DOES TMD TREATMENT HELP ALLEVIATE PARKINSON’S SYMPTOMS?

“The evolution of [the] human masticatory complex is strongly related to diet, the use of tools and fire, and finally speech, and has a more important part in the evolution of mankind than the dentists know.” (Emes et al., Bull Int Assoc Paleodont. 2011; 5(1):37-47.)

The relationship between your jaw and your body is complex and is the result of 100,000 years of evolution. However, our modern soft diet results in underdeveloped jaws, crooked teeth, and inactive tongues, which can disrupt the delicate balance of our jaw to skull relationship. An unbalanced jaw, or temporo-mandibular disorder (TMD), results in damage to the jaw joint (TMJ), which normally protects nerves and blood vessels. As the jaw begins to degrade the jaw joint, it can damage these vital structures every time you close your mouth, resulting in many common symptoms, such as headaches, neck pain, and jaw pain. Fortunately, readjusting the jaw to the proper place relative to the skull using non-invasive dental orthotics treats TMD.

TMD sufferers have a long list of symptoms, including chronic pain (https://youtu.be/SvMaJb8o2RI), many of which are in common with Parkinson’s disease (PD) symptoms. Although more studies are needed to understand the link between TMD and PD, we have used TMJ therapy to successfully treat patients with movement disorders (tremors, ticks, Tourette’s, dystonia, tingling, numbness) and PD-like symptoms (https://youtu.be/QBnRzCDJFVU).

When the jaw is out of balance, the cranial muscles experience stress as they try to compensate. This can cause the muscles of the jaw and ear canal to spasm, which affects all aspects of the trigeminal nerve: sensory, motor and propioreceptive. Therefore, patients suffering from TMD may experience chronic pain as well as movement issues, and respond well to TMJ therapy. A pioneer in this field, Dr. Brendan Stack, has impressively alleviated many tremor and movement disorder cases with jaw repositioning therapy (https://youtu.be/QUTzY5c6JOg).

This case history of a lovely 42 year old patient explores the connection between TMD and PD. In November 2012 she came to our office with a variety of TMD and PD symptoms. She suffered from arm & jaw tremors, twitching muscles, numbness and tingling in the hands and fingers, limited mouth opening, shoulder, neck, and lower back pain, limited movement of neck, parietal headaches, fatigue, depression, poor sleep, pain and pressure behind the eyes, photophobia (extreme sensitivity to light), ear congestion, sinus congestion, chronic sore throat and sinusitis, grinding and clenching teeth, jaw clicking and popping, jaw pain, jaw soreness upon waking, numbness on the side of her head, and ringing in the ears. She also had trouble opening her jaw in the morning because her jaw locked closed. She first noticed her symptoms in 2010-11, and found that they were gradually increasing in severity, and her jaw tremors became so pronounced that her teeth chattered. She also felt that her dexterity was not quite right.

The importance is proper jaw alignment before treatment. Her jaw was too far back, and rotated clockwise to the right, so that every time she closed her mouth, she put pressure on nerves and blood vessels in her right TMJ.  Her skull was also internally rotated on the left side, her neck bent to the left, and her left eye, jaw, mastoid and zygomatic bones were higher (Fig. 1). Stage 1 treatment focuses on fixing the 3D imbalance of her skull and jaw by putting the jaw in the proper position. Stage 2 focuses on expanding her dental arches, leveling her cranial bones, and moving her teeth into the proper position to support her jaw joint.

After her initial exam in November 2012, she was fitted with a temporary acrylic MORA (mandibular oral orthotic repositioning appliance) to relieve the pressure on her jaw joint. After only 2 weeks, she reported a pronounced improvement in her symptoms! For the first stage of treatment, she was fitted with the Gelb MORA to be worn all day and while eating, and with the Farrar appliance to be worn at night. Proper jaw position from the use of oral appliances prevented the condyle of her mandible from colliding with the temporal bone and ear canal, and by wearing the appliances while eating, she was able to speed up the healing process of the joint.

Once the alignment of her lower jaw was corrected with these oral orthotic appliances, the repeated trauma to her jaw joint was removed and her condition improved dramatically, and her tremors disappeared. However, she moved away and was only able to receive treatment sporadically, and sometimes went 8 months between adjustments to her oral appliances. In these periods her numbness and tremors returned as her bite and jaw relationships were shifting, and compressing the TMJ once again. Ideally, oral appliances are adjusted every 4-8 weeks in order to maintain proper jaw position. Fortunately, once her appliances were adjusted regularly and her jaw position corrected, her symptoms improved and her tremors disappeared again and she had no complaints! She is still in treatment and currently starting stage 2 treatment with the ALF appliance and Myobrace.

How The Tongue Affects Posture

In addition to being tongue tied (frenum below tongue is very short), she had a weak tongue. Many TMD sufferers have an inactive tongue that sits on the floor of the mouth. When the tongue is low, the back of the tongue blocks the airway, and in order to breathe, a patient must subconsciously stick their head forward. This change in posture aggravates the neck and shoulder muscles, and increases the pain symptoms. In addition, patients with an inactive tongue also breathe through their mouths, and have their lower jaw open, which adds unneeded pressure to the jaw joint.

The proper tongue position is on the roof of the mouth, which naturally keeps the lower jaw forward and the airway open. Daily myofunctional tongue exercises (see video at youtu.be/zxXyge1EfnQ) are useful in strengthening the tongue muscles so that the tongue can rest on the roof of the mouth. The patient also has started doing daily tongue exercises to strengthen her tongue and expand her arches, and pull her jaw forward at rest, thereby relieving pressure on the TMJ. The goal is that after treatment, her tongue, jaw muscles and teeth will work together to hold her jaw in the proper balance, leaving her pain-free!

1 Jennings, D. Parkinson’s disease: are some cases misdiagnosed cranio-mandibular dysfunction?

2 Arien, H. The otomandibular syndrome: a new concept. 

3 http://www.bronsonfamilydentistry.com/upload/ALF%20Quantum%20Appliance.pdf

4 http://www.myobrace.com

5 http://old.myoresearch.com/cms/index.php?article_johnflutter

For more information about Doctor Hurme’s TMJ/TMD practice, visit the Wellness Village. He has been a member of the Wellness Village since September 2012