The Journal of Craniomandibular Practice | Jan 2004; 22(1): 1-3.
As interdisciplinary healthcare matures, understanding that patient care should ultimately be our focus, hopefully differences can be put aside in light of our common goal. Within the cranial manipulative field mutual research cooperation between chiropractors, osteopaths, and physical therapists will hopefully be imminent in the 21st Century. This is presently happening with the multi-divisions of dentistry as relating to the field of craniomandibular/temporomandibular dysfunction (TMD/CMD) and conditions affecting condylar positions, functional orthodontic care, and the relationship of occlusion to the stomatognathic system and posture. The best way for us all to proceed is with an open mind and heart and willingness to learn and work together.
The Journal of Craniomandibular Practice (Cranio) has been a guiding light for those of us in the field of TMD/CMD since its inception in the early 1980s. When Cranio was started there was a paucity of literature substantiating care of the TMJ and often times healthcare professionals would chalk up a patient’s profound symtomatology as solely emanating from a psychosomatic disorder.
In the early 1980s it was common to see the chiropractic and dental fields working separately with patients suffering with TMD/CMD. Often times our paradigms and mode of diagnosis were completely different. While it is not uncommon for chiropractors to treat patients presenting with TMJ disorders 1-13 often times that care can reach a “roadblock,” and the patient’s ability to improve can only be resolved with help from those in the dental field.
Dental – Chiropractic co-treatment models are being developed and what appears to be essential in these early stages is educating each other to a syntax that can be readily understood between both fields. Initially a large obstacle between the dental and chiropractic fields related the dynamics of the craniofacial sutural system. The chiropractic field, particularly those practicing Sacro Occipital Technique (SOT), worked under the premise that the cranial and facial bones were not completely fused in adulthood. 14-19 That concept was not readily accepted by those in the dental field since the whole paradigm of craniofacial orthopedics and orthodontics would have to be viewed in a completely new light. However in spite of this the dental field is beginning to open up to these possibilities, 20 which has also opened the door to greater co-treatment possibilities with the chiropractic profession.
As the issue of cranial and facial bone compliance and its affect on occlusion and TMJ functioning has gained greater acceptance in the dental and chiropractic fields what has become a common theme between our professions is the relationship between the stomatognathic system and posture. 21-24 While the pelvis and TMJ might seem to be distal and unrelated aspects of our patient’s presenting symptoms, research is suggesting otherwise. 25-27 “Before fitting dental splints or equilibrating the occlusion, the sacroiliac joints should be examined for proper function and any sprain should be reduced. Correspondingly, after occlusion-altering (or potential occlusion-altering) dental procedures, the sacroiliac joints should be examined for proper function to determine if they show ongoing functional stability.” 27 The rationale for greater relationships between chiropractors and dentists has been discussed in the literature, since in some cases the only possible chance of a patient having any resolution of their TMD/CMD was with co-treatment. 28-31
SOT chiropractors have found that patients can present with ascending problems, which are , lower extremity, lumbosacral or cervical spine dysfunction or at other times descending problems which are lumbosacral or cervical spine dysfunction secondary to craniomandibular or occlusion imbalance. Working together with a dentist familiar with CMD/TMD is sometimes the only way to help patients suffering from this complex condition. One way the professions can advance a working relationship is by developing methods of determining when a patient’s case is a dental or chiropractic primary. Presently there are no absolute gold standards, but evaluation of the TMJ in standing, sitting, and supine postures, for instance, can help determine if there are lower extremity, pelvic or other related conditions affecting the TMJ, independent of the occlusion. There are other tests and modalities being used by both dentists and chiropractors evaluating neuromuscular functionality of the body and its relationship to TMD and further need to be agreed upon and developed. 32
Sacro Occipital Technique Organization (SOTO) – USA is a multidisciplinary organization formed to promote the awareness, understanding and utilization of the Sacro Occipital Technique method of chiropractic as founded and developed by Major Bertrand DeJarnette, DC, DO. SOTO-USA has conferences and symposiums yearly and incorporate dental chiropractic co-treatment models, helping to integrate both professions. Since SOTO-USA’s inception we have taught dental chiropractic co-management of TMD type conditions. This year’s SOTO-USA Dental Chiropractic Clinical Symposium will take place in Nashville, Tennessee – May 19-22, 2011, click here for more information[The prior sentence, in italics, was added post publication of this article by the author].
Robert Walker, DC of “Chirodontics” has often stated that “The most complex case for a dentist is the easiest for a chiropractor to help and the most complex case for a chiropractor is the easiest for a dentist to help.” At the SOTO-USA dental chiropractic conferences the most common question is, “Where can I find a chiropractor or dentist that I can work with?” SOTO-USA plans in the near future to have a free directory on our website [http://www.soto-usa.org] for dentists, chiropractors and patients who want help with treatment or treating TMD/CMD. If you are interested in working with a chiropractor or dentist and would like to be a part of this directory, please contact SOTO-USA at (336) 793-6524 or firstname.lastname@example.org online. Aside from the possibility that our professions working together can be mutually advantageous, ultimately from this partnership it will be the patient that will achieve the greatest benefit.
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