Descending TMJ – The Facts You Need to Know

Imagine setting up for a well-deserved, relaxing movie night at home after a hectic day at work. The lights are dim, your favorite movie is all queued up, and you’re cozied up on the couch with a hot, buttery bowl of popcorn. It sounds perfect, doesn’t it?

But just as you take that first delicious bite of popcorn, you’re suddenly unable to fully enjoy it, as you’re faced with a sharp, uncomfortable pain in your jaw. Ruins the whole experience, doesn’t it? Unfortunately, this might not just be an isolated incident but rather indicative of a condition called Descending TMJ, which affects countless individuals worldwide.

Let’s dive deeper into this commonly misunderstood and often overlooked disorder, explore its causes, symptoms, and most importantly—how to effectively manage it and rediscover the joy in life’s simple pleasures, like savoring the delightful taste of popcorn during movie night.

1. Postural alignment and occlusal balance

Postural alignment and occlusal balance play a crucial role in maintaining optimal overall health and well-being. The intricate relationship between these two factors is evident in the impact they have on various aspects of the body, including the temporomandibular joints, lower back, pelvis, legs, and feet.

• A significant aspect of optimal occlusal balance is mandibular position and its impact on the masticatory system. The muscles of the cervical and shoulder regions, in conjunction with the temporomandibular joints, contribute to overall postural alignment.

• Unstable pelvis and malalignment concerns are correlated with occlusion, contributing negatively to other parts of the body in a descending downward pattern. This can result in an abnormal anterior rotation of the pelvis and an inward roll of the feet, exacerbating postural imbalances.

Dr. Clayton A. Chan states, “Wearing foot orthotics and mouth orthotics, I personally believe from my experience that treating the mouth and jaw issues will dominate foot issues over time due to the power of the trigeminal neural sensory feedback loop.”

• The Chan Dental Model on proprioceptive signaling emphasizes the importance of recognizing whether the primary pain stimulus arises from the craniomandibular system (descending) or elsewhere (ascending). This distinction helps identify the root cause of postural imbalances and allows for targeted treatment to alleviate chronic pain and stiffness.

In conclusion, proper postural alignment and occlusal balance are essential for maintaining overall health and well-being. Recognizing and addressing any imbalances or dysfunctions in these areas can help alleviate chronic pain, improve posture, and promote a more balanced and stable body. Health professionals should understand the interdependence between these factors to effectively diagnose and treat related conditions.

2. Impact of mandibular position on the body

The impact of the mandibular position on the body is a crucial aspect to consider when addressing temporomandibular dysfunction (TMD). Mandibular positioning can significantly affect various aspects of an individual’s overall wellbeing, as the jaw joints and muscles are closely connected to the spine and nervous system. In recent years, numerous scientific studies have researched the clinical correlations between malocclusions, TMD, and postural abnormalities. This analysis will discuss the significance of mandibular positioning on the body, based on factual data obtained from recent literature.

• The mandibular position plays a major role in achieving proper occlusion and alignment of teeth and jaw joints. Anomalies in the temporomandibular joint (TMJ) due to malocclusion negatively impact the spine, leading to postural abnormalities (Department of Biomedical and Dental Sciences and Morphological and Functional Imaging Messina University, 2019).

• In cases of mandibular retraction, the lower jaw can become compressed into the joint socket, leading to gradual deterioration over time (MSK Neurology, n.d.). This improper positioning can ultimately result in increased pressure on the spine, causing postural issues and exacerbating existing malalignments.

• Apart from causing TMJ disorders, underdevelopment of the maxilla bone (upper jaw) can also compel the mandible to compensate, leading to postural changes (Dr. Mike Mew, n.d.). This compensation process often results in an unbalanced and over-closed TMJ, increasing the risk of further damage and discomfort.

In conclusion, the proper positioning of the mandible is essential for maintaining overall bodily health and reducing the risk of TMD, as well as postural abnormalities. By addressing these concerns, healthcare professionals can help their patients achieve a healthier and more functional body, improving their overall quality of life. [*]

3. Unstable pelvis and malalignment concerns

The connection between the jaw and pelvis is a fascinating aspect of human anatomy that can significantly impact a person’s overall wellbeing. Unstable pelvis and malalignment concerns are closely related to temporomandibular disorder (TMD) due to the interconnectedness of these two areas. When the pelvis is misaligned, it can directly influence the movement and alignment of essential vertebrae in the spine involved in jaw motion, which is explained by Guzay’s theorem. A misaligned pelvis often affects a person’s posture, contributing to both jaw and neck pain, which are common symptoms of TMD.

The unstable pelvis and malalignment concerns can have consequences in daily life, including:

– Imbalanced movement of the temporomandibular joint (TMJ) due to a direct effect on the upper neck vertebrae
– Increased stress on the dura mater, the protective layer surrounding the spinal cord, adversely impacting neurological well-being
– Abnormal spinal curves, pelvic rotation, or tilt causing head tilt and cranial bone misalignment
– Hindered communication between the sacrum and cranium through the dural tube, potentially causing dissonance in the central nervous system and hormonal fluctuations

Women tend to experience more pelvic floor issues than men, which makes them more susceptible to TMJ disorders. Addressing both the jaw and pelvis alignment problems simultaneously could be the key to alleviating TMD-related discomfort. Moreover, it is essential to keep in mind that stress also plays a role in the development of TMJ disorders, as many people tend to clench their jaw during stressful situations.

In conclusion, understanding the connection between an unstable pelvis and temporomandibular joint disorders is crucial for proper diagnosis and treatment. By addressing the underlying causes of pelvic misalignment in addition to TMD, healthcare professionals can develop a comprehensive approach to relieving chronic pain and improving overall posture.

4. The Chan Dental Model and proprioceptive signalling

The Chan Dental Model, developed by Dr. Clayton A. Chan, addresses the significant aspect of postural body alignment and balance in relation to optimal occlusal balance. This model highlights the importance of mandibular position and its associated entities such as the temporomandibular joints, masticatory system muscles, cervical and shoulder regions, lower back, pelvis, legs, and feet. In particular, the Chan Dental Model emphasizes the role of proprioceptive signalling, stemming from either the craniomandibular system (descending) or the rest of the body (ascending) in causing pain and postural issues.

Key points of the Chan Dental Model and proprioceptive signalling include:

– Unstable pelvis is a concern; it correlates with occlusion, contributing negatively to other parts of the body in a descending pattern.
– Descending patterns arise from stomatognathic or craniomandibular nociception, resulting in divergence between the occlusal, pectoral, and pelvic planes with a tendency toward double scoliosis.
– Ascending patterns involve the tilt of the axial skeleton following the nociceptive upward flexed pelvis, leading to compensating contractions of the contralateral shoulder and neck, attempting to correct the visual and occlusal plane relative to the horizon.
– Chronic pain results in progressive painful postural stiffening and abnormal postural patterns.

According to the Chan Dental Model, “The pattern of responses initially depends on whether the primary pain stimulus arises in the craniomandibular system (descending – CMD) or elsewhere (ascending – CMD).” Thus, understanding and addressing proprioceptive signaling and its origin is crucial for effectively treating temporomandibular joint disorders and achieving optimal postural alignment.

5. Descending vs. ascending pain patterns

Understanding the various pain pathways is essential to comprehend and tackling chronic pain conditions effectively. The nervous system primarily consists of two major pain pathways, namely descending and ascending patterns, which are responsible for communicating pain signals from our sensory receptors to the brain and vice versa.

• Ascending pain pattern:

In this pattern, the pain signals from the site of injury travel through the peripheral nervous system, ascending to the brain where it processes the type and severity of pain. It primarily follows a neurotransmitter release mechanism from primary nociceptors to secondary order neurons located in the spinal cord, transmitting the signals to the somatosensory cortex.

• Descending pain pattern:

Conversely, the descending pain pattern aims to modulate pain perception in response to pain stimuli. It starts in the periaqueductal gray (PAG) – a region in the midbrain where it receives and processes pain signals from the spinomescencephalic tract, which is then relayed to the rostral ventral medulla (RVM). The neurons in RVM send inhibitory signals down to the spinal cord, activating our body’s endogenous pain suppression system.

“Within the central nervous system there are three types of opioid receptors which regulate the neurotransmission of pain signals. These receptors are called mu, delta and kappa opioid receptors. They are G protein-coupled receptors and their activation leads to a reduction in neurotransmitter release and cell hyperpolarization, reducing cell excitability.” – Physiopedia

Descending pain pathways have an important role in mitigating and protecting against the development of chronic pain. A robust descending inhibitory system helps maintain a balance with ascending pain signals in normal physiological conditions. However, insufficiency in the descending modulation can lead to the chronification of pain.

In summary, the ascending pain pattern transmits pain signals from an injury site to the brain, while the descending pattern is responsible for pain modulation, aiming to alleviate our perception of pain. Recognizing the significance of these patterns is crucial in devising therapeutic interventions for managing chronic pain effectively. [*]

6. Effects of chronic pain on posture

Chronic pain, particularly in the temporomandibular joint (TMJ) and masticatory muscles, can have a significant impact on a person’s posture. TMJ dysfunction has been studied extensively in recent literature, with researchers striving to understand the connection between TMJ issues and postural irregularities. According to a study published in the National Library of Medicine, there is a strong correlation between TMJ anomalies and vertebral column dysfunctions. This correlation is especially pronounced when considering malocclusions, which can have negative implications for the spine.

The effects of chronic pain on posture can be outlined as follows:

– Altered spinal alignment: Chronic pain in the TMJ area can lead to compensatory postural changes in the cervical, thoracic, and lumbar regions of the spine. This, in turn, can result in an overall imbalance of the spinal column and can contribute to further discomfort and musculoskeletal dysfunction.

– Increased muscle tension: Chronic pain can cause affected muscles to tighten and become more rigid, leading to a limited range of motion and an inability to maintain proper posture. This can result in muscle imbalances and further aggravate the underlying TMJ dysfunction.

– Compensation in other body regions: As the body adapts to the pain and dysfunction in the TMJ and spine, it may develop compensatory patterns in other areas such as the hips, knees, and ankles. This can lead to a cascading effect of imbalances and postural irregularities throughout the body.

– Weakness and fatigue: Chronic pain can lead to muscle weakness and fatigue, making it difficult for individuals to maintain proper posture. This can perpetuate a vicious cycle of pain and postural dysfunction.

In conclusion, chronic pain caused by TMJ dysfunction can have a significant impact on a person’s posture, leading to further musculoskeletal issues and contributing to a decline in overall well-being. It is crucial for healthcare professionals to consider the multifaceted relationship between TMJ dysfunction and posture when developing treatment plans for their patients.

7. Treating foot issues through optimizing GNM orthotics

Optimizing GNM orthotics plays an essential role in treating foot issues, providing various benefits that contribute to the overall improvement of patients’ quality of life. One of the distinguishing factors in Gneuromuscular (GNM) dentistry, as opposed to the traditional Neuromuscular (NM) dentistry, lies in its approach toward a comprehensive and customized treatment plan that extends beyond dental support to include orthopedic features.

The benefits of optimized GNM orthotics in treating foot issues are as follows:

– Customization: The GNM orthotic is specifically designed and fabricated according to the patient’s needs, incorporating both gnathologic and neuromuscular principles. This ensures that the orthotic is tailored to the individual’s requirements, providing optimum comfort and effectiveness.

– Comprehensive support: Treating foot issues using GNM orthotics goes beyond merely addressing dental occlusion; it encompasses overall muscular balance, TM joint harmony, and various other functional features that contribute to the improvement of the patient’s physical health and wellbeing.

– Collaboration with medical professionals: GNM-trained dentists work closely with other healthcare specialists, including medical doctors, chiropractors, physical therapists, massage therapists, and osteopaths. This approach ensures a well-rounded and inclusive treatment plan that addresses foot issues in conjunction with other contributing factors.

– Patient-centered approach: In the words of Dr. Susan Go, a GNM-trained dentist, “We only move into Phase 2 after the patient is happy. We don’t do Phase 2 hoping that the patient will be happy.”

By implementing optimized GNM orthotics, patients experiencing foot issues are provided with a customized, comprehensive, and collaborative treatment plan that aims to deliver optimal results. As supported by various testimonials, this approach has proven effective in addressing not only dental-related concerns but also improving patients’ overall quality of life.

8. Dysregulation of the descending pain system in TMD

Descending Temporomandibular Joint Disorder (TMJ) is an increasingly recognized condition that affects the temporomandibular joint, a joint responsible for the function of the jaw. Several aspects contribute to the etiology of TMJ, and one of the significant factors to consider is the dysregulation of the descending pain system in relation to TMD.

* Dysregulation of the descending pain system:

A study conducted by researchers at the University of L’Aquila, Italy, and published in PLOS ONE found that the descending pain system’s dysregulation might be involved in TMD. The study used computerized pupillometry to determine the connection between the autonomic nervous system (ANS) and TMD pain. It was revealed that the ANS is dysregulated in patients suffering from TMDs, which suggests a potential role for ANS dysfunction in pain modulation and the etiology of TMD.

* Pupil size differences:

The study found that under light conditions, TMD patients presented a smaller pupil size compared to controls. This further indicates impaired modulation of the descending pain system in TMD patients.

* TENS stimulation:

Transcutaneous electrical nerve stimulation (TENS) has been extensively used for pain relief as low-frequency stimulation can activate µ receptors. The study aimed to evaluate the effect of low-frequency TENS stimulation of µ receptors on opioid descending pathways in TMD patients. The results revealed that TENS stimulation significantly reduced pupil size in both groups (patients and controls), but only the control group displayed significant differences in pupil size before and after TENS. This suggests a different pattern of response to TENS stimulation in TMD patients compared to controls.

In conclusion, dysregulation of the descending pain system in TMD may impact the modulation of pain in TMD patients. Further research is needed to understand the mechanisms involved in this process better and develop effective treatment strategies for managing TMD pain. [*]

9. Pupillometric study and ANS dysfunction in TMD

Temporomandibular disorders (TMDs) are known to cause pain and discomfort in the jaw and surrounding areas. Recent research has indicated that autonomic nervous system (ANS) dysfunction may play a significant role in the etiology of TMDs, as well as in pain modulation. One study providing evidence for this link is a pupillometric study published in PLoS ONE by researchers from the University of L’Aquila and the Politecnico di Torino in Italy, which explored the dysregulation of the descending pain system in TMD patients.

* The study evaluated 18 females with myogenous TMD and 18 matched-controls, using computerized pupillometry to measure pupil size under dark and light conditions before and after sensory transcutaneous electrical nerve stimulation (TENS).
* According to the researchers, “stimulating the descending opioid pathway with low-frequency sensory TENS of the fifth and seventh pairs of cranial nerves affects the peripheral target”.
* Findings revealed that TMD patients had a different pattern of response to TENS stimulation compared to the control group, suggesting impaired modulation of the descending pain system in TMD patients.

As stated by the authors, “Pupillometry revealed that stimulating the descending opioid pathway with low-frequency sensory TENS of the fifth and seventh pairs of cranial nerves affects the peripheral target. The TMD patients exhibited a different pattern of response to TENS stimulation compared with the controls, suggesting that impaired modulation of the descending pain system may be involved in TMD.” This pupillometric study contributes significantly to our understanding of the role of ANS dysfunction in TMDs and highlights the need for further research into pain modulation in these patients.

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