Figure 1 is the Panorex of a 23 year old female. She presented with numerous complaints of TMJ symptoms but also an extensive list of postural problems. Her difficulties started around the age of 12 years and had worsened steadily since then despite frequent attempts by various dentists and other professionals to assist her. Over a span of eleven years these included equilibration of the dentition, repeated efforts with both maxillary or mandibular orthotics, various forms of therapy including physical therapy, chiropractic treatment and a variety of medications both over-counter and prescription.
As can be seen, there has been extensive loss of tooth material, enough to require root canal treatment on three molars and extensive restorations on most of the other posterior teeth. In her teens veneers were placed on the six maxillary anterior teeth to compensate for excessive incisal wear but she then developed an open bite from second molar to second molar. The usual suspects of severe caries or erosion from reflux acid were not the cause. The evidence suggested some powerful force was involved. The problem was to identify why such severe bruxism was being triggered.
Figure 2a gives the key to the puzzle. In osteopathic language, there is a right torsion. In a torsion, both the ocular plane and the lateral occlusal plane run up to one side, roughly parallel to each other. In this case, the planes were tipped up to the right. Many individuals seem to cope with this anomaly all their lives without serious harm. For many others, there can be a host of unfavourable reactions including balance difficulties, possible strabismus and a wide variety of head, neck and spinal difficulties. The head of an adult female weighs about 6 - 7 Kilos. If the head is not balanced, the rest of the body adapts to achieve as efficient a distribution of weight as it can, sometimes at the expense of tissues a long way from the origin of the problem such as the pelvis.
Treatment for a torsion has been described previously. As the maxillary dentition and the ocular plane became more level the postural problems diminished steadily as did the bruxing. It was decided to restore the posterior dentition on the right quadrants as there had been so much loss of tooth material and the treatment had created spacing on that side. Gradual widening of the palate was also done to help provide adequate space for the tongue to be contained within the closed dentition. The anterior open bite closed spontaneously partly because of extraction of the mandibular third molars. A photo supplied by the patient of her face at age 6 years showed that the condition had been present at least since then and was most probably as a result of birth trauma.
(Source: Images used with patient permission)
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