Torticollis

Spastic torticollis (ST)--also called Dystonia--is a painful dysfunctional problem. The neck muscles on one side become spastic, causing the head to lean. The normal treatment involves using very strong anti-inflammatory medications; however. It does not offer a lot of relief. These people desperately need help. There is nothing in the literature that supports clenching as a cause, but there is no doubt in my mind and colleagues knowledgeable in the cause and effect of clenching.

ST is a good place to start in the clenching syndrome. It demonstrates how clenching trauma can cause serious problems. ST may be the worse muscle problem that clenching trauma can cause, but balancing the jaw clearly shows how an unbalanced jaw causes problems. These people have an unusual and not too common bite. Most occlusomuscular problems involve facial muscle spasms, which simulate headaches, migraine, and earaches. plus other assorted muscle problems. Muscles problems are just a few of the problems clenching causes.

In order to cause spasticity in neck muscle one has to squeeze on the back teeth, usually one that is severely out of line allowing a person to create a lot of leverage—much more that the normal acquired bite. 

When I palpate the sternocleidomastoid muscle (SCM)—as seen below--in a person suffering for TMJ type problems it may be a little sore, but in ST, it can be very sore. If it is tender, I check the patient’s posture. I often find that there will be a little leaning to one side and the opposite shoulder will be dropping a bite, such as the 13-year-old Guatemalan girl below. Right away, I know that the patient is a potential ST case. Further, when I check her bite I found the usual open bite that has no anterior support during cross over (moving side to side). This indicates that a posterior tooth—often a third molar—is preventing the anterior crossover support as seen her photo below.

 

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As you can see, Susan is unable to hold her head erect, when she tried to straighten it, there was excruciating pain.

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When I examined her, I found that she had no crossover anterior contact. In laymen’s language, this means that when she moved her jaw to the left or right, only back teeth make contact. The front teeth did not touch. This is a bad situation when someone clenches in that position. Front teeth need to support the jaw in all movements. Without this support she could squeeze on back teeth with tremendous leverage. This type of leverage can cause neck muscles to become spastic. 

You can see that there is no contact on the front teeth when she crosses over to the right. There would be many spastic neck muscles if lots of people had this much of a crossover problem.

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Keep in mind that a person has to clench on those back teeth to create muscle problems. The more one clenches the more severe the muscle problems will be; however, neck soreness is probably present in some degree in bites like this even if the person does not have a serious ST problem. 

I wanted to give her crossover support, which is the logical first thing to do for ST patients. The front teeth need a lot of build-up to guard against jaw leverage from those in the way-in-back teeth. I made her a simple anterior deprogrammer bite splint. The anterior bite splint was made on the lower front teeth because I could make it smaller and less obtrusive. 

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In the upper left photo, one can see that the splint gave her crossover support on the left side. In the center photo she had support when her jaw was centered in centric. In the right photo, she had crossover support on the right side. In lay terms, Susan could not contact those back teeth that kept her from touching front teeth when she moved her jaw left or right, when using the splint. The splint was a temporary solution, but it began to reduce the neck pain.

After a few weeks I started equilibration. The objective of equilibration was to balance her jaw so that there would not need of the bite splint, that is, she would have crossover support on her front teeth wherever she moved her jaw. You can see in the lower photos that equilibration solved that problem.

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The upper left photo shows that she has left crossover support. The center photo shows that she was balanced in Centric. The right photo shows she has right crossover support.

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This is Susan six years after therapy. The muscle pain is gone. More important, she can hold her head straight. No one asks her what is wrong anymore. She is a happy lady.

During the initial treatment (anterior deprogrammer) I start treatment with the help of a physician to reduce the muscle inflammation and following completion of occlusal therapy. It will take time to completely remove the chronic muscle inflammation. This can be done in a number of ways: Massage, myo-therapy (Bonnie Pruden), anti-inflammatory medication, and exercise. How much time it will take depends on how long the neck muscles have been spastic. In Susan’s case it took several months.

Any unbalance bite, when clenched on, can cause problems. What happens to people from clenching depends on the type of unbalanced bite they have, and what they do with that bite when they sleep. The object of therapy, for all clenching problems, is to balance the jaw with a balanced bite. ST is just another of the many clenching problems. In this case, I eliminated the serious clenching problem using logical occlusal therapy, a simple splint followed by balancing her jaw with equilibration.

While advanced ST can be treated with occlusal therapy, early ST is much easier to treat.