Temporomandibular Disorder: Is there a link to Parkinson’s disease?
David Chrisman D.D.S., F.A.A.C.P.
One of the core features of Parkinson’s disease is sleep problems and without quality of sleep all our problems get worse. In the book “Sleep and Pain” by Lavigne, Sessile, Choiniere, and Soja they discuss the relationship of pain and sleep. The poorer your sleep the more pain you will have, and the more pain you have the poorer your sleep will be. They state that “it is important to identify specific physiological disturbances that contribute to sleep fragmentation, poor sleep quality, and uncomfortable sensations that may lead to daytime sleepiness”.
In fact when you sleep less it can even affect your hormone levels. In the book “Lights Out” T.S. Wiley states “When you sleep less than you’re meant to, melatonin isn’t the only hormone affected. There are at least ten different hormones, as well as many more neurotransmitters in the brain, that go sideways when you don’t sleep enough. Melatonin is just the tip of the iceberg, so to speak.” If sleep is disturbed then growth hormone production may be affected so that our bodies don’t repair and consequently break down at a faster rate, in essence only partially charging the battery of life. It is all these shifts that change appetite, fertility, and mental and cardiac health.” Sleep problems is also a key problem with our TMJ patients so much so that we routinely screen for TMJ problems in sleep disordered breathing patients and sleep disordered breathing problems in our TMJ patients. Many believe there is as much as an 80% overlap in sleep problems and TMJ and in order to get these jaw problem patients to health we can’t exclude the airway. The mouth is the gateway for the airway and the dental physician is the gatekeeper, no other medical specialty can influence a patient’s wellbeing more than that of the dentist.
Dr Steven Olmos completed a study on TMJ patients that measured the amount of forward head posture of his patients and found that they were on average over 4 inches forward. Every inch forward places 10 pounds on the cervical spine which means that it might place as much as 40 pounds of stress on the neck. When we place the jaw in its corrected joint position with splints we find that we help to correct their cervical spine routinely along with chiropractic or physical therapy since these patients have had these conditions for extended periods of time.
These problems are what we call descending problems that affect the body from the head down opposite to ascending problems with the feet creating postural problems up the body. This forward head posture is also a problem in Parkinson’s patients, in looking at Parkinson’s patients we see the same forward head posture and shoulders rolled forward as in our more advanced TMJ patients. I believe the connection is jaw position and airway. Bringing a patient’s jaw forward and down can not only open the airway in the back of the throat from a front to back dimension but surprisingly a side to side dimension visually demonstrated in cone beam tomography of the airway. When the airway is opened the head can occupy a more normal position back over the spine without compromising the airway.
This is the reason that the American Academy of Sleep Medicine now states that oral appliance therapy should be the first treatment option for mild to moderate sleep apnea. It moves the jaw and the tongue attached to the jaw forward thus pulling the tongue out of the airway preventing collapse. Other muscles attached to the jaw are also pulled which widen the airway in a lateral direction further opening the airway. The difference in flow rates of a 1” pipe and a 1 1/4 “pipe is four times the flow.
Oral appliances have also shown to improve endothelial function in patients. Endothelial function is what the cardiologist use to gauge a person’s cardiac ability to withstand stress by improving blood flow to the heart by enlarging the arterial blood flow.
In conclusion, there are many similarities of Parkinson’s patients and the TMJ patients we see in our practice. They both have sleep problems, forward head posture, rolled shoulders, balance problems, neurologic problems, and dyskinesia. Parkinson’s and TMJ are also recognized as syndromes or sets of similar symptoms. Since Parkinson’s has no known cause (Idiopathic or primary Parkinson’s) perhaps this could be the connection!? Dentists have begun to treat many Parkinsonian patients with success and it may be only time before we uncover the connection with more clarity as more research is completed in this area.