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Temporomandibular Joint (TMJ)

Dental occlusion is the relationship between the teeth of the upper and lower jaw. Temporomandibular Joint (TMJ) is the only bilateral joint passing medial line. Since the objective of the dental treatment is to achieve a harmonious balance throughout the Stomatognathic System, teeth can be viewed as a system of toothed wheels, anchored in the bone of the maxilla and mandible which are connected to each other by TMS. The causes of Temporomandibular Joint (TMJ) disease can be divided into five categories: dental, traumatic, caused by lifestyle habits, stressful life situations and emotional factors. Trauma may be in the form of whip lash or caused by extra-oral apparatus or hit in the head, face or jaw. In terms of living habits the reasons could be bad body posture, non-ergonomic working environment, harmful oral habits and reflexes acquired in childhood, unhealthy diet and strenuous physical activity such as weightlifting and others. It was found that damages of the jaw muscles or dento-alveolar ligaments can impact on the visual control of posture stability and cause imbalance of the stand. The position and function of the mandible also affects the center of gravity.

Synchronization of the muscles of the head and jaw with other muscles
Patients suffering from occlusal or temporomandibular disorders often complain to have pain in the neck muscles. Pain in the neck can be caused by the unilateral loss of occlusal support. It is the presence of biomechanical effects on the cervical spine during chewing which confirms that the height of the occlusion may affect the distribution of pressure in the cervical spine. There is a connection between dental occlusion and the control of posture.

Temporomandibular Joint (TMJ) and stability of posture
TMJ affects the stability of posture. Upright position is a relatively unstable position for people, so its maintenance is associated with fluctuations in the center of gravity, which are controlled by information from the optic apparatus, the three semicircular canals in the inner ear and anti-gravity muscles.

Inadequate or no dental occlusion can reduce perceptive sensations from this area, which reflects on maintaining the stable position of the head and body. Losing teeth is a risk factor for instability of posture. Physiological mechanical receptors in the periodontal space control movement of the mandible and coordinate masticatory function, which is associated with motor activity of the muscles of the neck.

TMJ and physical performance
The condition of the TMJ may affect indicators of physical activity. Coaches often advise athletes to wear occlusal (safety) splints to improve their physiological performance. Restoration of occlusal support is essential not only to normalize masticatory function but also to maintain good physical shape.

TMJ and other body parts are interconnected by fascia representing unifying element between the various anatomical structures very similar to the three-dimensional network extending throughout the body. This network can stretch on contraction of underlying muscles and forward pressure.

Fascial tissues are organized in a vertical direction in the form of four overlapping cross fascial sheets that cross at different levels in the body. Therefore in case of injury, pain and dysfunction in one part of the body, they can spread throughout the body

Mechanism-based energy Chi and the system of meridians.
According to the second hypothesis of TMJ and other body parts are connected by a system of meridians, built by fascia.
Traditionally it is considered that acupuncture meridians form a network in throughout the body, linking peripheral tissues between them. Studies dealing with the system of points and meridians in acupuncture from the perspective of the West, focusing primarily on the identification of certain histologic features that distinguish the acupuncture points of the surrounding tissues. One of histological and anatomical associations with the meridians is intramuscular or intra-muscular loose connective tissue (fascia).

In ancient texts on acupuncture has repeatedly several reports of ‘fatty membranes, fascia and a network of connecting membranes’, which is believed to flow energy Chi. Some authors suggest that there may be a link between acupuncture meridians, concentrated along the fascial surface between muscles or between muscle and bone or tendon and connective tissue.

From the perspective of experimental science system of meridians can be viewed as an image of the network of interstitial connective tissue fibers. This assumption is supported by ultrasound showing cleavage sheets of connective tissue in the areas of acupuncture points in humans. Instead of being viewed as separate, independent units, acupuncture points may meet convergence network of connective tissue fibers, covering the whole body, like the junctions in the system of prime and secondary roads.

Correlation between trigger points and acupuncture points
Although there are two thousand years between them acupuncture and traditional methods for treatment of myofascial pain share fundamental characteristics. Recent analysis suggests the presence of clinically significant anatomical and physiological correlation between myofascial trigger points and acupuncture points. The analogy between triggers and acupuncture points is the subject of discussion since 1977 when it was reported 100% anatomic and 71% clinical matching for treatment of conditions associated with pain.

There is a number of similarities between them. Both structures have similar locations, and for pain management in both cases using needle (or injection techniques). Pain associated with local response to irritation of trigger points is similar to the feeling caused by energy “chi” and reflected pain generated by the prick of trigger points is similar to the sensation radiating along the meridians.

The acupuncture points located in areas of trigger points are not often used by acupuncturists and have the same clinical indications as a treatment of trigger points.

There is a statement according to which 71% correspondence between acupuncture points and trigger points is theoretically impossible. But even if we ignore this conceptual problem, not more than 40% of the acupuncture points are related to pain and probably only at 18 to 19% of the points was reported actually matching. It seems necessary to further clarify the relationship between triggers and acupuncture points.

Our theory of the fascial connection may explain the functional relationship between dental occlusion (TMJ) and other body parts on the basis of myofascial activity or energy Chi and the system of meridians or a combination of both. Therefore, dental occlusion must be restored and maintained in normal natural proportions and the reasons for TMJ disease should be treated in an effort to normalize its status.

Dr. Geun Young Lee and Geun Young Moon

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