Vertigo, Sense Of Balance and TMJ Disorder

By Maribel Vann, DDS

There is a strong association between the sense of balance, posture and bruxism (clenching and grinding). The sense of balance is the predominant factor. There are four components that are responsible for the sense of balance.

1. Semicircular Canals of the Ears. These are gravity sensitive balancing mechanisms.

2. Eyes on the Horizon. If the other two components of the balancing system are compromised, the individual may be heavily dependent on visual stimuli. Typically, these patients experience motion sickness as a passenger in a car.

In contrast, when they are driving, they are able to maintain a steady view of the horizon and eliminate the tendency to have motion sickness.

Another example is when going up on an escalator they do not experience dizziness, but do so on coming down on one. This pattern has to do with visual stimuli not coordinating with other balance mechanisms.

3. Sternocleidomastoid Muscles (muscles on the sides of the neck). These muscles are commonly overlooked as contributors to a sense of balance. These muscles inform the brain of the body's orientation in space.

When there is hypertonicity of these muscles, patients may report a brief loss of balance after turning the head quickly. This is particularly so if the patient has been standing for any length of time. In this event, there is increased fatigue of the sternocleidomastoid muscles.

A patient may also report difficulties with spatial relations such as walking into doors or bumping into walls. These symptoms are considered as balance related.

4. Occlusion (bite). If the maxilla (upper jaw) is elevated on one side, the patient will usually complain of dizziness, vertigo and/or motion sickness. See photograph A.

The loss of balance or equilibrium could accompany temporomandibular joint (TMJ) dysfunction. To a great extent, dental awareness of a loss of equilibrium and postural adaptation has been an incidental finding during TMJ diagnosis and treatment.

The links between balance, posture, oral structures and oral behavior have far wider implications than just possible findings associated with TMJ dysfunction. This is demonstrated in photograph B.

This patient was seen for a TMJ problem and low back pain. Placement of a Fox plane between the teeth brought about a spontaneous improvement in posture. What is happening here is of major significance.

The simple act of preventing this patient from biting her teeth together, such as in swallowing, allows the body's self correcting mechanism to come into play. Again, these are the semi-circular canals of the ears, the visual righting reflex, the feedback from the muscles and joints of the head and neck and the occlusion. These are able to bring about the spontaneous improvement in posture seen when the fox plane is in place.

This patient Photograph B (without the Fox plane) showed a forward head posture. Photograph C (with the fox plane) shows a straightening of the head posture. This patient was treated with the Advanced Lightwire Functional (ALF) appliances.