J Manipulative Physiol Ther. 1996 Nov-Dec; 19(9): 607-12.
Chiropractic/dental cotreatment of lumbosacral pain with temporomandibular joint involvement.
OBJECTIVE: To demonstrate the concept of integrated dental orthopedic and cranio-chiropractic care for treating structural disorders of the jaw, neck and spine. CLINICAL FEATURES: A 33-yr-old woman sought chiropractic care for centralized lumbosacral pain that had persisted for 3 months. She exhibited pain on lumbopelvic extension and marked limitations on lumbopelvic flexion. In addition, cervical rotation and cranial sutural motion in the right malar maxillary suture were restricted. The left temporal mandibular joint also was limited in translation. Based on initial chiropractic sacro-occipital technique, she was diagnosed with Category III lumbopelvic dysfunction. X-ray examination revealed a lumbosacral angle of 39 degrees, with sacral displacement posterior to the weight-bearing line. In conjunction with the beginning of chiropractic care, she was encouraged to seek dental-orthodontic evaluation. After 30 months of chiropractic treatment, she was still experiencing some lower back pain and limited improvement. She finally agreed to see the orthodontist. Orthodontic evaluation revealed a Class I malocclusion with significant loss of vertical dimension, characteristic of bilateral posterior bite collapse. INTERVENTION AND OUTCOME: Initial orthodontic treatment began in September 1991 and was followed by restorative dentistry to replace the missing teeth. This cotreatment approach, which integrated dental orthopedic and craniochiropractic care, ameliorated the pain and improved head, jaw, neck and back function. CONCLUSION: The position of the jaw, head and vertebral column, including the lumbar region, are intricately linked. Orthodontic treatment improved the position of the mandible, which in turn enabled the body to respond to chiropractic care.