Spasmodic Torticollis: The Dental Connection

Abstract

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.

Additional information

Notes on contributors

Anthony B. Sims

Dr. Anthony B. Sims Dr. Anthony B. Sims received his D.D.S. degree from Ohio State University in 1983. Currently, he has a general dental practice in Columbia, Maryland, where he also treats TMD and snoring/sleep apnea patients. His research interest is in understanding how dentistry interrelates with the many different types of movement disorders. He is a member of the American Academy of Craniofacial Pain, National Spasmodic Torticollis Assoc., Reflex Sympathetic Dystrophy Syndrome Assoc., and The International Association for Orthodontics. He has spoken in the United States and Europe on the perspective dentistry has on the possible abeyance of certain movement disorders. He has published the results of his treatment in peer-reviewed journals. To view the discontinuance of movement disorders associated with Tourette's syndrome and other disorders go to http://www.bodymovementdisorders.com.

Brendan C. Stack

Dr. Brendan C. Stack is an orthodontist who has limited his practice to orthodontics, craniofacial pain, and TMJ disorders for the past 42 years. Having graduated from Georgetown University, he is also the Tufts’ University 2003 recipient of the “Lifetime Achievement Award” for his years of contribution to the field of craniofacial pain. In the United States and Europe, he is frequently an invited lecturer on the topics of TMJ and craniofacial pain. He has published peer-reviewed literature on the longterm results of his treatment procedures. He has contributed chapters to TMJ textbooks and written numerous articles and manuals on the diagnosis and treatment planning of craniofacial pain patients and has also produced videotapes of his treatment technique to teach other doctors. Dr. Stack is a founding member and was the first president of the American Academy of Craniofacial Pain and is a diplomate of the American Board of Craniofacial Pain. He is a member of the International Headache Society, the American Pain Society, and the American Association of Orthodontics.

G. Gary Demerjian

Dr. G. Gary Demerjian received his D.D.S. degree from the University of the Pacific in 1990. He is a general dentist currently practicing in Glendora and Burbank California. His practice is primarily focused on the treatment of TMJ and craniofacial disorders. He currently holds a Diplomate with the American Board of Craniofacial Pain, the American Academy of Pain Management, and the American Board of Forensic Dentistry, and he is also a Fellow in the American Academy of Craniofacial Pain and the International College of Cranio-Mandibular Orthopedics. He has spoken in the United States on the subjects of TMJ, craniofacial pain, and systemic correlates. The results of his treatments have been published in peer-reviewed journals.