In this post we will outline the DIY (do it yourself) protocol that we have developed for the treatment of Cervical Dystonia.
This protocol does not invent anything new. It is the result of extensive study and integration of decades of previous research, experiments and practice of medical professionals, professors, dentists, orthodontists, technicians and parcticioners such as: Dr. Gelb (father and son), Dr. Gerber, Dr. Bennet, Dr. Stacks, Dr. Brown, Dr. Mew (father and son), Starecta, Dr. Lee, Dr. Nordstrom, Dr. Sims.
A complete bibliography of the relevant research papers is published in the page of this blog dedicated to Resources
We will start this exposition by describing the symptoms of the tipical case that we wish to treat with this protocol.
Next, we will describe the 3 phases that make up the protocol:
1) Phase 1: Stabilization of TMJ
2) Phase 2: Structural Alignment
3) Phase 3: Finishing Prosthetics
In order to implement this protocol correctly, you should be familiar with the concepts and procedures we introduced in the post dedicated to Principles of Splint Therapy and with the theory that we set out to test as we describe in the post A Bio-Mechanical Approach to Cervical Dystonia.
This protocol has shown to be effective also for the treatment of other occlusion related movement disorders, with varying levels of neurological symptoms (from postural collapse driven by a sinking skull to Parkinson’s, Generalized Dystonia, Oromandibular Dystonia and Tourette’s).
We do not claim to have found a cure. We have just observed empirically that the application of this protocol results in a major improvement of the quality of life – and often full discontinuance of neurological symptoms – for the patients who applied it.
The characteristics of this protocol are:
– Non invasive
– Non traumatic
– Fully reversible
– Inexpensive – it can be carried out for as little as 100$
– Compatible with every other drug based treatment that may have been prescribed by neurologists or dentists.
WHAT IS THIS PROTOCOL FOR?
This protocol is directed and recommend for the treatment of cases which present all or some of symptoms like the ones described below.
– Neurological symptoms such as movement disorders of different levels of intensity: from Postural Collapse to Cervical Dystonia, Oromandibular Dystonia, or Generalized Dystonia, or Tourette’s or Parkinson’s.
– Cranial collapse and derangement
– Twisted and side-bent sphenoid bone
The sphenoid bone is the key to cranial alignement. It sits in the middle of the skull and is connected to 20 different cranial bones.
– Postural collapse and lateral-frontal sinking skull
– Subluxation and misalignment of upper cervical vertebrae
– Unstable Centric Relation lateral to Max Intercuspation
– Displaced condylar disk
Torsion of the spine, postural collapse, scoliosis, neurological movement disorders (dystonia, Tourette, Parkinson, blepharism, etc.) happen when ONE CONDYLAR DISK IS ANTERIORLY DISPLACED and the OTHER IS POSTERIORLY DISPLACED.
– A pathologic ocular tilt reaction
Resulting in asymmetric input to the central nervous system and a tilt in the subjective visual vertical perception.
Please be advised that the great majority of dentists (even self proclaimed experts in TMJ disfunction) do NOT have experience with this sort of neurological symptoms and skeletal imbalances and instability. They do NOT understand the relation between neurological symptoms, cranial collapse and dental occlusion.
That is due to the fact that traditional mainstream dental school teachings are based on an oversimplified model (the articulator model) that considers the skeletal relation of skull bones and cervical vertebrae as FIXED and INDEPENDENT of dental occlusion.
Most of the patients who present these symptoms are likely to have been diagnosed by a neurologist with a specific kind of neurological movement disorder (be it Dystonia, Tourette’s, Parkinson’s, etc…) and are likely to have received prescriptions for Botox injections to paralyze specific muscles, systemic antiepilieptic, antidepressant drugs and pain killers. Many may have varying levels of functional disability.
This protocol will not “cure” and “heal” them of their condition, but it has empirically proven to be effective in the great majority of cases in massively improving their quality of life by reducing the intensity and range of neurological symptoms.
In particular, for many cases of Cervical Dystonia, this protocol has resulted in the complete discontinuance of neurological symptoms
The protocol that we recommend has 3 different phases:
- Phase 1: Stabilization of TMJ
- Phase 2: Structural Alignment
- Phase 3: Finishing Prosthetics
In order to implement this protocol correctly, you should be familiar with the concepts and procedures we introduced in the post dedicated to Principles of Splint Therapy, the Rectifier, the ALF and with the theory that we set out to test as we describe in the post A Bio-Mechanical Approach to Cervical Dystonia.
PHASE 1 – STABILIZING THE TMJ
The derangement of the Temporomandibular Joint (TMJ) has been associated to neurological symptoms and neurological movement disorders like Dystonia, Tourette’s and Parkinson’s, as well as chronic pain conditions like Occipital Neuralgia.
In the following video you will be able see inside a deranged Temporo-Mandibular joint and appreciate how a displaced condylar disk moves.
Manufacturing the Splint
We will use a Gelb – Rectifier partial coverage (i.e. covering only lower molars and premolars) lower splint and proceeded to “O” phonetic bite registration.
The patient will need a base splint for the lower dental arch. What works best is a clear orthodontic retainer of 2 mm of thickness. You can ask any dental lab (or even a dental technician student) to make one for as little as 32$. They will take an impression of the patient’s lower teeth and in 7 minutes (!!) produce a clear retainer. Please watch this video to see the whole process, lasting 7 minutes.
Polimorph to Register the Bite
On top of the base splint it necessary to register a new bite – whenever needed –
with polimorph (a plastic that melts at 66 degrees Celsius). Please watch this video to understand how to place polimorph on the base splint.
Polimorph is a non-toxic plastic material that melts at 66 degrees Celsius. It is possible to find it by googling “buy polimorph”. With 9 US$ you can get by mail delivery a bag with enough polimorph to make thousands of splints.
Phonetic Bite Registration
Bite registeration is carried out by closing the mouth on the fresh polimorph diretly in the patient´s mouth. The cusps of the upper molars and premolars will leave “pits” on the polimorph. We wil let the polimorph harden in the patients mouth (30 seconds).
In the picture above, the upper cusps have registered «pits» that fully embrace them on the polimorph. You can clearly notice the registration of both external (vestibular) and internal (palatal) cusp. For the purpuse of this protocol, we nees to have contact only on internal cusps and only between molar and premolar teeth.
Bite registrations have to be taken while the patient is standing or sitting straight and adopting the position of the mouth and lips that is the result of pronouncing the letter “O”.
“O” phonetic bite registration will produce an anterior, protruded and lowered position of the mandible and condyles which is referred to as “Gelb 4/7” in the scientific literature.
Various scientific papers published on academic journals describe how this method and condylar position is highly effective to recapture the condylar disks.
Cross Bite Splints
Due to the twisted and collasped skull, it may be necessary to use a “cross bite” splint to achieve stability.
A cross-bite splint is registered by imprinting on the polimorph pits that fully embrace upper cusps, leaving internal cusps on one side and external cusps on the other. Cross bite splints produce orthopedic forces that act on the canted maxillary bone and the sphenoid bone.
The splint should have a high vertical dimension (5-9 mm) to produce strong orthopedic forces by means of a lever effect centered on molar teeth to transform the force of swallowing and chewing muscles into a stretching force on different sides of the upper cervical. The process is described in the post dedicated to Treating TMD with the Molar Lever
The high vertical dimension is also necessary in order create enough room within the TMJ to unjam the articulation and allow the disks to recover a healthy physiological position.
In order to find additional information and how-to videos about the specifications of the base splint and the procedure for bite registration, please refer to the following posts on this blog: Principles of Splint Therapy and The Rectifer.
Re-iterative bite registration
We would use two splints to make sure that each time we register a new bite in the splint, it works better than the previous splint (by the patient’s assessment) or we can go back to the previous splint.
Over a few cycles of phonetic bite registration in a few days (only changing to a new splint if it is better than the previous one), we will get a fully functional Gelb – Rectifier that stabilizes the TMJ as much as possible given the circumstances.
In order to promote movement of cranial bones, we recommen that bite registration should be carried out very frequently – even daily.
Indexed versus flat splints
It s worth noticing that the protocol that Dr. Brendan Stack s and Dr. Jeffrey Brown reccomands call for the use of a flat plane Gelb splint for this phase. And they reccomand a registration of a new bite on the splint every 2 months. The reason of their recommendation of flat plane Gelb splints is to avoid the blockage of cranial bones.
We recommend the use of an indexed splint (where the splint has lower pits that fully embrace upper cusps). We found that the use of the polimorph DIY technique to register new bites on a splint allows for very frequent (even daily) bite registrations conducted by the patient in his own home and without any cost.
We find that the frequent registration of new bites on the splints promotes suficient cranial motion while at the same time maximizing the strenght of the masticatory muscles and stimjulating muscle tone in the body in general. Lower indexed Gelb-Rectifier splints have a proven record in stimulating muscle tone of the neck and upper body.
In essence, we consider that Cervical Dystonia is an impairment of the mechanism that the body has to support the skull. Therefore, we find that there is a therapeutic advantage in stimulating muscle activity and tone through the use of an indexed splint while recapturing the TMJ disk in this phase.
The second essential part of the treatment for this phase that we recommend involves specific tongue exercises: it is necessary to train the tongue to support the skull and reshape the palate.
The tongue is one of the biggest and strongest muscles in the body. Morover, it is one of the very few muscles that is built to push. The great majority of muscles are built to pull.
Whenever the patient is not speaking or eating, he should use the tongue to support the skull and reshape the palate.
Support of the skull can be achieved by using the tongue to push up on the palate pronouncing the letter “N.”
Reshaping of the palate can be achieved by sealing the tongue against the roof of the mouth with suction.
In all cases, the patient has to train to keep the lips closed, teeth in slight contact and breeth through the nose.
The following video by Dr. John Mew explains the basics of Myofunctional Therapy. We recommend it as a starting point. The patient should do his own research on Google Videos to continue this essential part of the protocol.
It takes 21 days to develop a habit. At first, it may be cumbersome for the patient to keep consciously an active tongue most of the day. By the end of 21 days, it will become an unconscious habit. It is just like learning to ride a bike or drive: when it becomes a habit, the patient will not even realize that he is doing it.
Duration of Phase 1
The splint will be used almost 24/7 for a month. The succes in stabilizing the TMJ will be judged by the personal assessment of the patient of being symptom and pain free.
In the second phase of the treatment (which we describe here below), the splint will only be used to sleep and to do sports and stretching exercises.
Cost: 32$ x 2 lower clear orthodontic retainers + 9$ of polimorph. Total: 71$
PHASE 2 – STRUCTURAL RE-ALIGNMENT
ALF TO UNTWIST AND EXPAND THE SKULL AND PALATE
In the post dedicated to ALF Orthodontic/Orthopedic Aplliance you will be able to find a longer explanation of the working of the ALF, as well as photograpich and RX evidence of case studies and a bibliographic reference.
The following video will provide you an introduction to ALF in 2 minutes.
The ALF appliance was originally designed in 1983 by Dr. Darick Nordstrom to be a vehicle in a comprehensive dental orthopedic/orthodontic treatment approach. What Dr. Nordstrom initially discovered and later a handful of his disciples is that the ALF proved to be the best instrument to unravel the structural distortions of the skull bones and stabilize the cranial/dental complex.
The ALF System represents the missing link between conventional orthodontics and the more progressive functional orthopedic/orthodontic concepts. In reality, the ALF concept goes beyond the dental realm and supplies many answers to solving the age old problems of chronic somatic pain and generalized ill health.
The ALF appliance allows to:
- Correct cranial bone distortions
- Correct maxillary cant
- Align teeth to stabilize the cranium
This is how an ALF device looks like when positioned on the maxillary teeth.
ALF is little more than a wire anchored on first molars and upper canines. It is activated and creates orthopedic forces by expanding the omega loops. In essence, it takes advantage of the force of the tongue when swolloing to expand and align the maxillary arch, palate and teeth. The force that it uses is extremely limited and light but constant.
The fact that the ALF is not anchored to teeth (unlike traditional brackets for orthodontics) allows for the maximization of cranial movement.
The final goal of ALF treatment is to achieve balance of the dental planes:
The key to making the ALF appliance work is to adjust the appliance so that it balances four cranial indicators. Only by correcting crania bone alignment will the patient experience a cure.
When used properly, the ALF appliance enables orthodontists to correct cranial base abnormalities, which in turn corrects bodily function.
Since the maxillae represents the anterior 2/3 cranial base and functions as the balancing mechanism for the entire skull, foramen magnum and atlas, it must be corrected first. By aligning the maxillae, it provides the foundation or template to build into.
From a clinical perspective, if the maxillae is distorted so goes the rest of the body. Since 46% of the motor and sensory neurons of the cerebral cortex of the brain relate to the face and mouth, maxillary distortions have the potential of disrupting the central nervous system and changing neurological function throughout the entire body.
Balance of the maxillae is critical for maintaining total structural integrity of the entire craniosacral mechanism. The dental complex via the occlusion provides the self-correcting mechanism for balancing the skull bones.
When the maxillae is crooked and teeth alignment is faulty the entire body goes into a compensation mode. This fact is exemplified by patient feedback that their structural manipulations do not hold. Invariably a dental component exists when there is strutural instability. No amount of symptomatic treatment will correct the underlying dental problem. It is for this reason that patient problems linger.
The following video will provide a description of how to carry out adjustments of the ALF appliance to correct cranial derangement.
RECTIFIER SPLINT THERAPY
While the ALF takes care of the structural alignment above the neck, the structural alignment below the neck is carried out by menas of a Rectifier-Gelb lower splint therapy to stretch the spine and untwist the upper cervical and bring the barycentre of the skull back on the axis of the body.
The Goal of Splint Therapy
The research line that we are following is based on the hypothesis that Dystonia and other neurological symptoms that bring about movement disorders are strictly related to a postural collapse driven by a sinking skull that does not find adequate support in the dental arches. To learn more about the rationale behind our bio-mechanical approach, please read this post: A Bio-mechanical Approach to Cervical Dystonia
The sinking skull creates compression and subluxation of the upper cervical vertebrae that result in twisting strain on the brain stem.
The pressure can distort and limit the transmission of the nervous signals between brain and body. Moreover, compression of the brain stem will trigger automatic, involuntary and asymmetric muscle movements to ease the twisting strain. In short, it triggers Dystonia.
Therefore, the goal of splint therapy is to produce orthopedic forces that will progressively stretch and realign the upper cervical vertebrae (C1 – Atlas- and C2 – Axis) with the axis of the spine and the skull.
In the next picture you will see RX evidence of how the orthopedic forces produced by splint therapy can realign the upper cervical and eliminate pathologic compression strain on the brain stem over a period of a few months.
All cases of Secondary Idiopatic Cervical Dystonia that we have treated with this method have resulted in complete discontinuance of neurological symptoms.
The following picture describes how we use orthopedic forces acting on dental occlusion to stretch and un-jam the upper cervical area.
It is also worth highlighting that this approach has resulted in the radical improvement – in some cases complete solution – of other occlusion related disorders like TMJ pain, clicking, disk displacement and bruxism in a matter of days from the beginning of treatment. In all cases, general body posture and symmetry improved dramatically.
The splints would start with a high vertical dimension to produce strong orthopedic forces in different sides of the upper cervical vertebrae by means of a lever effect centered on molar teeth to transform the force of swallowing and chewing muscles into a stretching force on different sides of the upper cervical.
The Starecta “O” shaped incremental bite registration would be used to stretch the spine vertically. “AH”, “E” phonetic bite registrations would be used to reduce the subluxation and untwist of the upper cervical vertebrae (with normal and cross bite splints to produce twisting force on the upper cervical and sphenoid).
Each splint would be used at least a week and we would still use the double splint system to make sure that each new splints produces better effects than the previous by the self assessment of the patient’s symptoms. In case a new splint produces stress or pain to the patient, we have a previous well adapted splint to fall back to.
We would use the same splints that we used for TMJ stabization in this phase. At no additional cost.
The splint would be used to sleep, to do sports and rehab and whenever the patient feels he needs it. Not 24/7.
Neurological Rehabilitation is one of the most important parts of the protocol that we have developed.
Eyes give your brain information about the level of the horizon. If they are not tracking well, the result is faulty propioception, uneven shoulders and scoliosis.
Here below we will describe a basic Eye Tracking Exercise that helps balance and rehabilitate the nervous system in case of Dystonia, scoliosis and postural collapse. For further information, you can read our post on Neurological Rehab for Dystonia.
The following test can show the extent of the imbalance. It is done by placing a pen vertically with the tip at the level of the eyes and the body of the pen touching the nose. When the eyes focus on the tip of the pen, the result might be like like picture 1 or picture 2.
To improve your eyes, you can perform eye exercises as shown in the video below. The effects on posture, skeletal alignment and propioception are nothing short than amazing.
SECONDARY TREATMENT AND PROCEDURES
The treatment using the upper-maxillary ALF and lower-mandibular Rectifier has to be carried out along with some secondarytreatmets which include:
– Postural Rehab
– Manual cranio sacral and atlas therapy to help mobilize the skull and the upper cervical vertebrae from the outside and help facilitate the lever effects of the splints.
– Exercises to increase lung capacity and rib cage volume
– Myofuntional therapy (toungue).
DURATION OF PHASE 2
This phase would last one year. Splints would have high vertical dimension at the beginning and gradually work towards the lowest possible vertical dimension that maintains thr patient symptom and pain free.
Cost: no extra cost for the splint. Cost of ALF would depend on the dental lab that manufactures it. But in the end it is just a bent wire with less than 1 hour of work to produce from start to finish.
PHASE 3 – FINISHING PROSTHETICS
After one year, if the patient is stable and symptoms free with one splint he has been using for a few months, he has two options:
1) Prosthetic work to build onlays that reproduce on lower molars and premolars the pits of the last Gelb – Rectifier splint
2) Using a splint to sleep and do sports for the rest of then patient’s life and concentrating in physical therapy that increases he capacity of the body to adapt and stay for up to 24 hours without a splint and still be symptom free.
Navigate Through this Blog
To further understand our reasearch, approach and method, please read:
A Bio-Mechanical Approach to Dystonia
An introduction to the theory and analysis that support the pilot research project to use an adaptive intraoral appliance to treat and possibly cure Secondary Idiopatic Cervical Dystonia.
Principles of Splint Therapy
A description of the principles on which we base our protocol for the treatment of Cervical Dystonia and other occlusion realated movement disorders with varying degrees of neurological symptoms (from Tourette’s, to postural collapse, Parkinson’s and Generalized Dystonia).
A step by step description of the 3 phases of the DIY protocol that we have developed for the treatment of Cervical Dystonia.
Our analysis of the bio-machinics of the Molar Lever and how dental occlusion is related to posture and skeletal allignment.>
Our analysis of the descending skeletal and postural effects of a collapsing and twisting skull that does not find adequate support in the dental arches.
A description of the adaptive intra-oral aplliance -dental splint – that we use to treat Cervical Dystonia and the orthopedic forces that it produces by progressively pushing the mandible in retrusion, maxila in extrusion and elevating the skull by stretching and aligning the cervical vertebrae.
Bibliography and links to scientific research on the treatment of Dystonia and other neurological movement disorders with a bio-mechanical approach.
A set of animations that present grafically the type of skeletal and postural effects that we intend to produce over a few months by modifying occlusion and the direction of forces between the skull and the mandible.