and other dystonia causal co-factors
In my experience with my own recovery and in helping clients, I have repeatedly seen that anatomical and occlusal imbalances are never the only factors that cause a crooked jaw or a TMJ imbalance. Other factors contribute as well, among them trauma, certain viral infections (Epstein-Barr Virus and other Herpes family viruses), toxicity and physical injuries. (Read “What Causes Dystonia, Really?” to learn more).
Viral infections and heavy metal toxicity can impair communication in the nervous system, and the role of both is now widely recognized in several neurological disorders and diseases. As the nervous system struggles to communicate properly, any slight imbalance that might have been present earlier in the use of the two sides of the cranial nerves becomes exacerbated. A somewhat overused set of nerves can become severely hypertonic and produce painful spasms. This, in turn, jams the corresponding condyle deeper into the fossa, creating greater compression of the cranial nerves there, taking the upper cervical vertebrae further out of alignment and exacerbating a cascade of effects from head to toe.
Psychological trauma, be it as a result of an event in adulthood or ongoing developmental deficits in childhood, can also wreak havoc on one’s nervous system, impacting one’s occlusion and TMJ balance. Medical science is only beginning to take an interest in the intersection of trauma and physical health, and it will be a while before we have clear links that are established between these two variables. Already now, however, we know that adverse childhood experiences (ACEs) raise one’s chances of developing often ‘mysterious’ illnesses, and that trauma is stored in the nervous system - and these are just two examples of established facts.
Beyond what is established in published research, I have learned from my own experience that the links between trauma and TMJ balance follow discernible patterns. People who have suffered sexual abuse, for example, may have a hard time inhabiting their mouth and throat, as these don’t feel like safe places to be. Their nervous systems’ fight-or-flight energy is generally not released during the traumatic event itself, as it would put the individual at risk of further violence. It is instead suppressed, and ends up lingering in cranial nerves that often are already making an effort to compensate for other issues, such as the ones outlined above. It is therefore extremely difficult for someone affected by this kind of trauma to try and hold their jaw differently: it’s too scary to even feel it in the first place!
Another, more subtle pattern I’ve recognized relates to developmental trauma. Children of emotionally immature parents (EIPs), parents with narcissistic traits, or in general children who developed anxious, avoidant or disorganized attachment patterns growing up seem to have a predisposition for misalignment of the jaw and TMJ imbalance. These are adults who have developed using survival patterns that forced them to hide certain parts of themselves and overemphasize others in order to feel safe, seen, and valued. This ends up being mapped out in the way they use their cranial nerves: one side ‘hides’ while the other does twice the work, so to speak, contributing to a TMJ imbalance.
The mechanism by which these imbalances turn into full-fledged neurological conditions such as dystonia is maladaptive neuroplasticity: the brain ends up adapting to a dysfunctional situation, and creates further compensations in the body that perpetuate this state.
How to understand if you need TMJ balancing
Many of those who have a TMJ imbalance are unaware of it: they might have been told that they grind their teeth, they might have missing or damaged teeth, or might have suffered from malocclusion as children even if they thought they had somehow fixed in with more or less invasive orthodontic and maxillo-facial surgical interventions.
In general, if you (1) have neurological symptoms, especially in your head and neck, and (2) have missing, damaged or worn-down teeth, malocclusion of any kind, cranial asymmetry and/or have had extensive orthodontic work in your lifetime, then you are quite possibly dealing with a TMJ imbalance as part of your overall health picture. (Again, this is not medical advice or a diagnosis!)
One way to better understand the state of your nervous system in your head and neck is through the first two hours of work with Hope for Dystonia, which are dedicated to mapping out hypo- and hyper-tonic (under- and over-working) cranial nerves and the inputs, such as TMJ imbalance, that contribute to that state of things. (Schedule a free consultation today if you’re interested in learning more).
How to get your life back, and what to avoid
TMJ imbalances develop as emergent phenomena: no single causal factor is sufficient to explain them; rather, they emerge from a constellation of causes. They are often the result of a physical input such as malocclusion, physical trauma, negligent treatments etc., combined with psychological trauma (either a single event or one that takes place over time, such as developmental trauma), toxicity, viral infections and more. Maladaptive neuroplasticity is the mechanism by which the brain learns to adapt to and perpetuate these imbalanced states.
The way out of maladaptive neuroplasticity is… adaptive neuroplasticity! If the brain has learned a maladaptive pattern as a result of the asymmetrical and dysfunctional inputs described above, the solution is to (1) provide correct inputs for the brain to learn and (2) induce neuroplasticity, i.e. stimulate the brain’s learning ability.
Here’s a key nuance though: it is extremely difficult, perhaps even impossible, to provide the correct occlusal input based on an external assessment. In other words, it is extremely difficult or even impossible to determine from the outside what the correct position of the jaw should be relative to the cranium. You are the only person who can determine the correct occlusal configuration (i.e. the way you bite) to help your nervous system find stability.
Practitioners who determine the supposedly correct TMJ configuration based on MRI and other scans of the joints, on external visual examinations of the occlusion, muscle testing, neuromuscular techniques, TENS devices etc. can sometimes (not nearly consistently) provide partial short-term relief, but they often end up missing the mark by a significant margin. The splints and treatments they devise based on this information, in turn, can create the need for further dysfunctional compensations in the body and ultimately create more debilitating neurological symptoms.
This has been my experience and that of many clients, and it is my hope that the information provided in this article can spare others the same pain. There is a better way!
Addressing cranial distortions
Before we get into what this better way looks like, we need to address cranial distortions. These are a complicating factor for some - but not all - cases of TMJ problems. They both increase the likelihood of a TMJ imbalance developing and may themselves arise as a result of the asymmetrical biomechanics that develop once the TMJs are imbalanced.
When it comes to non-surgical options, these distortions are sometimes addressed through osteopathy, myofunctional therapy and the ALF appliance (a wire usually placed behind the maxilla, or upper arch). These are beyond the scope of this article, but I may include them in a future one (comment below if you’d like to see this).
In the meantime, here’s an important thing to remember: some practitioners will try to address cranial distortions while completely ignoring TMJ balance and the cranial nerves. They may, for example, cover most of a patient’s teeth with composite while a combination of intraoral appliances and osteopathy attempt to correct cranial asymmetries. I have learned through my work with some of these patients that ignoring the nervous system in this way can lead to very difficult consequences.
The path to wholeness that has given me my life back, on the other hand, makes the nervous system the guide of the entire healing process. When composite and appliances are used by a dentist, they are employed in ways that help the nervous system rather than ignoring it. This ensures that the health improvements on all fronts, including slowly correcting cranial distortions, are matched by a steady improvement in one's ability to function.
They key is being able to guide your dentist to the occlusion that your nervous system craves.
A path to wholeness
I know, I know. Some of you might be thinking: I have no idea whatsoever of what kind of occlusion my nervous system needs in order to be at peace. You might even have tried splint therapy or other TMJ balancing approaches before, only to find yourself at a loss when it came to advocating for what you needed, and ending up at the mercy of practitioners who adjusted your occlusion based on what they could understand from the outside.
My message to you is this: this is your body. You have sovereignty over it (you get to call the shots) and you are the only one who can get instantaneous feedback from the nervous system as to what TMJ balance and occlusion you need. Step into your power.
In order to do so, you need to embark on a journey of self-knowledge and healing that is much broader than the mechanical imbalances in the TMJs. You are being called to develop intimate, fine-tuned embodiment so that you can:
understand the messages coming from your cranial nerves;
even out hypo- and hyper-tonic pathways so that you hold your jaw in a more functional position;
address all other causal co-factors as described above (check out the Eight Steps of the Hope for Dystonia Recovery Roadmap); and
slowly build the occlusion you need.
The process of rebuilding the occlusion will have to be carried out with a holistically minded dentist who is both skilled at working with the occlusion and has the listening skills and humility to be able to follow the inputs from the nervous system.
The first necessary step on the path to TMJ balance and peace in the body starts with you: learning to get to know and regulate your nervous system. This is what Hope for Dystonia coaching is all about.
If you feel called to learn to listen to your body and pursue a holistic path of healing, sign up for the Hope for Dystonia newsletter and watch the Eight Steps of the Hope for Dystonia Recovery Roadmap that you'll receive right away; book a free call and get answers to your questions. There is hope! Will you take action?