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Iatrogenic TMJ difficulty: Cervical traction may be the etiology
MAXILLOFACIAL PROSTHETICS TEMPOROMANDIBULAR JOINT . DENTAL
!_(.‘s[ :<, 1 >‘i yj-ri’:; IMP
Iatrogenic TMJ difficulty: Cervical traction may be the etiology Nathan Allen Shore, D.D.S.,* Merlin New York, N. Y
G. Schaefer, D.D.S.,* and Stanley Hoppenfeld,
M.D.*”
F
unctional temporomandibular joint (TMJ) dysfunction is most often caused by occlusal disharmony.‘-* Less widely recognized is iatrogenic TMJ difficulty that may be evidenced in patients treated with cervical traction for cervical spine syndromes.5 Cervical traction forces the temporomandibular joints to become weight bearing as opposed to being subjected only to slight loads by muscle tension. In patients in cervical traction who have normal dental occlusion, force is transmitted primarily through the chin portion of the head-holder to the maxillary bones by way of the teeth and partially by way of the temporomandibular joints. However, when a patient has abnormal occlusion because of missing posterior teeth, stress is placed on the temporomandibular joints and produces TMJ symptomatology (Fig. 1).
DISCUSSION A patient who complains of pain in the head, neck, and along the ulnar aspect of one or both hands, accompanied by weakness of the grip, may be diagnosed as suffering from a cervical spine syndrome. Such a patient would likely be treated with cervical traction. In addition, the patient would perhaps be instructed to wear a cervical collar. If the head and neck pain should increase in severity despite this therapy, the patient may be placed in cervical traction in a hospital. For the patient with abnormal dental occlusion, intensified cervical traction could soon result in complaints of pain in the temporomandibular joints. Such a patient would require dental-medical consultation and treatment. Splints? similar to those worn by prizefighters *Postgraduate **Assistant Einstein iI,
Lecturer, Temple University School of Dentistry. (Xinical Professor of Orthopedic Surgery, Albert College of Medicine.
1). Caulk
Co., Milford,
OOZ-3913/79/050541
Del.
+ 02$00.20/O 0 1979 The C. V. Mosby Co.
Fig. 1. Cervical traction forces the temporomandibular joints to bear weight and results in increased pain when a patient has missing posterior teeth. (Drawing courtesy of Appleton-Century-Crofts, New York.) should be prescribed for patients with missing posterior teeth who are treated with cervical traction. When these splints are placed on the teeth, the force of cervical traction is distributed equally through the teeth to the maxillary bones rather than through the temporomandibular joints. TMJ symptoms should disappear promptly because cervical traction is no longer transmitted through the joints.
SUMMARY Patients in cervical traction for the treatment of cervical spine syndromes frequently complain that the traction makes them worse. It is possible that such patients may be suffering from TMJ symptoms. The physician treating a patient with cervical trac-
THE JOURNAL
OF PROSTHETIC
DENTBTRY
541
SHORE, SCHAEFER,
tion should consider prescribing an occlusal splint for patients without posterior teeth. The splint should be designed to distribute the stresses through the mandible to the maxillae via the teeth, splint, and TMJ. REFERENCES 1. Shore, N. A.: Head pain of temporomandibular Headache 63 1, 1966. 2. Shore, N. A.: Mandibular autorepositioning J Am Dent Assoc 75:908, 1967.
joint origin. appliance.
INFORMATION
AND
HOPPENFELD
3.
Shore, pi. A.: Headaches traced to temporomandibuiar joints. J Am Med Assoc 209:1153, 1969. 4. Shore, N. A.: Temporomandibular Joint Dysfunction and Occlusal Equilibration, ed 2. Philadelphia, 1976, J. H. Lippincott Co., pp 130-134. 5. Hoppenfeld, S.: Physical Examination of the Spine and Extremities. New York, 1976, Appleton-Century Crofts. Rejnnt requeststo: DR.NATHAN ALLEN SHORE 210 CENTRAL PARK SOUTH xEWYORK,N.Y. 10019
FOR AUTHORS
Most of the provisions of the Copyright Act of 1976 became effective on January 1, 1978. Therefore, all manuscripts must be accompanied by the following written statement, signed by one author: “The undersigned author transfers all copyright ownership of the manuscript (title of article) to The C. V. Mosby Company in the event the work is published. The undersigned author warrants that the article is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors.” Authors will be consulted, when possible, regarding republication of their material.
542
MAY 1979
VOLUME
41
NUMBER
5
!_(.‘s[ :<, 1 >‘i yj-ri’:; IMP
Iatrogenic TMJ difficulty: Cervical traction may be the etiology Nathan Allen Shore, D.D.S.,* Merlin New York, N. Y
G. Schaefer, D.D.S.,* and Stanley Hoppenfeld,
M.D.*”
F
unctional temporomandibular joint (TMJ) dysfunction is most often caused by occlusal disharmony.‘-* Less widely recognized is iatrogenic TMJ difficulty that may be evidenced in patients treated with cervical traction for cervical spine syndromes.5 Cervical traction forces the temporomandibular joints to become weight bearing as opposed to being subjected only to slight loads by muscle tension. In patients in cervical traction who have normal dental occlusion, force is transmitted primarily through the chin portion of the head-holder to the maxillary bones by way of the teeth and partially by way of the temporomandibular joints. However, when a patient has abnormal occlusion because of missing posterior teeth, stress is placed on the temporomandibular joints and produces TMJ symptomatology (Fig. 1).
DISCUSSION A patient who complains of pain in the head, neck, and along the ulnar aspect of one or both hands, accompanied by weakness of the grip, may be diagnosed as suffering from a cervical spine syndrome. Such a patient would likely be treated with cervical traction. In addition, the patient would perhaps be instructed to wear a cervical collar. If the head and neck pain should increase in severity despite this therapy, the patient may be placed in cervical traction in a hospital. For the patient with abnormal dental occlusion, intensified cervical traction could soon result in complaints of pain in the temporomandibular joints. Such a patient would require dental-medical consultation and treatment. Splints? similar to those worn by prizefighters *Postgraduate **Assistant Einstein iI,
Lecturer, Temple University School of Dentistry. (Xinical Professor of Orthopedic Surgery, Albert College of Medicine.
1). Caulk
Co., Milford,
OOZ-3913/79/050541
Del.
+ 02$00.20/O 0 1979 The C. V. Mosby Co.
Fig. 1. Cervical traction forces the temporomandibular joints to bear weight and results in increased pain when a patient has missing posterior teeth. (Drawing courtesy of Appleton-Century-Crofts, New York.) should be prescribed for patients with missing posterior teeth who are treated with cervical traction. When these splints are placed on the teeth, the force of cervical traction is distributed equally through the teeth to the maxillary bones rather than through the temporomandibular joints. TMJ symptoms should disappear promptly because cervical traction is no longer transmitted through the joints.
SUMMARY Patients in cervical traction for the treatment of cervical spine syndromes frequently complain that the traction makes them worse. It is possible that such patients may be suffering from TMJ symptoms. The physician treating a patient with cervical trac-
THE JOURNAL
OF PROSTHETIC
DENTBTRY
541
SHORE, SCHAEFER,
tion should consider prescribing an occlusal splint for patients without posterior teeth. The splint should be designed to distribute the stresses through the mandible to the maxillae via the teeth, splint, and TMJ. REFERENCES 1. Shore, N. A.: Head pain of temporomandibular Headache 63 1, 1966. 2. Shore, N. A.: Mandibular autorepositioning J Am Dent Assoc 75:908, 1967.
joint origin. appliance.
INFORMATION
AND
HOPPENFELD
3.
Shore, pi. A.: Headaches traced to temporomandibuiar joints. J Am Med Assoc 209:1153, 1969. 4. Shore, N. A.: Temporomandibular Joint Dysfunction and Occlusal Equilibration, ed 2. Philadelphia, 1976, J. H. Lippincott Co., pp 130-134. 5. Hoppenfeld, S.: Physical Examination of the Spine and Extremities. New York, 1976, Appleton-Century Crofts. Rejnnt requeststo: DR.NATHAN ALLEN SHORE 210 CENTRAL PARK SOUTH xEWYORK,N.Y. 10019
FOR AUTHORS
Most of the provisions of the Copyright Act of 1976 became effective on January 1, 1978. Therefore, all manuscripts must be accompanied by the following written statement, signed by one author: “The undersigned author transfers all copyright ownership of the manuscript (title of article) to The C. V. Mosby Company in the event the work is published. The undersigned author warrants that the article is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors.” Authors will be consulted, when possible, regarding republication of their material.
542
MAY 1979
VOLUME
41
NUMBER
5