TMJ dysfunction is often associated with trauma (such as occurs with dental extractions or motorcycle accidents), malocclusion (when the upper and lower teeth don’t meet properly), emotional problems, grinding or clenching of teeth at night, muscular imbalance, mechanical insults such as gum-chewing or pipe-smoking, and even unequal leg length.

Most usually, though, the problem occurs when the articular disc – the fibrous tissue or cartilage pad that sits between the bones making up the TMJ – is perforated or displaced.

Pain in front of the ear, popping or clicking sounds in the TMJ, limited jaw movements, tinnitus (ringing in the ears), difficulty in swallowing, loss of balance, and fatigue or tightness when chewing are all symptoms associated with TMJ dysfunction.

One of the best means of diagnosing this problem is through osteopathic or chiropractic physical evaluation. During such an assessment, the osteopath will:
* check out any facial asymmetry or malocclusion of the teeth
* measure the amount of jaw opening (40 mm for the average adult)
* look for any midline deviation of the mandible (lower jaw)
* palpate the TMJ during jaw motion to detect any abnormality
* assess any spasms or jaw noises (such as a click on opening)
* palpate the area around the TMJ for abnormalities and tenderness.

An X-ray or tomograph can also assess symmetry, bone positioning and any degenerative changes. MRI (magnetic resonance imaging) is sometimes useful for uncovering any misalignment of bones as well as soft tissues in all planes.

If you are diagnosed with any of these problems, it’s preferable to try out a number of conservative treatments before considering surgery. An osteopath or chiropractor with experience in treating TMJ problems will first eliminate any of the above causes, and then begin appropriate manipulative therapy, such as the ‘counterstrain’ and ‘muscle energy’ techniques, which help to reposition the misaligned joint and reduce pain. Sometimes even treating the sacrum may help, as may the passive stretching of any tight or stiff pterygoid muscles (the muscles that move the TMJ) inside the mouth.

It’s also useful for the patient to carry out a suitable exercise regime regularly at home.

Occasionally, dentists or orthodontists who are aware of osteopathic concepts and techniques may apply interocclusal stabilisation devices (splints, in essence) to be worn for several months to reposition the malocclusion. These usually involve frequent readjustments as the alignment of the jaw shifts.

Another useful device can help to decrease jaw muscle spasms which, in turn, will reduce the associated muscle pain.

Yet another device – an antibruxism pad, doctorese for an antitoothgrinding pad – can be worn during sleep to reduce the effects of nighttime teethgrinding on both the teeth and the muscles of the TMJ.

Harald Gaier is a registered homoeopath, naturopath and osteopath.

References
Blood SD, The craniosacral mechanism and the temporomandibular joint, J Am Osteopath Assoc, 1986; 86: 512-9

Downs JR, Treating TMJ dysfunction, Osteopath Phys, 1976; 106-13

Goulet JP, Clark GT, Clinical TMJ examination methods, Can Dent Assoc J, 1990; 25-33

Greenberg SA, Jacobs JS, Bessete RW, Temporomandibular joint dysfunction: evaluation and treatment, Clin Plast Surg, 1989; 16: 707-24

Hasso AH, Christiansen EL, Alder ME, The temporomandibular joint, Radiol Clin North Am, 1989; 27: 301-14

Levitt SR, McKinney MW, Willis WA, Measuring the impact of a dental practice on temporomanidibular disorder symptoms, J Craniomand Pract, 1993; 11: 211-6

Mohl ND, Ohrbach R, Clinical decision-making for temporomandibular disorders, J Dent Educ, 1992; 56: 823-33

Royder JO, Structural influences in temporomandibular joint pain and dysfunction, J Am Osteopath Assoc, 1981; 80: 60-7

Smith SD, Head pain and stress from jaw-joint problems: diagnosis and treatment in temporomandibular orthopaedics, Osteopath Med, 1980; 35-51

* If you have amalgam fillings and want to minimise damage:
– eat a healthy diet. Low levels of micronutrients increase the toxic effects of metals (Environ Health Perspect, 1998; 106 [Suppl 1]: 203-16). Include plenty of high-fibre foods plus lots of garlic (a natural antibiotic)
– keep up your antioxidant levels with high doses of vitamins such as beta-carotene, and vitamins A, C and E
– supplement with selenium (but no more than 200 mcg/day). It detoxifies mercury by forming inactive selenium-mercury compounds (Am J Clin Nutr, 1995; 61 [3 Suppl]: 646S-50S)
– drink plenty of good-quality water
– look after your teeth and gums
– choose natural toothpastes that avoid sodium lauryl sulphate (SLS), artificial colours and preservatives.

* Alternatively:
– make your own toothpaste from sea salt, baking soda and vitamin C
– keep your toothbrush clean by soaking it once a week in hydrogen peroxide
– use dental floss, or wooden (or waterjet) toothpicks
– supplement with coenzyme Q10 for healthy gums.

Another man who’s pulled a hamstring muscle goes to see his dentist for a check-up. The dentist makes a quick realignment of one of his teeth, and his hamstring problem is cured.

These seemingly fantastical cases are just a few selected from the patient files of David Hefferon, one of a small handful of holistic dentists in Britain.

In itself, holistic medicine is not new. In the 1980s, it was the buzzword for seeing the patient as a whole person, and also referred to the integration of a number of different medical systems, both alternative and conventional. The concept has taken years to arrive in the relatively staid world of the dental profession.

Nevertheless, holistic dentistry is now one of the fastest-growing branches of medicine. It has taken off in the US (where it’s called ‘biological dentistry’), and there’s a growing band of practitioners in Europe.

Of all the medical specialties, dentistry has always been the one most set apart from the rest of doctoring. In terms of physical wellbeing, the teeth are seen to be almost irrelevant, with no apparent connection to either health or illness. This is an attitude that dentists themselves have reinforced. In Britain, for example, they have divorced themselves from the rest of the National Health Service (NHS).

But evidence is mounting that teeth are an integral part of health, with links to diseases in other parts of the body. For example, gum disease can almost double your risk of a heart attack, and low levels of vitamin B6 can cause tooth decay – two facts that your ordinary dentist is unlikely to have ever mentioned to you.

“Nutrition is just one of the tools I use,” says Hefferon. “I also look at the patient structurally, energetically and chemically.”

Central to Hefferon’s approach is the way he has set up his clinic. Under the same roof as his high-tech dental surgery, he has gathered together a team of alternative therapists – a cranial osteopath, a herbalist, a nutritionist and a physiotherapist who specialises in energy medicine. “We each have our area of expertise, and there’s lots of interreferring,” he says. “For example, if something I’m doing in the mouth isn’t working, I can get advice on what the underlying problems may be – and have them sorted out on the spot.”

The importance of bite
One of the guiding principles of holistic dentistry is the importance of the ‘perfect bite’. If the top and bottom teeth don’t mesh correctly, this can set up stresses in the jaw. We open and close our jaws about 2000 times every day, so a bad bite will lead to chronic muscle stress. There are ligaments that connect the teeth to the jawbone, and these have stretch receptors that are constantly trying to readjust the jaw muscles to ease the stress on the teeth. This, in turn, creates spasms in the muscles surrounding the joint that connects the jaws to the skull – the so-called temporomandibular joint (TMJ).

Learning about the TMJ is essential for any holistic dentist because the jaw joint is linked to virtually every part of the body. The importance of the TMJ was first discovered by chiropractors and osteopaths, who called it ‘the great impostor’ after they discovered that TMJ dysfunction can be linked to a whole raft of problems that have no obvious connection to the jawbone. These include postural and back (spinal) problems, arthritis, headaches, and leg, neck or shoulder pain (J Am Dent Assoc, 1987; 115: 251-6; Minerva Stomatol, 2002; 51: 167-71; Acta Med Austr, 2004; 31: 18-22).

David Hefferon’s hamstring patient is a case in point. He was a footballer who suffered recurrent hamstring injuries. At first, he went to an osteopath, who recognised that the problem was coming from the lower back; the back was treated and the problem went away – but only for a while. It was when he went for a routine dental check-up with Hefferon that the real cause of the muscle problem came to light.

Hefferon saw that the man’s TMJ was misaligned due to a poor bite. “This had obviously been a long-term problem,” says Hefferon. “His TMJ was out of true, and his body unconsciously tried to compensate – in his case, by permanently making the jaw jut out. This bent the spine, pushing the pelvis forward, upsetting the normal running position. This put undue strain on the legs, causing the chronic hamstring problem.” Hefferon fixed the TMJ, and the hamstring problem has never recurred.

A similar case comes from American holistic dentist Dan Gole, of Michigan. One day, Gole was doing a TMJ-related tooth adjustment on a patient. When it was all done, he asked the patient how he felt. “The tooth is fine,” said the patient, “but what’s interesting is that the pain I’ve had in my foot for a couple of weeks has completely stopped.”

New York dentist Frederick Milton specialises in using holistic dentistry to relieve chronic physical pain. Often, he finds that it’s due to shoddy work done by other dentists. “Every time you swallow, your teeth touch and your body gets a neuromuscular reading off your teeth,” says Milton. “If your teeth are maloccluding – for example, because of too prominent a filling or a crown – your body quickly readjusts. You won’t be aware of this, but the readjustment will be chronic; this can sometimes result in chronic pain elsewhere in the body. And you will have no memory of how it started.”

David Hefferon goes further: “The TMJ is the headquarters of the body’s balance mechanism, and if the jaw doesn’t close properly because of maloccluded teeth, the balance mechanism is forced to adapt. However, because it’s under constant stress, the brain is pumping out lots of noradrenaline [norepinephrine] and serotonin. This sensitises the autonomic nervous system, making the patient vulnerable to any other stressors like bad diet or emotional problems. So depression, for example, could be linked to TMJ dysfunction.”

Hefferon says 95 per cent of his patients have TMJ problems due to maloccluding jaws, but admits that he may be seeing a biased sample of people. “Most of my patients are rejects from other dentists, so I’m bound to get problem cases,” he says.

Nevertheless, US dental expert James E. Carlson concurs with Hefferon’s figure. “Ninety per cent of people have a problem with malocclusion,” he says in a 500-page report on TMJ problems (Orthocranial Occlusion and the Accu-Liner System, Blue Pine Unlimited, 2000). “This may be because most people have underdeveloped jaws – probably due to diet.”

It was in the 1930s that US dentist Dr Weston Price first proposed the theory that the lack of chewing required by modern eating habits has resulted in smaller lower jaws and “deformed arches” (the palates that connect the teeth) compared with our Neanderthal ancestors. This was Price’s explanation for why overcrowding of the teeth is now so common in children. Price’s theory sparked a huge debate that is still raging on today.

Big teeth or small jaws
The controversy over overcrowded teeth is focused on two main questions: why do they happen, and what should dentists do about them?

The prevailing theory is that overcrowded teeth are caused by a genetic error in the womb, where the developing child inherits its jaw from one parent and its teeth from the other. This leads to a potential mismatch, with the big teeth of one parent not fitting into the jaw of the other.

But not everyone agrees with this scenario. “The ‘daddy’s teeth, mummy’s jaws’ theory is not universally shared,” says Hefferon. “The opposing theory says overcrowded teeth are the right size; it’s just that we have inherited a smaller jaw because of thousands of years of evolution responding to a diet that doesn’t require much chewing.“

As far as solving the overcrowded-teeth problem, for most dentists, the answer is obvious: remove a few teeth to give the rest of them enough room – in other words, make the teeth fit the jaw. But a growing minority of dentists are saying: “These are perfectly healthy teeth, so why extract them?” Instead, they suggest making the jaw fit the teeth by expanding the jaw to accommodate them. This solves the problem by addressing its root cause – an undersized jaw.

This extraction/expansion debate is a huge issue within dentistry, with hotly argued positions on each side (see WDDTY vol 11 no 4, p 12). Holistic dentists tend to favour the expansion camp because they believe that extraction can often upset TMJ balance. This may then lead to a host of spine-related problems, such as poor posture, wrong breathing and back pain. However, partly because this is such a new field of study, the evidence is still mostly anecdotal (Orthod Fr, 1992; 63 Pt 2: 443-53).

Australian dentist Joseph da Cruz is another holistic dentist with a growing international reputation (to contact him, see: http://www.wholisticdentistry.com.au). He has developed a simple jaw-expansion device that is claimed to be a major advance on the usual ‘functional appliances’ as it requires fewer fixings to the teeth, making it considerably easier to wear. “It avoids or minimises the need for tooth braces, thus helping the flow of cerebral fluid in the spine,” he says.

Although it’s mostly children who are treated for overcrowded teeth, adults can benefit from jaw expansion, too. One of David Hefferon’s cases was a 60-year-old businessman with such chronic backache that he could no longer travel. A small expanding device on the lower jaw stopped the backache – and the man is now happily flying all over the world.

Unlike conventional braces, jaw-expansion devices work incredibly quickly. Joseph da Cruz has before-and-after photos showing remarkable changes after as little as three months, including a noticeably more attractive facial appearance.

Holistic dentists also deal with cavitations – holes in the jaw, often at the site of an old extraction, such as a wisdom tooth, or under a root-canal filling – which can occasionally affect the entire jaw. Cavitations can lead to facial pain, headache and neuralgia, and phantom-tooth pain. The treatment is to clean them out and encourage bone to grow back through nutritional support.

A complementary programme
But the real promise of holistic dentistry is that it offers an entirely new way of looking at the connection between teeth and general health. In doing so, it is exploring how alternative medicine can be brought into the dental surgery – with astounding results.

Take acupuncture, for example. Years ago, this was only thought useful for pain relief – teeth have been extracted with nothing but acupuncture analgesia. But the benefits of acupuncture are far subtler than that; it is now believed that every tooth is linked energetically with different organs in the body via the acupuncture meridians.

This knowledge can turn conventional dentistry on its head. In the case of the patient with toothache cured by a colonic, he had suffered acute pain for weeks and arrived begging to have the tooth removed. But Hefferon could see nothing wrong with the tooth. “I knew that acupuncture theory says this particular tooth is connected to the colon, so it didn’t take more than a few questions to discover this man had an intestinal problem,” he recalls. “I advised him to get his colon irrigated, and the tooth pain vanished.”

Hefferon takes things even further by using colour therapy. “If the patient needs calming or if I’m working on a tooth connected to the kidney, I will give him blue protective glasses to wear,” he says. Hefferon also uses his knowledge of the martial arts to teach his patients qi gong breathing techniques. “Poor breathing causes acidity in the body which impairs mercury detoxification,” he says.

Indeed, in moving on from being oral carpenters, holistic dentists offer a model for medicine as a whole.

Tony Edwards

Bunions: try iodine on them, but they could also have an emotional cause best treated by a flower remedy practitioner. In the meantime try aloe vera juice, and vitamins E and C.

Omega-3 sources: try Arctic Sea with omega-3 and -6, or Perilla oil, while a natural source is purslane, which can be added to salads or cooked.

Bedwetting: pumpkin seeds may help, as they are high in zinc. Reflexology, Bach flower remedies or chiropractic may all offer help. Try Virtual Scanning, says our man at the Virtual Scanning centre. One boy was cured with the help of an aura therapist, one reader relates.

White spots: they’re a sign of dehydration and an inability to break down fats. If it is caused by high cholesterol, it’s called xanthelasma, says one reader helpfully.

Itchy scalp: a scalp massage with 3 drops teatree oil, 2 drops rosemary oil to 30 ml jojoba oil, left in the hair overnight might help matters.

And so to other issues. . .one reader wonders if the ‘interview’ last week between WDDTY and a Department of Health official was a spoof. Well, we know our sense of humour can be subtle, but we didn’t realize it had become invisible! But yes, it was a spoof. . .

a homoeopath takes us to task for suggesting that ‘homoeopathic remedy x can cure disease y’. It doesn’t work like that, she says. Point taken, but these suggestions come from other homoeopaths. . .another homoeopath takes us to task for a different reason. We don’t give enough references to back up all the statements we make. For that, you’d have to read our monthly newsletter What Doctors Don’t Tell You, which is packed with references. E-news doesn’t seem to be an appropriate platform for this. So if you want the references, you have to subscribe. Sorry!. . .

we hear of a doctor called Dr John Reckless who wants to add a statin, the cholesterol-lowering drug featured last week, into the public water supply. So you’d have fluoride in the water to protect your teeth, and statins to protect your heart. Marvellous stuff. No wonder he’s called Reckless. . .

a few American readers say we’re attacking their country’s foreign policy, an accusation based on our tongue-in-cheek headline ‘There are weapons of mass destruction in Iraq’. We thought we were taking a swipe at the UK’s foreign policy, but never mind. One gentleman says that Lynne McTaggart (WDDTY editor) doesn’t understand because she’s not American. Well, we think Lynne does understand, and she is an American.

But to spoil our argument, Lynne doesn’t write E-news. Damn.

Sufferers feel as if they are recovering from a severe bout of flu. Because of this, it is associated with chronic fatigue syndrome (CFS), and appears to affect more women than men.

Most sufferers also have the ‘alpha-EEG anomaly’, where they fall asleep easily, but deeper sleep is interrupted by waking-state brain activity. Irritable bowel symptoms, including constipation, diarrhoea, abdominal pain and gas, and nausea are experienced by up to 70 per cent of sufferers. Severe-to-moderate jaw pain – or temporomandibular joint dysfunction syndrome – and chronic headaches affect 50-75 per cent. Other complaints are poor memory/concentration, mood swings and dry eyes/mouth.

Although the cause is uncertain, speculative suggestions range from a viral/bacterial infection, accident trauma or another disorder such as lupus or rheumatoid arthritis. The Pill has also been blamed (Dig Chiroprac Econ, 1991; 34: 100-1), and four women who had fibromyalgia for up to 17 years had an almost immediate remission in symptoms when MSG was removed from their diets (Ann Pharmacother, 2001; 35: 702-6).

But a credible body of research links the condition to the thyroid. It was found that virtually all sufferers have altered hormonal feedback mechanisms (Scand J Rheumatol Suppl, 2000; 11: 8-12). Other studies concur, finding hypothyroidism to be a common factor (J Rheumatol, 1992; 19: 121-2; 1993; 20: 469-74). A similar theory is the basis of Dr John Lowe’s book, The Metabolic Treatment of Fibromyalgia (Lafayette, CO: McDowell Publishing, 2000).

What doctors tell you
Many doctors still consider fibromyalgia and its cousin, chronic fatigue, to be mainly ‘all in the head’ of hysterical women, even though the World Health Organization has recognised them as genuine conditions.

Physicians who do treat fibromyalgia sympathetically may first try to establish a deep and undisturbed sleep pattern, using medications to boost serotonin and norepinephrine, the neurotransmitters that modulate sleep, pain and immune function. These may be prescribed in low doses, and include amitriptyline, cyclobenzaprine and citalopram. Sleeping pills that may be prescribed include clonazepam and trazodone.

To treat the muscle pain, drugs such as the opioid analgesic tramadol – but, more often, a powerful painkiller, probably one from the family of NSAIDs (non-steroidal anti-inflammatory drugs) – may be prescribed, along with muscle relaxants such as Valium.

Bryan Hubbard

Repeat this breathing with the words until you feel RELAXED. As you are doing this exercise, picture your face completely RELAXED and send loving energy to this part of your Body Temple through your hands and your thoughts. Do this exercise for several minutes throughout the day or whenever you feel tense or nervous or are experiencing any emotional stress.

This exercise is a wonderful gift of love to yourself.