JOURNAL of THE SACRO OCCIPITAL TECHNIQUE of AUSTRALASIA
CHIROPRACTORS,
DENTISTS AND THEIR CRANIAL CONNECTION.
There
are Dentists who look beyond the teeth. As one such Dentist, I routinely
look at Temporomandibular Joints, muscles, the structures of the jaws and
skull and how these structures interrelate with the rest of the body, the
body posture and even the feet! I realise that the teeth and jaws are just
a few components of the very sophisticated and complex human organism.
I appreciate that to make changes to the teeth there is going to be inevitable
changes to the rest of the body as a result.
Dr
Major DeJarnette, the founder of the Sacro-Occipital Technique agreed with
the beautiful work of Sutherland that there were minute rhythmic motions
of the skull which were synchronized with palpable sacral motion. He developed
a model which placed the sphenoid bone as the keystone of the bony cranium.
The sphenoid supplies the driving force which is transmitted to the rest
of the cranium via its articular relationships with the occiput, temporals,
parietals, frontal, ethmoid, vomer, palatines and zygomae. The sphenoid
also influences the maxillae by way of the vomer and palatine bones. It
is obvious from this model that a force which moves the sphenoid must necessarily
cause motion in all the bones it articulates.
The
cranium is similar to other weight bearing bones, such as the pelvis, in
that the forces placed on it need to be dissipated in a healthy manner.
The forces of the dental occlusion can generate pressures up to hundreds
of psi during function and even higher during parafunction (subconscious
grinding and clenching). The direction of these forces in the cranium is
of major importance for proper cranial function.
“Angulation
of the posterior roots(teeth) establishes a vector of force that focuses
toward the vomer. The posterior bicuspid and
molar axial root planes are directed within a range of the sphenobasilar
symphysis. Forces generated during swallowing and chewing are directed
via the vomer to the sphenobasilar area and enhance flexion”
Gerald
H. Smith, Cranial Dental Sacral Complex, 1983.
The
cranium is influenced by pelvic distortions and the pelvis can be influenced
by dental malocclusions. Chiropractic stabilization of the cranium may
produce muscular changes which affect the mandible in its relationship
with the maxillae but a dental malocclusion will not automatically be balanced
by chiropractic treatment alone. Conversely, correction of a malocclusion
by a dentist will produce stabilization of the cranium but not have an
effect on pelvic distortion. It is therefore important that a cohesive
treatment plan be structured to incorporate a balance between the pelvis
and cranium and the occlusion and cranium. It makes sense that for patient
care to be truly effective there is a need for an integrated interdisciplinary
relationship between the Dentist and the Chiropractor.
Dental
Considerations and Cranial Function
Dental
Malocclusion
This
is, by definition, faulty closure of the upper and lower teeth. Dentists
who previously focussed on tooth to tooth relationships are becoming aware
of the importance of the bony relationship between the maxillae and the
mandible and the other structures of the cranium. Changes can be initiated
early in life by pelvic and cranial distortions that affect the sphenobasilar
synchondrosis. Parafunction and oral habits such as thumb sucking and mouth
breathing can change the occlusion of the teeth creating
cross bites, open bites and over bites that persist throughout life unless
treated.
The full
effect of altered dental arch shape on the rest of the cranium is not fully
understood but it appears that constriction and asymmetry of the arches
of the maxilla and mandible affects the normal cranial rhythmic motion
and thus overall whole body health.
I am
continually asked why so many of our children have crooked teeth and bad
bites (malocclusion). The answer lies in the so called civilisation of
our society. Dr Weston Price, in his classic book, Nutrition and Physical
Degeneration, compared the effects of primitive
diets and highly refined modern diets on dental and cranial structures.
He showed that primitive people who ate native foods developed wide symmetrical
dental arches, wide patent nasal passages, broad heads and faces. He also
showed that people in the same culture and of the same race who ate a highly
refined modern diet developed dental caries (tooth decay), narrow heads,
long narrow faces, narrow nasal passages, constricted dental arches and
malocclusion. He also referred to the effects of the modern refined food
diet on the development of the pelvis of women. A modern diet can be one
of the causes of the underdevelopment of the pelvis of women resulting
in a diminished size of the birthing canal.
Dr Kathleen
Vaughn in her book, Safe Childbirth, showed clearly that the shape of
the pelvis is determined by the method of life and nutrition. She showed
that in primitive tribes “…childbirth is easy and labour
is of short duration and that this is associated with a round pelvis. The
distortion of the pelvis to a flattened or kidney shape, even to a small
degree, greatly reduces the capacity and therefore the ease with which
the infants head may pass through the birth canal”
There
is a marked difference in the shape of the arches of the maxillae of modern
man versus primitive man. It was the opinion of Dr Price that the diet
of the mother affects the development of the cranial facial complex of
the child in the womb. The poor diet of the foetus, restricted size of
the birthing canal of the mother, prolonged labour and subsequent forceps
delivery by well-meaning physicians during childbirth, and subsequent poor
diet of the child during growth and development of the cranial mandibular
complex has lead to constriction and underdevelopment of the normal cranium
(including the maxilla and mandible). Thus a poor diet is a major contributing
factor in the malrelationship of the jaws, predisposing the child to dental
and cranial orthopaedic problems.
In many
developed countries such as Australia and New Zealand, cranial deformities
go unnoticed but this is not the case for dental malocclusion. Children
with dental malocclusion will usually be placed under the care of an orthodontic
specialist. Generally under the present standard of care, children with
narrow dental arches will be treated with surgical removal of bicuspid
teeth followed by fixed appliances on both upper and lower jaws. In many
cases the child is placed in headgear employing forces to distalize the
upper posterior teeth. When the maxilla is forcibly retruded to meet a
retruded mandible, it forces the palatine bones into the pterygoid plate
of the sphenoid bone causing a restriction of the normal cranial motion
at the sphenobasilar synchondrosis. Retrusion of the mandible in the glenoid
fossa creates irritation on the retrodiscal tissues which affects the proprioceptive
nerve bed and forces the temporal bones into bilateral internal rotation.
The consequences are to the detriment of the vestibular cochlear mechanism
and cranial nerves VII and VIII which can result in vertigo, tinnitus and
loss of equilibrium.
The shape
and relative position of the arch of the maxilla to the cranial base also
affects the direction of the forces generated within the cranium during
normal occlusal function. The direction of the forces of occlusion affects
the dural attachments, flow of the cerebral spinal fluid, articular motion
of the cranium, craniosacral mechanism and the rest of the central nervous
system.
Spinal
Lordosis and Cranial Sutural Locking
In a
normal occlusion the upper incisor teeth should not contact the lower incisors
during swallowing or chewing but forced retrusion results in continued
occlusal interference from the incisor teeth eventually causing a chronic
forward head posture. This changes the cervical spine lordosis at the level
of C3, C4 and C5 inducing an anterior curve which may result in degenerative
changes at those levels.
The anterior
head tilt results in spasm of the temporalis muscle. The temporalis covers
most of the sutures of the lateral aspect of the cranium and as the muscle
continues to spasm the cranial bone sutures beneath it lose their mobility,
or lock. The natural cranial bone motion is inhibited and so is homeostasis.
Arch
Expansion
Ideally,
dental and cranial clinicians would like to treat the arches of the maxilla
and mandible toward achieving the arch shape and size found in primitive
man. However, full complete arch expansion cannot be accomplished once
the bones of the skull have completed their growth in size and shape. But,
Dentists can attempt to permanently modify the size and shape of the dental
arches of most patients, thereby approaching ideal symmetry. The amount
of expansion achievable is dependent on the size, shape and mobility of
the rest of the facial and cranial bones.
For many
years the technique of developing arches in growing children has been successfully
used and the application to adults is improving but limited. In treating
severely compromised cranial and dental patients, expansion of the dental
arches of adults may be required for best clinical results. If an adult
patient has had prior extraction of bicuspid teeth, expanding the dental
arches will result in “opening up” the extraction sites resulting
in the need to place prosthetic teeth in those spaces.
Early
diagnosis and treatment of deficiencies of the Cranio-Dental Complex in
children should be the goal of every dental and cranial clinician. This
will require abandoning many of the traditional orthodontic diagnostic
and treatment methods and embracing functional orthopaedic techniques.
Wisdom
Teeth Extraction
As the
orthodontically treated children who had bicuspid extractions become adults
the wisdom teeth appear between ages 18 and 25. Because the dental arches
are underdeveloped and retractive orthodontic forces have utilized any
posterior arch spaces, these third molars are quite often impacted and
fail to erupt adequately so they too are extracted. This being the case
then 25% of the natural dentition has been re moved by early adulthood
for the sake of straight front teeth.
These
patients tragically may require a full reversal of their earlier treatment
with expansion of upper and lower arches, protruding of the mandible, erupting
posterior teeth and replacement of the missing bicuspids.
Loss of Posterior Support
Loss of posterior support may occur as a result of the tooth
loss and over a period of time, will create an imbalance and impaction
of one temporomandibular joint and distraction of the other. Damage to
the retrodiscal tissues results and jamming of the temporal bone which
drives the malocclusion. These types of malocclusions affect the anterior
pivot at the maxillae-sphenoid junction. This is a major descending stress
pattern that needs to be addressed prior to any changes made to the cranial
vault.
Temporo Mandibular Dysfunction
This can be caused by a pelvic problem, a cranial problem
or a dental/cranial problem. A wide range of seemingly unrelated symptoms
can be produced as result of structural and functional anomalies in the
relationship between the maxillae and mandible and the relationship between
condyle to glenoid fossa. The scope of this subject is wide and warrants
further consideration. Commonly symptoms can be in
The Eyes pain behind the eyes, bloodshot eyes, bulging eyes,
sensitivity to light, photophobia and disturbed vision. Typically, spasms
of the pterygoid muscles on the pterygoid plates will disrupt and alter
the position of the lesser wing of the sphenoid bone affecting the superior
orbital fissure. This may affect Cranial nerves III, IV, V and VI. These
muscle spasms may also constrict the maxillary artery which results in
reduced blood supply to the orbit and subsequent visual disturbances. The
visual aura preceding some headaches may be caused in this way.
The Jaws symptoms
include clicking and noisy jaw joints, pain in and around the jaw joints
and ears, pain in the cheek muscles and uncontrollable jaw and tongue movement.
Pain is the usual consequence of muscle spasm which affects the relationship
of the condyle in the glenoid fossa, the articular disc, the delicate retrodiscal
tissues and the articular eminence.
The Head headaches can take the form of frontal, temporal, parietal
and occipital. Muscle spasm leading to restriction of cranial motion and
sutural locking affects the endosteal dura and will ultimately affect venous
drainage which may create zones of hydrostatic pressure change in the cerebrospinal
fluid within the cranium.
The
Face symptoms
include facial neuralgia, tic douloureux and Bell’s palsy. Temporal
bone changes may alter the internal acoustic meatus which carries the
facial nerve (CN VII) and the vestibular cochlear nerve (CN VIII). This
can affect the facial muscles, facial function, eyelid function, hearing
and balance.
The
Throat symptoms
include swallowing difficulties, hoarseness, laryngitis, voice irregularities,
constant clearing of the throat, coughing and the persistent feeling
of a foreign object in the throat. A retrusion of the mandible will cause
a change in the tone of the digastric, geniohyoid, mylohyoid and sternocleidomastoid
muscle affecting the oesophagus, trachea, larynx and pharynx.
The
Neck symptoms
include stiffness, muscle spasms, shoulder girdle and upper trapezius
pain and paraesthesia into the arm and fingers.
The
Teeth occlusal
changes will alter the lines of force through the teeth, producing damage
to the cusps. Premature contacts and occlusal interferences can lead
to excessive pressure with subsequent loosening of the periodontium and
alveolar bone loss.
Interdisciplinary
Treatment Approach
A major descending stress area is primarily a dental problem
that needs chiropractic support to ensure a return to biomechanical stability.
A major ascending stress is primarily a chiropractic problem requiring
dental reinforcement to ensure that premature contacts of teeth, loss of
dentition and occlusal interferences can be monitored while the sacroiliac
lesion is stabilized. The interdisciplinary cooperation between a chiropractor
with cranial skills and a dentist/orthodontist indicates that with effective
teamwork between the two disciplines the required results can be achieved.
Initially the Dentist must ensure there is adequate TMJ
health prior to any dental orthopaedic or prosthetic changes can be made.
Once the Dentist has provided a stable condyle to fossa relationship there
will be stability at the anterior cranial pivot which will allow the chiropractor
to initiate structural changes to enhance the craniosacral mechanism and
stabilise any sacroiliac lesion. Once this is achieved the patient enjoys
significant relief of symptoms.
In order for skeletal balance to be stable it is essential
to make certain that the arches of both feet are supported and that pronation/
supination of the feet is corrected. If this is not achieved by stabilizing
the pelvis, another practitioner, the Podiatrist, may be required to assess
the feet and prescribe the correct orthotics to support the arches. Neutral
rear foot and fore foot position supports the pelvis, which in turn supports
the cranium.
As a result of their cranial/dental distortions and the
stress placed upon them during treatment, many patients become exhausted
and run down. Due to pain and discomfort, a sometimes harmful diet and
low energy levels, they often have high medication levels. To allow the
body to re-establish some stability, especially in the early stages, nutritional
support is imperative. Enzymes, minerals and vitamins, essential amino
acids and fats are vital to allow the body’s physiology to facilitate
the structural changes. Ultimately it is hoped that this will free the
patient from analgesics and anti-inflammatory drugs.
There is an unsettling trend of increasing numbers of patients
who present with unusual and apparently unrelated symptoms that conventional
medical tests, despite the sophistication of advanced technology, are unable
to clarify. The long term effect is structural exhaustion, lowered immune
system, pathophysiology and a breakdown in homeostasis. These patients
and their problems cannot be fully resolved with conventional medical or
dental therapy which doesn’t acknowledge that any injury to the body
is an injury to the nervous system. A sound understanding of the effects
of structural instabilities on the nervous system and their compound symptomatic
profiles is needed.
It is thus left to the new age of multidiscipline, holistic
treatment teams to address all the issues and provide a rational and functional
protocol. These teams by necessity will have knowledge of dynamic structural
change and through perseverance, in spite of criticism, will influence
orthodox thought to achieve benefits to all of our patients in the Twenty-first
century. I feel privileged to be a practitioner in just one of these new
age treatment teams.
.
Bibliography;
Buddingh,
C.C., Sphenomaxillary Craniopathy, Los Angeles, CA: Woodland Hill, 1988.
DeJarnette,
Major B., Cranial Technique, Nebraska city, Nebraska. 1978.
Denton,
D.G.,Craniopathy and Dentistry, Los Angeles, CA: David Denton, 1979.
Howat,
J., Complimentary Therapies in Dental Practice: chpt 3, Wright, 1998.
Price,
Weston: Nutrition and Physical Degeneration; The Price-Pottenger Nutrition Foundation,
Inc. La Mesa, CA 1948
Smith,
Gerald H., Cranial Dental Sacral Complex, Newtown, Pennsylvania, 1983.
Sutherland,
W. Osteopathy in the Cranial Field 3rd Edition, Sutherland Teaching Foundation
