The Symbiotic Partnership of Dentistry
And Craniosacral Therapy (Part One)
by Benjamin Shield, Ph.D.
Introduction
This article will explore the symbiotic partnership between the
dental profession and craniosacral therapy. With the simple integration
of craniosacral techniques, the dental professional will significantly
enhance the effectiveness of existing modalities, increase the
economic return in their practice, and benefit from greater patient
satisfaction.
Craniosacral therapy (CST) can be thought of as the missing puzzle
piece in the efficacy of many dental procedures. CST, as it expands
our awareness beyond the mandible and maxillae, provides a holistic
awareness of the dental mechanism and the well-being of the dental
patient. And, whether performed by the dentist, dental assistant,
or craniosacral therapist, the dental professional and the patient
alike immediately recognize the benefit.
The goal is to better serve our patients. In addition to enhanced
dental care, CST offers the dental professional the ability to
solve many instances of craniocervical pain and dysfunction. The
dental professional is in an unique position to correct underlying
anatomical and functional dysfunction that may have been unseen
or mistreated by other professionals.
The first article of this series appeared in the Number 6 (June
1998) issue of ZMK and offered a brief introduction to the craniosacral
system and craniosacral therapy. It discussed the importance that
the correction of dental mechanics should be made to a cranium
that is as balanced as possible. This is important to insure the
effectiveness and longevity of the correction, the prevention
of negative symptoms, as well as the overall health of the individual.
The Craniosacral System
Craniosacral therapy involves the gentle manipulation and normalization
of the cranial bones. CST also involves the treatment of the underlying
membranes that provide the dural structure of the cranium as well
as their continuation to the sacrum as they surround and support
the brain and spinal cord. Craniosacral therapy also addresses
the soft tissue affecting the craniosacral system.
Any imbalance of the craniosacral system can result in imbalances
of the gross anatomical structures as well as producing a myriad
of unwanted symptoms. The goal in the utilization of CST is to
bring the skeletal structure, particularly that of the cervicocranium
and its underlying membranes back into balance. A general principle
of this work is that as the structure is normalized, function
will follow.
The cranial bones and their underlying membranes move in relation
to the production and resorption of the cerebrospinal fluid. The
cerebrospinal fluid is produced in the ventricles of the brain
and resorbed via processes of the arachnoid dura into the venous
sagittal sinus. These cycles of cerebrospinal fluid production
and resorption create a palpable motion of the cranial bones that
can be easily observed by a trained craniosacral therapist.
The filling phase of the cycle in which the cerebrospinal fluid
is produced is referred to as "flexion." The draining
phase of the cycle in which the cerebrospinal fluid is resorbed
is referred to as "extension." The terms "flexion"
and "extension" refer to the angle created by the occipital
base and the body of the sphenoid which "flexes" and
"extends" in relation to the filling and draining of
the cerebrospinal fluid.
Each cranial bone follows a predictable motion in this "cranial
rhythm." And, we can use this motion to both evaluate and
to gently treat the craniosacral system. The movement of particular
cranial bones will be discussed in regard to specific dental conditions.
Craniosacral therapy can be highly effective in treating facial
asymmetry, cranial imbalances, and soft tissue hypertonicity.
These conditions play a direct role in chronic malocclusion, temporomandibular
dysfunction, cranial pain, sensory impairment, and a variety of
mechanical disorders.
Orthodontia
Dental professionals often observe that after a patient completes
orthodontic treatment, a disturbing phenomenon occurs. Much to
the disappointment of the dental professional and the patient,
after the appliances are removed, often the teeth begin to return
to their original, pre-treated positioning.
This can often be due to the appliances being applied to a cranium
that has torsion and restriction. The appliances will move the
teeth to the appropriate positions, but at the same time will
torque and distort the cranium even further. When the appliances
are removed, the cranium will seek to return to some degree of
balance and in doing so, will move the teeth back towards their
original faulted placement.
The simple utilization of craniosacral therapy can eliminate,
or at the very least minimize, this unpleasant phenomenon. Whether
it be fillings, inlays, onlays, implants, bridges, dentures, splints,
or orthodontics, we want to equilibrate our work to a cranium
that is as balanced as possible. For example, if we were being
fitted for a suit or dress, we wouldn't want to be fitted while
we were slouching!
The dentist, dental assistant, or craniosacral therapist balancing
the craniosacral system can affect significant improvements in
occlusion and positioning the teeth.
Craniosacral therapy may not only improve the orthodontic treatment,
it can also serve to minimize and possibly eliminate the necessity
of appliances.
It was discussed that during the cycle of cerebrospinal fluid
production and resorption, the cranial bones moved in a predictable
manner. During the filling phase ("flexion"), the structures
of the hard palate respond by widening and flattening. As this
occurs, the anterior teeth are withdrawn slightly posteriorly.
If a patient suffers from a significant "flexion" lesion,
this could result in the presentation of an underbite.
Conversely, during the draining phase ("extension"),
the hard palate narrows and is drawn upwards. As this occurs,
the anterior teeth are slightly extruded forward. If a patient
suffers from a significant "extension" lesion, creating
a high, narrow arch to the hard palate and extruding the anterior
teeth forward, this could result in the presentation of an overbite.
Dental professionals often note that, during the course of orthodontic
treatment, patients may report numerous ancillary symptoms such
as cranial pain, sensory disorders, temporomandibular pain, and
a decrease of energy levels. This may be due to the effect of
the appliances "ratcheting" the cranium into a distorted
and lesional pattern creating a variety of unpleasant symptoms.
During orthodontic treatment, keeping the cranial bones balanced
and relieving the torsion and opposing tensions that can be created
by the increased pressure of the moving teeth, will help eliminate
these accompanying symptoms.
It is fascinating to treat the individual teeth using craniosacral
therapy. Just as it is possible to normalize the cranial bones
and related soft tissue, it is also possible to reposition individual
teeth through the process of "unwinding." Unwinding
is a gentle process involving the release of the periodontal tissue
that, due to trauma or excessive occlusal pressures, lock the
teeth into their sockets. The release of these tissues assists
the individual teeth to seek a more balanced position. The results
are extremely rewarding.
It is also extremely beneficial to utilize craniosacral therapy
after orthodontic treatment is completed and the appliances have
been removed to maintain the balance of the cranial bones and
membranes.
We can readily see the benefit to both the dental professional
and the patient in utilizing craniosacral therapy before, during,
and after orthodontic treatment. Integrating these simple techniques
will enhance the efficacy and longevity of the dental work. Additionally,
CST will greatly improve patient comfort, satisfaction, and confidence.
Temporomandibular Joint Dysfunction and Treatment
Another field of dental health in which dentistry and craniosacral
therapy are richly intertwined is in the treatment of temporomandibular
joint dysfunction.
The temporomandibular joints, because of their position in the
skull, serve as a major neurological pathway for motor and sensory
activity. The proximity to the ears, eyes, nose, throat, tongue,
sinuses, and cervical spine make them among the most important
joints in the body. 38 percent of all neurological input to the
brain comes from the face, mouth, and TMJ region. Their structure
makes them perhaps the most special and most complex joints in
the anatomy.
The two-cubic-inch area that contains the TMJ contains the sinuses,
glands, the middle and inner ears, various tissues of the throat,
brain tissue, different muscles, ligaments, nerves, blood vessels,
lymphatic tissues, bones, teeth and the TMJ itself.
Because no individual has a perfect TMJ, everyone has some degree
of TMJ dysfunction (ìTMDî). The TMJ compensates for
all the rotations, compensations, and imbalances that radiate
from our feet up and from our head down. We might think of our
jaw as being like the pole used by the tightrope walker to maintain
a delicate balance. The TMJ can be thought of, as well, as a repository
for all our frustrations, excitement, unspoken words, and uncried
tears.
The complex, interwoven network of nerves in the head and neck
explains the fact that many TMJ patients also complain of pain
in their neck, face, ear, eyes, sinuses, teeth, and head. Other
disturbances may include dizziness, headaches, nausea, ringing
in the ears, visual disturbances, loss of equilibrium, earaches,
numbness or tingling in the face and hands, and oropharyngeal
symptoms. Clicking and grating in the jaw joints, inability to
open or close the mouth freely, and difficulty in chewing and
swallowing are also reported.
Craniosacral therapy significantly augments the treatment of temporomandibular
joint dysfunction by the dental professional. CST is effective
in assisting corrections in the functional anatomy of the TMJ,
abnormal muscular traction (external derangement) effecting the
TMJ, alteration of occlusion and TMJ function due to facial trauma,
anterior disc dislocation, joint noise, and chronic malocclusion.
Craniosacral therapy addresses specific TMJ movement disorders
such as deflection (pulling to one side), deviation (a "hitch,"
as if the mandible is maneuvering itself around some obstacle),
and the locking of the TMJ (either when open or closed).
Craniosacral therapy addresses important muscle groups that are
crucially important to dentistry and the craniosacral system.
The muscles that are among the most significant are the lateral
pterygoid, masseter, and temporalis muscles. The specific treatment
of TMJ soft tissue improves the tonus and function of these muscles
as well as improving the function of the innervating cranial and
cervical nerves.
Treating and normalizing the soft tissue of the cranium has ramifications
throughout the dental mechanism. Soft tissue influence on mandibular
positioning is significant. There are sixteen muscle groups controlling
mandibular positioning. This is more than any other bone in the
human body with the exception of the scapulae which each have
attachments of seventeen muscle groups.
In addressing the soft tissue of the TMJ, craniosacral therapy
helps reduce compression and abnormal traction on the joint. Compression
in the TMJ often has the effect of displacing the articular disc
anteriorly. The disc, then, no longer adequately protects the
structures in the TMJ. Compression does not allow the cartilaginous
disc to hydrate and to receive nutrients. The disc has no direct
blood supply and depends on a "sponge-like" motion to
squeeze out waste products and to absorb into itself synovial
fluid and nutrients. Consequently, the disc begins to degenerate,
causing wear and tear to the TMJ.
Compression also squeezes out the synovial fluid and wears away
the synovial tissue that produces the fluid. In the absence of
sufficient lubrication, the moving parts of the TMJ system experience
friction and wear and tear whenever the jaw moves.
Joint noise
The excessive pulling of the disc anteriorly by the lateral pterygoid
muscle can also create temporomandibular joint noise such as "popping"
and "clicking." When the disc is anteriorly displaced,
the condyloid process of the mandible is caused to "pop"
or "click" onto the disc as the jaw opens. Similarly,
as the jaw closes, it may pop or click back off of the disc
Another source of popping and clicking is as ticking disc. This
is often caused by undue soft tissue compression and / or the
pressures accrued from misalignment of the cranium. The pressure
on the disc "squashes" the disc flat and presses all
the lubrication out of it. The disc is not able to move smoothly
and the mandible may slide off of the disc.
As cranial alignment and soft tissue traction are normalized,
the disc is assisted back to its proper position. Lubrication
can again flow around the disc. The disc is then able to move
with the jaw, and the popping or clicking sound may disappear.
Mandibular Whiplash
Whiplash, with resultant injury to the temporomandibular joint,
is often caused by rear end motor vehicle collisions. This type
of accident causes the head to be suddenly thrown back. Because
the anterior, sub-mandibular muscles of the neck do not have time
to relax, they anchor the mandible while the head is thrown backward.
This causes the mouth to open far beyond its functional capacity,
causing the TMJ musculature, tendons, ligaments, and synovial
membranes to be significantly bruised, strained, and / or torn.
Most often, the disc is forced out of position, relocating in
front of the joint, from the traction exerted by the lateral pterygoid
muscle. This type of injury is called an "anterior displaced
disc," or an " ìnternal derangement."
The subsequent "whipping" motion of the head and neck
forward into hyperflexion further exacerbates this injury, causing
the jaw to snap shut. Along with injury and anterior displacement
of the disc, the mandible is forced posteriorly.
Craniosacral therapy helps to reduce the traction of the lateral
pterygoid muscles and the various soft tissue structures of the
TMJ. Normalizing the traction of the lateral pterygoid muscle
will help to recapture the disc. CST also assists in repositioning
the mandible, which results in decreasing the hyperstimulation
and the nociceptive (pain) impulses of the trigeminal nerve. Additionally,
repositioning the mandible will help restore a more balanced occlusion
with the maxillary teeth.
Temporal Bone Rotation
Temporomandibular joint compression causes both rotation of the
temporal bone and displacement of the mandible. Because of the
placement of the condyloid process in the fossa of the temporal
bone, when the TMJ is compressed, the temporal bone is "internally"
rotated and the mandible is retruded. If cranial imbalances exist
such that the temporal bone is "externally" rotated,
the mandible is protruded.
Whenever the temporal bone is out of its proper position ("lesioned"),
the mandible does not have appropriate seating in the joint. This
is a direct cause of TMJ dysfunction. Moreover, as will be discussed
in part two of this article, temporal bone lesions can be a major
cause of tinnitus, vertigo, and equilibrium dysfunctions. Craniosacral
therapy acts to normalize the positioning of the temporal bones.
Discussion
Dentists hold a unique role in the treatment of various mechanical
and functional disorders. In addition, they are often in the position
to resolve many craniofacial dysfunctions that have not been resolved
by other specialists.
By incorporating craniosacral techniques into their practice,
the effectiveness of their treatment, their ability to treat their
patients holistically, as well as the satisfaction of their patients
will escalate. Whether the dentist, the dental assistant, or a
craniosacral therapist performs the work, the dentist's practice
and reputation will benefit.
In the next edition of ZMK, further benefits of incorporating
craniosacral therapy into the dental practice will be discussed.
Topics will include the dental / craniosacral influence on conditions
including sensory dysfunctions, headaches, neuralgias, endocrine
dysfunction, and autonomic nervous system imbalances.