Oral appliances in the treatment of oromandibular dystonia: a systematic review.

Oromandibular dystonia (OMD) is a clinically and etiologically heterogeneous form of focal dystonia with variable social and functional implications. The results of pharmacological treatment and botulinum toxin infiltrations are often unsatisfactory. We performed a systematic review on the effects of oral and dental appliances in patients with OMD. Most of the reports in the literature are single subject descriptions or small case series with a considerable variability in the type of dystonia, the type of evaluated appliances and in the outcome measures. Only one report included a large group of unselected patients that were evaluated with a mixture of outcome measures. Although it appears that a number of OMD patients, especially those who benefit from sensory tricks, may sustain some improvement with the use of oral appliances, no definitive conclusions can be drawn about the type of patients that may benefit, nor about the preferred type or mode of appliance. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of OMD patients that are clinically and diagnostically well characterized.

Spasmodic torticollis: the dental connection.

Spasmodic torticollis or cervical dystonia (CD) is the most common form of focal dystonia and is characterized by sustained abnormal muscle contractions in the head and neck area resulting in abnormal positioning or posturing of the head. The dystonic muscle spasms associated with spasmodic torticollis may affect any combination of neck muscles. Three cases are reported of spasmodic torticollis that were treated by a dental appliance with individual varying occlusal heights to open the maxillomandibular vertical dimension. Upon increasing the vertical dimension of occlusion, there was a slowing and/or discontinuance of the symptoms of cervical dystonia. The proposed hypothesis for this reversal is that there may be neuritis of the auriculotemporal branch of the trigeminal nerve, which has direct input into the reticular formation (RF), and it may activate the cells of the pontine region of the RF known for the control and deviation of head posture. There is growing clinical evidence that temporomandibular joint (TMJ) dysfunction may be a factor in this neurological and painful disorder when it coexists.

An intraoral neurocranial vertical distractor appliance provides unique treatment for Tourette's syndrome and resolves comorbid neurobehavioral problems of obsessive compulsive disorder.

Evidence has existed for many years that individuals with Tourette's syndrome (T.S.) have associated neurobehavioral comorbid disorders. Though these disorders are not necessary to give a definitive diagnosis for Tourette's syndrome, many patients present with clinical signs of additional problems. Many believe that Tourette's is a neuropsychiatric disorder with symptoms originating from the brain or basal ganglia. Some of these coexisting conditions include attention deficit hyperactive disorder (ADHD), obsessive compulsive disorder (OCD), depression, sleep disorders, and enuresis. We hypothesize that an intraoral device can be utilized to eliminate these associated comorbid neurobehavioral signs and symptoms. Use of this device, called a neurocranial vertical distractor (NCVD), results in the elimination of unwanted neurobehavioral disorders via normally existing trigeminoreticular fibers and tracts (Fig. 1).

The relationship between posture and equilibrium and the auriculotemporal nerve in patients with disturbed gait and balance.

Balance is defined as a state of equilibrium or parity characterized by cancellation of all forces by equal opposing factors. This is the act of maintaining an upright posture (static balance) or in locomotion (dynamic balance or gait). This system depends on vestibular function, vision, and proprioception to maintain posture, to navigate in one's surroundings, to coordinate motion of body parts, to modulate fine motor control, and to initiate the vestibuloculomotor reflexes. These parts of the vestibular system provide our brains with information about changes in head movement with respect to the pull of gravity. Besides the visual, vestibular, and skeletal systems, which contribute to balance disorders, the dental (stomatognathic) system may also contribute to balance disorders. It is when all four of these systems are in coordination with one another, that a person will maintain equilibrium and balance, proper gait, and posture. The current article demonstrates, through normal anatomical and neurological processes, how the stomatognathic system influences these activities.

Tourette's syndrome: a pilot study for the discontinuance of a movement disorder.

For a century and a half, Tourette's syndrome (TS) has been a mystery to the medical profession with physicians believing that it was a psychological disorder, then a neurological brain disorder, and then, an infectious disease caused by streptococcus. What was never considered was that this disorder called Tourette's was due to a structural deformity which would manifest itself as a neurological problem. What has been discovered is that Tourette's syndrome is neither psychological, infectious, genetic or environmental in origin, but is what we have termed a structural-reflex disorder, and have shown through this pilot study of multiple cases how and why Tourette's and its multiple co-morbid disorders can be discontinued with a device that requires no medicines or surgery called the Neurocranio Vertical Distractor (NCVD).