An Osteopathic View of Dental Problems

Dentists and DOs having been working together on problems involving the mouth, teeth, jaw and face since the Cranial Concept was first taught. OCF and dentistry are intimately interrelated.

The key to the integration of the concepts of both professions is the respect for inherent motion in the human body (which is a result of primary respiration), including the structures of the head (bones, membranes, fluids, CNS). Furthermore the idea needs to be appreciated that the body is a unit and all parts are interrelated. The mouth and jaw are not separate parts of the body and changes in those areas will be reflected in the body and visa versa.

An osteopathic physician is not trained as a dentist and a dentist is not trained as an osteopath. However there is a great deal of overlap.

Only a small number of dentists have any training in this area, and even fewer understand and apply it on a daily basis. My experience has been that a dentist who is trained in this fashion, working with a DO who understands how dentistry is related to OCF can deal with many problems that other dentists and osteopaths cannot deal with alone.

It is surprising to find just how many dental problems have an underlying mechanical cause.

Among the common dental problems treated are:

• TMJ problems
• Dental pain
• "Orthodontic problems"
• Bruxism
• Symptoms from traumatic extractions

To understand this, you must look at the body from a different point of view:

We swallow 1200-1300 times a day, so over the course of a day, there is a great deal of force that is exerted on the mouth. Muscles of mastication (chewing) pull down and in on in the face, while with proper swallowing, the tongue pushes and spreads the upper jaw/lower face apart. It is the balance between these forces that helps determine the structure of the mouth and position of the teeth.

If proper (nasal) breathing is compromised, the jaw (and with it, the tongue) must drop open, resulting in an improper swallowing pattern. In a child this will interfere with growth of the palate, causing it to be too narrow, further compromising breathing and swallowing. Mouth breathers usually bury their face into their pillow to quiet and humidify their breath. This results in abnormal pressures on the face and jaw, causing uneven growth of the face, jaw, and neck problems.

Again, if swallowing is adversely affected it will affect the structure of the mouth, the position of the teeth and the lower jaw. If this occurs in a child the palate will not develop as widely as it should. Conversely, if the palate is too narrow, there will not be enough room in the mouth for the tongue, creating swallowing problems. This can be a vicious circle.

Sometimes the size of the palate is determined by genetic factors; other times trauma to the face can interfere with proper growth.

If a person has a chronic swallowing problem, the muscles involved tighten up creating tension in the jaw, face, neck, and upper back. This can cause a characteristic posture with the head moved more forward on the body and larger curves in the neck and low back than usual.

With the increase in tension of the muscles of swallowing, the lower jaw usually moves backwards from its normal postion to compensate (occasionally it moves forward). This will put stress on the TMJ (jaw joint) and can eventually cause pain, popping, and/or clicking in the joint. It will also change the alignment of the teeth causing increased forces on some and decreased forces on others.

Increased mechanical forces on the teeth can cause pain, tooth, and gum problems. It makes the teeth more susceptible to problems, such as infections.

Some of these problems can be treated with osteopathic manual medicine alone. Others require a combination of osteopathy and the proper type of dental appliance. With this type of dental appliance (A.L.F.) swallowing can be retrained and bone growth in the upper and lower jaw can be stimulated causing it to widen. Osteopathic treatment is important to keep the tissues free and pliable, allowing them to change with ease.

Osteopathically oriented dentistry works with the body, that is, it harnesses the body's inherent forces whenever possible. It recognizes the fact that changes in the head can affect the rest of the body and visa versa.

Below is a comparison of orthodontic and dental orthopedic philosophies:

Orthodontics	Dental Orthopedics
Has the dentist deciding the length of treatment- generally 2 years (works at the dentist's pace).	Lets the body decide the length of treatment (works at the body's pace)
Works with the idea that the dentist knows what is best and decides when and where everything should go	Works with the idea that the body knows what is best and it decides when and where everything should go
Uses large forces over a short period of time to generally move teeth in the bone.	Uses small forces over a long period of time to assist and make space for the body to change.
Moves the teeth in the bone primarily	Allows the bone to grow so teeth are in proper adult relationship
Is not very concerned with proper swallowing function	Develops proper swallowing function
Looks mostly at the teeth	Looks at the whole body

Remember that the true problem is rarely just where the symptoms present (face or TMJ), as it is a whole body problem. So the DO treats what they find, not just symptoms.

The causes of dental orthopedic problems vary but commonly involve:

• Trauma, which can be direct, indirect or from inertial injuries (such as auto accidents).
• Dental work, which can include:
• Traumatic dental extractions
• Orthodontia
• Crowns
• Root canals
• Unphysiologic bite adjustments
• Sleep position
• Surgery
• Radiation Therapy
• Systemic disease
• Developmental problems

Summary

1. Oral Facial Development depends upon Proper Swallowing
2. Proper Swallowing depends upon Proper Breathing
3. Proper Breathing depends upon Primary Respiration
4. Primary Respiration is dependent upon a full first breath

For more information on osteopathic dental applications look at the Foundation for Advanced Craniofacial Esthetic Studies web site.

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