Vertigo and Your TMJ Health
If you are suffering from vertigo there may be an underlying cause that isn’t so obvious. The health of your jaw joint (TMJ) and your bite (occlusion). When issues arise with either of these two things it can result in a temporomandibular joint disorder or dysfunction. TMD sufferers have been complaining to many members of the neuromuscular dentists community about issues with balance, nausea and vision that are commonly associated with benign positional vertigo (BPV) or Meniere’s disease. Research has shown that there may be a correlation between TMD and Vertigo which helps in resolving some cases by treating the patients’ misaligned bite and reducing tension in the connected jaw muscles.
Vertigo is a reasonably common complaint and affects even the most healthy people, as demonstrated by professional golfer Jason Day’s struggles with symptoms during his U.S. Open championship win of 2015. The dizziness symptoms were so severe that they caused him to fall to the ground during play and required him to sit down to regain his wherewithal several times.
Dizziness symptoms have many potential causes and there is still limited information available regarding how often TMD is the cause. This article will investigate case studies, current research and how a medical practitioner may diagnose whether or not a TMJ disorder may be the root cause of dizziness or vertigo.
What is Vertigo?
Vertigo is a kind of roundabout dizziness, a loss of body balance, observed in many diseases. The words origin is from 1520’s Latin, vertigo “a whirling round”, from vertere meaning “to turn”.
Characteristic features of vertigo
- Mental bewilderment
- Nausea and vomiting (in intense situations)
- Perception that objects are moving
- Feeling of being pulled toward the floor
- Symptoms that intensify with head movement, turning while lying down, etc.
Common causes of Vertigo
The cause of vertigo is often unknown. However, following diseases and disorders of the inner ear can cause the condition:
- Benign paroxysmal positional vertigo (BPPV; a mechanical inner-ear disorder),
- Meniere’s disease (a progressive ear disease)
- Vestibular neuritis (inflammation of the vestibulocochlear nerve)
- Labyrinthitis (another condition caused by inner ear infection)
Other causes of BPV
- Minor or severe head injury
- Prolonged bed rest
- TMJ dysfunction
Recent studies and research demonstrate a close connection between TMD and the ear and discuss the possibility of TMD being another important cause of vertigo. In the next section we explore the connection between Vertigo and the TMJ. To learn more about more causes of BPV refer to Vestibular.org
Is Vertigo Related to TMJ Health?
According to current research, there are three theories for the correlation between TMD and vertigo based on the anatomical and functional relation between TMJ and middle / inner ear.
We need to dive into the anatonmy of the ear and TMJ in order to best explain the relationship. First, the discomalleolar ligament (DML) and anterior malleolar ligament (AML) are ligaments found in the middle ear, the TMJ and in the jaw. All of them share a common origin when developing.
The discomalleolar ligament (DML) passes from the malleus, a small bone in the middle ear, to the retrodiscal tissue of the TMJ, and the anterior malleolar ligament (AML) connects the malleus with the lingula of the mandible. This means that the bones that are directly responsible for your hearing are highly involved in the anatomy of the temporomandibular joint.
A TMJ disorder may stretch the DML and AML out of their natural position. That can result in movement of the malleus, thereby affecting middle ear structure which is responsible for maintaining equilibrium.
Second, balance comes from the brain integrating information from the vestibular system (labyrinth) in the inner ears. This is housed in the petrous portion of the temporal bone. The glenoid fossa, which is the “socket” of the TMJ, is also part of the Temporal bone. TMD may move this temporal bone just enough to move the labyrinth housed inside to be moved out of position as well.
The third relationship that may cause vertigo from a dysfunctional TMJ is hyperactivity in the masticatory muscles. In TMD this can lead to contraction of the tensor tympani muscle and the tympanic membrane or muscular contraction of the soft palate. This can cause eustachian tube dysfunction, which leads to imbalance and other symptoms associated with vertigo.
How is Vertigo from TMD Diagnosed?
Considering the mysteries that still surround symptoms of TMJ disorder, vertigo and diagnosis and treatment of each issue, identifying TMD as the cause of vertigo is not always obvious to your health care provider. In fact many practitioners are not fully aware of the connection. It is best to see a trained TMJ specialist to get a proper diagnosis.
The causes and symptoms of Vertigo are carefully ascertained using clinical examination and medical history. After ruling out the more known causes of vertigo, the possibility of TMD causing Vertigo is evaluated following a discovery conversation with the patient which will include questions about presence of one or more other TMD symptoms like clicking or popping jaw joints, depression, facial pain, tmj migraines, jaw pain, limited jaw movement or lockjaw, neck and shoulder pain, numbness or tingling in the fingers, hands and arms, tinnitus, sleep apnea.
A physical examination will include a investigation of the TMJ using the hands to feel the position and movement of the joint itself. This is call a bilateral palpation. Next a similar investigation will be done on the masticatory muscles that are connected to the TMJ as well as the cervical muscles. Many times a TMJ specialist will evaluate the presence of joint noises and measure the distance of the jaw opening. This is the initial test that is conducted in order to isolate the possibility of dysfunction in the TMJ.
Next, diagnostic tools like radiography, CBCT, MRI, electromyography, ultrasonography are used to relate the presence of TMD as a possible cause for vertigo symptoms. Click here for more information on the process of diagnosing TMJ disorders.
How is Vertigo Treated when Related to TMJ Dysfunction?
In all cases involving TMJ disorders, reversible therapies should be the first treatment elected. This means appropriate handling of TMD would begin with non-invasive TMD therapies.
Regulating jaw usage and eliminating bad oral habits can help to maintain more relaxed muscles, avoiding a lack of blood movement to the TMJ or accumulation of intramuscular and articular substances. Conscious lifestyle changes including a TMJ diet that eliminate overuse of the muscles must be used by the sufferer. In all cases patients must be dedicated to their physical treatment and reducing harmful habits to see improvements.
Prevention or reduction of factors such as bruxism, jaw clenching and other things that may cause muscle inflammation have vital importance in any therapeutic treatment. It is necessary to stop these harmful habits and give the body the opportunity to repair itself and adapt to positive habits like good posture and a proper bite.
In cases where the neuromuscular dentist and his team are able to associate vertigo symptoms with a TMJ disorder, the following treatments may be recommended to help to correct TMD and relieve vertigo.
- TENS Therapy ( transcutaneous electric nerve stimulation): This is an electrical impulse unit that is used to relax the jaw muscles and to allow it to settle into its natural position. While many patients report alleviation of symptoms through use of TENS Therapy, the goal is to find the natural resting position in order to fit an mouth piece that can retrain the jaw muscles to rest in the correct position.
- TMJ Orthotics: Customized orthotic (a device resembling an athlete’s mouth guard.) is particularly effective for realigning the jaw. Many patients have reported near-immediate relief of vertigo symptoms they have had for years upon using an orthotic.
- Restorative Dentistry: In some cases a bad bite is caused by the way that the teeth come together. While an mouth pieces may temporarily fix this issue, the position of the teeth may result in a return to the bad bite. In these cases restorative dentistry may be required to ensure a proper bite and avoid a reoccurrence of the TMD symptoms.
The relationship between TMJ and vertigo symptoms are still being uncovered. While the symptoms are often associated with each other, a causal relationship is yet to be verified. That said, tests and diagnosis of TMJ disorders when vertigo is present may be beneficial in shortening the road to recovery and reducing other related symptoms. In cases when the cause of vertigo cannot be isolated and normal treatments are not effective, exploration of the potential cause being rooted in TMD may be a next step. In those cases it is important to see a dentist that has verifiable training in diagnosing TMJ dysfunction and the proper tools to assess the resting state of the jaw and provide accurate imaging of jaw function.
- Marchiori, Luciana Lozza de Moraes et al. “Probable Correlation between Temporomandibular Dysfunction and Vertigo in the Elderly.” International Archives of Otorhinolaryngology 18.1 (2014): 49–53. PMC. Web. 6 May 2016.
- RAMÍREZ, L. M.; BALLESTEROS, A. L. E. & SANDOVAL, O. G. P. A direct anatomical study of the morphology and functionality of disco-malleolar and anterior malleolar ligaments. Int. J. Morphol., 27(2):367-379, 2009.
- Cranio. 1995 Jan;13(1):42-3.The TMJ-ear connection.Morgan DH1, Goode RL, Christiansen RL, Tiner LW.
- TEMPOROMANDIBULAR DISORDERS: AURAL SYMPTOMS AND CRANIOFACIAL PAIN Ramirez LM, DDS., MSD., Sandoval GP, MD., MSD., Schames J, D.M.D., James P Boyd, DDS. Sarra Cushen, BS