As dentists, we are always looking for ways to ensure that we provide a total care experience to our patients. While we are often well-versed in treating problems within the mouth, we may be missing out on opportunities to go beyond this first layer and provide holistic care.

Growing evidence shows that there may be a connection between the cervical spine and TMJ. The relationship between the nerves, muscles, and other soft tissues may hold secrets to enhancing our treatment methodology.

So, let’s look at this potential new frontier in dental care – and how it will change the way we diagnose and treat.

The Cervical Spine and TMJ Connection

The connection between the cervical spine and TMJ is not taught in traditional dental school. However, more and more evidence is showing that this is a key part of oral and facial pain we need to consider.

The proximity of the cervical spine to the jaw and the web of nerves and muscles in this area creates a complex relationship that affects our patients’ oral health. Here are just a few of the ways that this connection can impact our treatment methods:

1. Anatomical Connection: The cervical spine (C1-C3) is connected to the skull and jaw.
2. Referred Pain: Cervical spine issues can show up as pain in the jaw, face or head and mimic TMJ disorders.
3. Postural Influence: Bad cervical posture can affect jaw position and function, potentially leading to temporomandibular joint (TMJ) dysfunction.
4. Muscular Imbalances: Tight or overactive muscles in the neck and shoulders can pull on jaw muscles, causing pain and dysfunction.

Cervical Neck Junction Anatomy

To understand the cervical spine-TMJ connection we need to look at the anatomy of the cervical neck junction. The Atlas (C1) and Axis (C2) vertebrae are key to this relationship:

1. Atlas (C1): The first cervical vertebra that articulates with the occipital bone of the skull.
2. Axis (C2): The second cervical vertebra with the odontoid process (dens) that acts as a pivot for head rotation.

These vertebrae are special in that they don’t have intervertebral discs, which allows for more mobility but also more propensity to misalign. This can cause compression and irritation of the nerves that supply the jaw muscles, leading to pain and dysfunction.

The cervical neck junction is also surrounded by important muscles such as the sternocleidomastoid (SCM), scalene, and trapezius. These muscles play a crucial role in head posture and movement. When these muscles become tight or overactive, they can pull on the jaw muscles and contribute to TMJ imbalances.

Diagnostic Approach: Looking Beyond the Mouth

To treat cervical spine related TMJ issues we need to expand our diagnostic protocol. Here is what a potential diagnostic approach could look like:

1. Complete Exam: Conduct a thorough examination of the airway, occlusion, gingiva, and individual teeth.
2. TMJ Assessment: Evaluate TMJ condition, including range of motion and any displacement.
3. Cervical Neck Examination: Assess cervical spine alignment and mobility.
4. Photographic Documentation: Take a complete series of intraoral and extraoral photographs.
5. CBCT Imaging: Utilize Cone Beam Computed Tomography (CBCT) with a large field of view (at least 15×15) to visualize both the TMJ and cervical spine.

When analyzing CBCT images, pay close attention to:

• Alignment of C1 and C2 vertebrae
• Relationship between the dens and dental midline
• Any rotations or misalignments of the mandible or maxilla relative to the cervical spine

Collaboration with Cervical Specialists

• It’s important to acknowledge our limitations in this area – and as we begin to adapt our methods, we will need to collaborate with cervical specialists, particularly upper cervical chiropractors.

  There are different schools of thought in upper cervical chiropractic care:

  1. NUCCA (National Upper Cervical Chiropractic Association)
  2. Atlas Orthogonal
  3. Blair Technique

  These specialists can provide valuable insights and input when it comes to analyzing CBCT images and identifying any potential misalignments or issues with the TMJ and cervical spine.

  When referring to a cervical specialist:

  • Schedule a follow up appointment within 24 hours of their adjustment
  • Keep the specialist informed of the patient’s progress
  • Consider a 2 month stabilization period before doing further dental work

Case Study: Cervical Adjustment Impact

To illustrate this let’s look at a case:

John, a 20 year old, was referred by an orthodontist due to TMJ pain and couldn’t start orthodontic treatment. John said:

• Occasional left side jaw and neck pain since 2016
• Felt his jaw was shifting to the left
• Teeth were becoming misaligned

In the exam, the following was found:

• Left side muscles were tender to palpation
• Midline was off by 2mm
• CBCT showed 4.6mm deviation of the dental midline from the dens

After referral to an Atlas Orthogonal chiropractor and subsequent adjustment:

• John reported instant neck relief
• His bite changed significantly more contact on the right side
• Left side jaw pain gone

By seeing John as a whole person and not just focusing on his teeth, more effective and long-lasting treatment was able to be provided. The alignment of the spine and musculature had a direct effect on John’s TMJ pain and orthodontic progress. As dental professionals, we have the unique opportunity to play a role in this holistic approach to health and well-being.

Adding Cervical Spine Assessment to Your Practice

So, how do you go about adapting your current practice to add in these methods for better patient care?

Don’t feel overwhelmed to add cervical spine assessment to your practice. There are actionable steps you can take starting today to start offering a more in-depth and comprehensive treatment plan for your patients:

Educate Yourself: Attend dental continuing education courses on the cervical spine and TMJ connection. By taking the time to learn about the relationship between the two, you’ll be better equipped to assess and treat your patients.

Update Your Health History Forms: Add questions about chiropractic care and neck pain, such as previous injuries, daily activities, and any pain or discomfort in the neck region. This will help you gather important information about your patients’ cervical spine health and potential risk factors.

Invest in Technology: Get a CBCT with a large field of view or gain access to one – this is a key component in examining the cervical spine and TMJ. It provides a 3D image of the temporomandibular joint, allowing for more accurate diagnosis and treatment planning.

Collaborate with Other Healthcare Providers: Reach out to dentists and oral surgeons in your area to develop a referral network. By working together, you can provide a more comprehensive approach to treating the cervical spine-TMJ connection.

Are There Other Therapies To Consider with the Cervical Spine and TMJ Connection?

While collaboration with cervical specialists is important, we can also add these therapies to our practice:

1. Photobiomodulation: Low level laser therapy to reduce inflammation and promote healing in TMJ and cervical areas.
2. Myofunctional Therapy: Addressing muscle imbalances for TMJ and cervical spine health.
3. Sleep Assessment: Many cervical and TMJ issues are sleep related so consider adding sleep evaluations to your practice.