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A Possible Dental Connection for Spasmodic Torticollis
BRUXISM-IS IT RELATED TO CERVICAL DYSTONIA?
As a practicing general dentist for the past 29 years, I have had the opportunity to treat hundreds of patients who presented with jaw pain and/or dysfunction. Most of those patients suffered daily headaches and facial pain, and a smaller number had difficulty chewing. Changes to the chewing surfaces of the teeth and surrounding soft tissues could be seen during dental examination. These changes include excessive wear of the teeth on the occlusal (chewing) surfaces, notches on several teeth at the gum line, scar tissue formation on the inside of the cheeks, and indentations on the side of the tongue from the teeth. Treatment usually involved fabricating a dental appliance to cover the biting surfaces of the upper teeth to prevent further wear and alleviate the headaches and facial pain that occurred due to hyperactivity of the muscles controlling the jaw. This treatment was successful in over 80% of the patients treated, as long as they were compliant in wearing the appliance. The success of this treatment was defined by a decrease or elimination of the pain symptoms, but it was not a cure. To cure this disorder, the cause would have to be identified.
Bruxism is defined as involuntary grinding or clenching of the teeth resulting from hyperactivity of the muscles of mastication. Bruxism can occur mainly during sleep (nocturnal), or while awake (diurnal). The similarities between cervical dystonia and bruxism are striking. They are both characterized by involuntary, repetitive, sustained (tonic), or spasmodic (rapid or clonic) muscle contraction, resulting in significant pain and dysfunction. In fact, both disorders have been treated in similar ways: pharmacological agents, botulinum toxin injections, and physical therapy.
A possible link between cervical dystonia and bruxism has been explored by the scientific community. Although a direct link has not been proven, there are cases when bruxism is seen when there are identifiable brain lesions or following brain trauma. However, most bruxism cases are seen in people without central nervous system disorders. Bruxism is possibly a clinical form of dystonia, although the causes are different in most cases. Dentists who treat facial pain must work with physicians (especially Neurologists) to accurately diagnose the disease causing the pain. Cervical dystonia is a central nervous system disorder, while most bruxism is a functional pathology.
If you suffer from orofacial pain, you should discuss your symptoms with your dentist as well as your physician. The dentist can usually identify the dysfunction and the muscles that are affected by the bruxism. A combination of a removable dental appliance, physical therapy, and behavioral modification is highly effective in managing the pain. More complex cases of dysfunction should be examined by a physician with possible referral for neurological evaluation.
Charles H. Margiotta, D.D.S.