Facial and Postural Asymmetry, TMJ Problems and Back Pain

By Maribel Vann, DDS

Patient History

A female patient was seen for a routine dental examination. Upon examination, she reported a history of jaw pain and lower back pain. Further questioning illuminated a history of facial pain on the right side of the jaw, with inability to move the jaw from side to side. In addition to these symptoms, she also complained of ringing in the ears and headaches.

Dental examination revealed a deep overbite and minor crowding of the lower front teeth. Though seemingly straightforward from a dental perspective, the asymmetry and/or facial imbalance is an important part of the diagnosis.

The photograph below (Figure 1) shows the patient’s eye level is elevated up to the right, while the bite plane is elevated to the left.

The back view skull x-ray (Figure 2) also shows that the eye plane is up to the right, and the bite plane as well as the floor of the nose is up to the left.

Postural Assessment

An assessment of the patient’s posture (Figure 3) shows that the shoulders and the pelvis are not level. The left shoulder and shoulder blade are lower than the right, and the left pelvis is lower than the right.

The right shoulder is also rotated forward. The spine has a lateral curvature (scoliotic curve). This is usually considered a compensatory adaptation for the discrepancy between the level of the base of the skull and the pelvis.

Treatment

Treatment was accomplished with the Advanced Lightwire Functional (ALF) appliances (Figure 4) which was designed to treat and correct each component of the patients existing upper and lower jaw problems.

Once the bite plane was leveled and arch development was completed, then minor tooth rotations and spacing were corrected using braces for detailing the teeth alignment.