Guest post by Dr. Lidia Yavich.
The patient of this post contacted me through a derivation from a colleague from abroad.
Soon after he sent an email, where he explained the reason for his consultation on Cervical Dystonia or Spasmodic Torticollis, I answered that it was not my area and that I treated TMJ Pathologies and Orthodontics and Facial Orthopedics.
The patient insisted, commenting that the colleague that recommended me and knew me from the AACP meeting where I was invited as a lecturer explained to him that he didn´t know if I treated Dystonia, but he thought that considering what he had watched I could help him.
I began to study more on the published articles in this field. One of the articles that impacted me was: Spasmodic Torticollis: The Dental Connection. Anthony B. Sims, D.D.S.; Brendan C. Stack, D.D.S., MS.; Gary Demererjian, D.D.S.
Dystonia is a neurological movement disorder, which sustained muscle contractions causing twisting and repetitive movements or abnormal postures. The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.There are multiple types of dystonia, and numerous diseases and conditions may cause dystonia.
Focal dystonia: affects a muscle or group of muscles in a specific part of the body causing involuntary muscular contractions and abnormal postures, like eyes, neck or hands.The precise cause of primary dystonia is unknown. It is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia.
Most common dystonia denomination are:
A blepharospasm (from Greek: blepharon, eyelid, and spasm, an uncontrolled muscle contraction), is any abnormal contraction or twitch of the eyelid.
Oromandibular dystonia is a form of focal dystonia affecting the mouth, jaw and tongue, and in this disease it is hard to speak.
Cervical dystonia (spasmodic torticollis) affects the muscles of the neck. Causes the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.
Pasmodic dysphonia (or laryngeal dystonia) is a voice disorder characterized by involuntary movements or spasms of one or more muscles of the larynx (vocal folds or voice box) during speech.
Patient Testimony: Iatrogenic Dental Implants Caused Dystonia
Everything began approximately after the placement of the lower implants.
One year after that, I began to feel uncomfortable.
I felt a back and neck stiffness, a strong weight in the back of the head and pain.
I began to make a lot of examination tests with neurologists, physical therapist, rheumatologists, orthopedists and all of them followed the same line, saying that it could be a stress problem and fatigue.
Later I began to feel a twist movement in my neck towards the left. It was not so strong but I felt I had no control on my neck.
My neck always tried to rotate to the left, especially when I walked, and when I tried to hold an object.
After doing physical therapy, quiropraxia, acupuncture and all those techniques I began to research and finally with another neurologist I had a diagnosis of CERVICAL DYSTONIA. He asked for many exams to eliminate the possibility of being a trauma or other problem related to Wilson disease. That hypothesis was soon discarded.
I searched for another neurologist that confirmed the same diagnosis of CERVICAL DYSTONIA.
The neurologist initiated a treatment with Botox, to alleviate, and relax some muscles, trapeziums, esternocleidomastoideo, and splenius. I was also oriented to have three applications of miorelaxants.
I began to investigate more on the subject and I found some videos about TMJ and some treatments with dental appliances.
The situation is very bad because the diagnosis is neurological: we don´t know the etiology and it has no cure until today..
I believe all of this must have a relation with the implants, because I passed more than 30 years without these teeth, maybe the position of my mouth could have provoked some slow alteration that end up in this situation. I´m not an specialist to affirm that this is the real situation, but I believe that it is worthy to investigate because there is the existence of written articles. Moreover Dr. Anthony Sims, and other doctors in the dentistry field point for possible head and neck disturbance, motor coordination, Tourette disease or something like that, so many things could provoke changes in that TMJ region, the temporomandibular joints.
Intra oral pictures of the patient before treatment in habitual occlusion.
Patient Report: Detail of Main Symptoms
– Impossibility of head stabilization
– Ringing ears
– Ear compression sensation
– Muscle spasm when trying to move the head down and to the right.
– Noises in the vertebras in the back of the neck region, C1 and C2, and noises in the spine.
– Noises in the TMJ, specially when yawning.
RX and MRI Evidence Before the Treatment
Patient’s panoramic radiograph before treatment.
Patient’s frontal radiograph where it is clearly seen the impossibility for straight posture of the head.
Patient’s initial laminography, in habitual occlusion where we can observe the retro position of both mandibular heads.
Patient’s initial lateral radiograph in habitual occlusion before treatment.
We can observe in this lateral radiograph and cervical spine radiograph the total lack of space between the ATLAS posterior arc and the Occipital base. I suspected adherences so I solicited a lateral radiograph in flexion.
In the Cervical Spine radiograph in flexion we can observe a REDUCED space between the ATLAS posterior arc and the base of the occipital. THE SPACE IS REDUCED, BUT EXISTS.
The MRI in closed mouth shows a small disc, superior facets in both mandibular condyles and bilateral retro discal compression. The patient has no limitation in opening the mouth and the discs are well situated on the mandibular heads when opening. I didn’t consider important to include the image of open mouth for this clinic case.
The Semg dynamic record shows an important asymmetry between superficial right and left temporalis, low activity of both masseters muscles. The trapezius doesn’t show activity during mandibular closing, which is physiologically correct. Important activity from the digastrics muscles in closing movement, which is not physiologically correct.
The Semg dynamic record shows an important asymmetry between superficial right and left temporalis, low activity of both masseters muscles. The sternocleidomastoid muscles show activity during mandibular closing, which is NOT physiologically correct (the sternocleidomastoid muscle is not a masticatory muscle). Important activity from the digastrics muscles in closing movement, which is NOT physiologically correct.
Treatment with the Intraoral Device
His masticatory muscles were electronically deprogrammed with TENS (Transcutaneal Electronic Neural Stimulation). A jaw tracker then registered a neurophysiologic position from where an intraoral appliance was constructed and tested with SEMG (Surface Electromyography.)
For this record we used the neurophysiologic technique of Dr. Learreta.
4 Months after the Initiation of Treatment with the Intraoral Device
Patient’s frontal comparative images: initial and four months after IOD (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.
Patient’s left profile comparative images: initial and four months after IOD (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.
Patient’s right profile comparative images: initial and four months after IOD (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.
Patient’s lateral radiograph with the device in neurophysiological position. Notice the space between the posterior arc of the atlas and the occipital base that didn´t exist before.
Patient’s frontal comparative radiograph: before the treatment and with the IOD (Intra Oral Device), the patient manages now to have a straight posture of the head.
Patient’s lateral and cervical spine comparative radiograph: before the treatment and with the IOD. Notice the space between the posterior arc of the Atlas and the occipital base that did not exist before.
Patient’s comparative laminographies: initial in habitual occlusion where we can observe the retro position of the mandibular heads and with the intraoral device with retrodiscal decompression.
9 Months after the Initiation of Treatment with the Intraoral Device
Patient’s frontal comparative images: initial, four months and nine months after IOD wear. The patient had a physiological posture recovery.
Patient’s right profile comparative images: initial, four months and nine months after IOD wear. The patient had a physiological posture recovery.
Patient’s left profile comparative images: initial, four months and nine months after IOD wear. The patient had a physiological posture recovery.
The patient also sent videos where he shows his initial incapacity to rotate the head and also comparative videos where he could do that again. The videos are not in the post to preserve patient’s identity.
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).
Protocol for the Treatment of Cervical Dystonia
A step by step description of the 3 phases of the DIY protocol that we have developed for the treatment of Cervical Dystonia.
The Molar Lever
Our analysis of the bio-machinics of the Molar Lever and how dental occlusion is related to posture and skeletal allignment.>
Phases of Lateral Postural Colapse
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.
Postural Colapse and Dental Arches
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.