The Symbiotic Partnership of Dentistry
And Craniosacral Therapy (Part Two)
by Benjamin Shield, Ph.D.
Introduction
This article is the concluding part of the exploration of the
symbiotic partnership between the dental profession and craniosacral
therapy. 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, craniosacral therapy, and its importance
in the dental field.
In the previous issue of ZMK, it was discussed that the integration
of craniosacral techniques by the dental professional can significantly
enhance the effectiveness of existing modalities, increase the
economic return in their practice, and benefit from greater patient
satisfaction. The article discussed how cranial misalignments
("lesions") contribute to malocclusions, TMJ dysfunction,
and a variety of dental mechanical disorders. It discussed
the unique role of the dental professional and highlighted the
ability of craniosacral therapy to assist the dentist in the diagnosis
and treatment of these disorders.
This concluding article will focus on the evaluation and treatment
of functional disorders such as sensory disturbances, headaches,
neuralgias, endocrine dysfunction, and autonomic nervous system
imbalances. It will explore the interrelationship of dentistry
and craniosacral therapy and how the dental professional holds
a unique and crucial role in the approach to these conditions.
Dental anatomy and function powerfully influence the health of
the individual. Malocclusions, temporomandibular joint dysfunctions,
and cranial imbalances reach far beyond the masticatory system.
This is the reason patients often report to their dentist a myriad
of "non-dental" symptoms that accompany their dental
disorder. The dentist, dental assistant, or craniosacral therapist
working in conjunction with the dentist can address many of these
conditions utilizing craniosacral therapy. They are often
able to treat the "root causes" of conditions, often
overlooked by other specializations.
Dentistry, the craniosacral system, and functional systems of
the body are profoundly intertwined in an "elegant ecology."
To present a discussion of one without discussing the other's
influences would be an artificial separation of these topics.
Any change in dental anatomy and mechanics will have a significant
influence on the craniosacral system and other functional systems
in the body. Any craniosacral lesion, or correction of that
lesion, effects dental anatomy and mechanics and the body's functional
systems.
This "elegant ecology" exists throughout the body, affecting
anatomy and function. Its influence is so extensive that
it is difficult to imagine any part of the body that is not affected.
Let's look at some of these relationships.
The sphenoid bone is considered the central bone of the craniosacral
system. Because of its unique and complex anatomy, it articulates
with almost every other bone in the cranium. We can imagine
the sphenoid being like a central cog in a wristwatch. If
that central cog is out of balance, we would imagine that it can
effect the balance of all of the other cogs in the watch, or in
this case, all of the other cranial bones in the head.
The craniosacral system produces cerebrospinal fluid (CSF) in
the choroid plexus in the brain's ventricles. This fluid
is rhythmically produced and resorbed approximately eight to ten
times each minute. When the CSF is produced, it creates
a pressure that wasn't there a moment before. This pressure
creates a predictable movement of the cranial bones. When
the CSF is resorbed via the arachnoid villi into the venous sinuses,
the pressure is reduced and the cranial bones return to their
original position.
As the CSF is produced and resorbed, it creates a motion of "flexing"
and "extending" in the angle between the body of the
sphenoid and the occipital base. This is why we call the
production (filling) phase "flexion", and the resorption
(draining) phase "extension."
The sphenoid comes into intimate contact with the hard palate
via its pterygoid processes abutting the palatine bones.
If the sphenoid is out of alignment in anyway, it will directly
affect the anatomy of the hard palate. This in turn will
influence the position of the upper teeth, the individual's occlusion,
and the function of the temporomandibular joint.
Located between the pterygoid processes of the sphenoid and the
palatine bones are the sphenopalatine ganglia. The sphenopalatine
ganglia innervate the lining of the nose, sinuses, and nasopharynx.
If the sphenopalatine ganglia are hyperstimulated because of improper
pressures of the hard palate and the sphenoid, it can result in
rhinitis and rhinorrhea. It can also increase an individual's
susceptibility to air born allergens by the hypersensitivity of
these affected mucous membranes.
The maxillary branch of the Trigeminal nerve (CN V) innervates
the sphenopalatine ganglia. As such, the sphenopalatine
ganglia play an important role in migraine headaches due to its
sensory influence of the Trigeminal nerve.
Just as any lesion of the sphenoid will affect the hard palate,
any change in the anatomy of the hard palate will profoundly affect
the sphenoid. We can see how important it can be to normalize
the cranial structure with the use of dental and craniosacral
modalities.
Located directly on the sphenoid is the pituitary gland.
It sits on the sphenoid in a formation that looks like a "Turkish
saddle." In fact, the Latin name for that structure
is called the "sellae tursica." The pituitary
exerts profound influence over the endocrine system and, as such,
directly influences the body's physiology and health.
If the sphenoid is out of position ("lesioned") due
to misalignment of the hard palate, pituitary function will suffer,
and the body's physiological systems will be affected. The
pituitary depends on the normal alignment of the cranial bones
for its proper functioning.
The pituitary is located outside of the brain because it needs
to operate in a cooler environment than the brain has to offer.
One of the ways that the body helps "cool" the pituitary
is the gentle rocking motion of the sphenoid provided by the craniosacral
rhythm. This rocking motion ("flexion" and "extension")
helps to pump the hot blood away from the pituitary. Any
cranial misalignment interferes with this motion, causing the
pituitary to heat beyond its optimal physiological range.
Even a slight temperature increase of the pituitary will result
in diminished pituitary function.
If you've ever felt "out of sorts," you may have splashed
cool water on your forehead. This instinctual behavior wasn't
to cool your forehead. Rather it was to help cool the pituitary
and restore a sense of well being.
A "faulted" or "lesioned" sphenoid caused
by misaligned dental anatomy can result in a myriad of physiological
and behavioral symptoms. Facial asymmetry, cranial pain,
and sensory disorders may be indications of cranial imbalance.
Often an individual will unconsciously attempt self-corrective
measures. It is important to notice if a child keeps having
accidents involving hitting their heads or if the child is involved
in head banging, particularly if the same part of the head is
hit each time. This may be the child's attempt to self-correct
a cranial lesion. Even bruxism in adults may be an attempt
to remedy cranial misalignment.
Craniosacral balance and TMJ function was discussed in the prior
article. Of significant interest is the role that TMJ function
has in cranial pain, sensory dysfunctions, emotions, and autonomic
nervous system balance.
TMJ disorders are a major contributor to head pain. Because of
its intricate anatomy, myriad of related structures, and sensory
innervation of the Trigeminal nerve, any dysfunction of the temporomandibular
joint can create pain throughout much of the head.
The lateral pterygoid muscles directly influence the movement
of the mandible and the interarticular joint discs. Hypertonicity
of the lateral pterygoids not only affects the anatomy and function
of the TMJ, but also directly influences the anatomy and functioning
of the important sphenoid bone.
The lateral pterygoid muscles connect the TMJ to the pterygoid
processes of the sphenoid. So, any imbalance of the TMJ
affecting the lateral pterygoid muscles will pull the sphenoid
out of position and affect its motion and functioning.
This "faulting" of the sphenoid can result in visual
disturbances because the sphenoid is a major structural feature
of the orbits. Also, cranial nerves affecting visual acuity
and eye movement travel through or above the sphenoid bone.
Moreover, all but one of the muscles that control the movement
of the eye are attached to the sphenoid.
When the condyloid process of the mandible is forced up into the
temporal bone due to a "tight jaw," the temporal bones
are forced into rotation. The temporal bones contain the
mechanisms for hearing and balance, and these functions can be
seriously impaired if these bones are out of proper alignment.
There are many ways that a "tight jaw" perpetuates its
condition without the aid of a trained practitioner. For
example, when muscles contract and go into spasms, insufficient
blood reaches the muscles. This can cause an anaerobic condition
and a build-up of lactic acid and toxins. This discomfort
results not only in the muscles going into further contraction,
but also produces throbbing or continual pains in the muscles,
joints, teeth, and other areas of the head and neck.
Located slightly anterior to the temporomandibular joint is an
autonomic nerve plexus call the Reticular Activating System.
Imbalance of the temporomandibular joint can produce a constant
hyperstimulation of this autonomic system, resulting in the patient
experiencing a pervasive sense of "fight or flight."
It is like leaning on a fire alarm 24 hour a day. This can
affect not only the patient's emotions, but their endocrine and
other physiological systems as well. If the patient clenches
their jaw and / or grinds their teeth during sleep, they may wake
up more fatigued than they had been when they went to bed due
to the constant firing of the sympathetic nerve fibers.
A complex pattern of cranial and cervical nerves provides sensory
and motor pathways in the head. Motor and sensory disturbances
can accrue when the functional anatomy associated with these nerves
is out of balance ("lesioned").
Cranial nerves of particular interest in dentistry include cranial
nerves 5, 7, 9, 10, 11, and 12.
Craniosacral therapy (CST) serves to balance the bones and related
soft tissue of the craniosacral system. In balancing these
structures of the cranium, cranial nerve function is optimized
and many disorders of cranial nerve origin are corrected.
Many of these cranial nerves and related disorders are directly
involved in the field of dentistry. Disorders of cranial
nerves (particularly CN V, CN VII and CN IX) can refer pain to
the TMJ and related structures.
The fifth cranial nerve, known as the Trigeminal nerve, is the
largest of the twelve-paired cranial nerves. It supplies
motor fibers to the masticatory muscles and sensory input from
the face, mouth, and much of the head. Disorders of the
Trigeminal nerve are often the reason a patient will seek the
help of their dental professional. Trigeminal nerve pain
radiation can often confuse the diagnosis whether a pain is coming
directly from a tooth or is a referred pain.
Branches of the Trigeminal nerve can be compressed and / or entrapped,
creating excruciating head and facial pain in the patient.
This condition is referred to as "Tic Douloureux."
This entrapment can be caused by disturbance of the dural membranes
enveloping the gasserian ganglion, or caused by articular strain
of the temporal and sphenoid cranial bones. This condition
can often be successfully resolved utilizing craniosacral therapy,
particularly if treated soon after the onset of symptoms.
The seventh cranial nerve is known as the "Facial nerve."
This nerve provides much of the motor fibers to the muscles of
facial expression and the buccinator muscle. When there
is irritation or entrapment of this nerve, there is often a pattern
on one side of the face that can include the mouth drooping, impaired
chewing due to a weak buccinator muscle, and loss of the sense
of taste to the anterior two-thirds of the tongue. This
condition is referred to as Bell's Palsy. Cranial lesions, particularly
of the temporal bones, can be a significant factor in the pressure
exerted on the Facial nerve. Utilization of craniosacral
therapy by the dental professional or craniosacral therapist can
often successfully treat this condition.
Just as the fifth cranial nerve can become entrapped creating
debilitating pain, so can the ninth cranial nerve (the Glossopharyngeal
nerve). This entrapment manifests as severe pain in the
middle ear, mastoid air cells, tongue, and / or pharyngeal wall.
This condition can be successfully addressed with the utilization
of craniosacral techniques.
These two articles examining the symbiotic partnership of dentistry
and craniosacral therapy have discussed a broad spectrum of topics.
Even more can be written on how these two disciplines are intertwined
in the evaluation and treatment of other dental mechanical disorders,
treatment of chronic and acute cranial pain, sensory disturbances,
TMJ function, occlusal balance, post-traumatic injury, tongue
mechanics, nerve entrapment and irritation, swallowing, and speech
disorders. The disciplines of dentistry and craniosacral
therapy not only support each other; they are dependent on each
other.
Dentists have a unique role in health care. The work that
they do goes far beyond the mandible and maxillae and has ramifications
throughout the patient's entire system. Craniosacral therapy
enhances the dentist's ability to have this profound influence.
The utilization of craniosacral techniques assures a more holistic
approach in dental care. Craniosacral therapy provides benefits
before, during, and following dental procedures. And, whether
performed by the dentist, the dental assistant, or a craniosacral
therapist working in conjunction with the dentist, this approach
will significantly enhance treatment results, economic returns,
and patient satisfaction.
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