Temporomandibular Joint Dysfunction, Trigeminal Nerve Inflammation, and Biomechanical Dental Treatments for the Suppression of Neurological and Neuropsychiatric Symptoms

  • Anthony B. Sims
  • G. Gary Demerjian


The authors present clinical work that links dysfunction of the temporomandibular joint (TMJ) to a variety of neurological disorders. We demonstrate that mechanical realignment between the maxilla and the mandible with oral orthotics can be used to rapidly suppress certain debilitating neurological and neuropsychiatric symptoms, including the movement disorders characteristic of Tourette’s syndrome, cervical dystonia, blepharospasm, and Parkinson’s disease. Some of these disorders may be initiated by peripheral nerve injury of the mandibular nerve, particularly its auriculotemporal branch, located near the TMJ.


Cervical Dystonia (CD) Blepharospasm Tourette Temporomandibular Joint Disorders (TMJD) Chronic Obstructive Pulmonary Disease (COPD) 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





Temporomandibular joint disorders



Declaration of Conflict of Interest: Dr. Garabed G. Demerjian receives financial remuneration from patients for the construction and fitting of the oral orthotics.

Dr. Anthony B. Sims also receives financial remuneration from patients for the construction and fitting of the oral orthotics.


  1. 1.
    Dworkin SF, Huggins KH, LeResche L. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc. 1990;120:273–81.CrossRefGoogle Scholar
  2. 2.
    Isberg A. Temporomandibular joint dysfunction a Practitioner’s guide. Reprinter copy right. Anika Isberg; 2008.Google Scholar
  3. 3.
    MacDonald SM, Song G, Poon CS. Nonassociative learning promotes respiratory entrainment to mechanical ventilation. PLoS One. 2007;2:e865.CrossRefGoogle Scholar
  4. 4.
    Lundh H, Westesson PL. Clinical signs of temporomandibular joint internal derangement in adults. An epidemiologic study. Oral Surg Oral Med Oral Pathol. 1991;72:637–41.CrossRefGoogle Scholar
  5. 5.
    Demerjian GG, Sims AB, Stack BC. Proteomic signature of temporomandibular joint disorders (TMD): toward diagnostic predictive biomarkers. Bioinformation. 2011;5(7):282–4.CrossRefGoogle Scholar
  6. 6.
    Soland VL, Bhatia KP, Mardsen CD. Sex prevalence of focal dystonias. J Neurol Neurosurg Psychiatry. 1996;60:204–5.CrossRefGoogle Scholar
  7. 7.
    Brodal PR. The central nervous system: structure and function. 3rd ed. New York, NY: Oxford University Press; 2004.Google Scholar
  8. 8.
    Jahn K, Zwergal A. Imaging supraspinal locomotor control in balance disorders. Restor Neurol Neurosci. 2010;28:105–14.Google Scholar
  9. 9.
    Naumann M, Magyar-Lehmann S, Reiners K, Erbguth F, Leenders KL. Sensory tricks in cervical dystonia: perceptual dysbalance of parietal cortex modulates frontal motor programming. Ann Neurol. 2000;47:322–8.CrossRefGoogle Scholar
  10. 10.
    Nikolakis P, Nikolakis M, Piehslinger E, Ebenbickler G, Vachuda M, Kirtley C. Relationship between craniomandibular disorders and poor posture. J Craniomandib Pract. 2000;18:106–12.Google Scholar
  11. 11.
    Tamai Y, Iwamoto M, Tsujimoto T. Pathway of the blink reflex in the brainstem of the cat: interneurons between the trigeminal nuclei and the facial nucleus. Brain Res. 1986;380:19–25.CrossRefGoogle Scholar
  12. 12.
    Demerjian GG, Barkhordarian A, Chiappelli F. Testing patient target therapies in patients with temporomandibular joint disorders with the arthrokinetic reflex: individual patient research. J Transl Med. 2016;14(231):231.CrossRefGoogle Scholar
  13. 13.
    Tolosa E, Martí MJ. Blepharospasm-oromandibular dystonia syndrome (Meige’s syndrome): clinical aspects. Adv Neurol. 1988;49:73–84.PubMedGoogle Scholar
  14. 14.
    Takahashi M, Ni Z, Yamashita T, Liang N, Sugawara K, Yahagi S, Kasai T. Excitability changes in human hand motor area induced by voluntary teeth clenching are dependent on muscle properties. Exp Brain Res. 2006;171:272–7.CrossRefGoogle Scholar
  15. 15.
    Tomas X, et al. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics. 26(3):765–81. Published Online: May1 2006. Scholar
  16. 16.
    Rimpel J, Geyer D, Hopf HC. Changes in the blink responses to combined trigeminal, acoustic and visual repetitive stimulation, studied in the human subjects. Electroencephalogr Clin Neurophysiol. 1982;54:552.CrossRefGoogle Scholar
  17. 17.
    Raffaele R, Vecchio I, Alvano A, Proto G, Nicoletti G, Rampello L. Blink reflex abnormalities in Tourette syndrome. Clin Neurophysiol. 2004;115:320–4.CrossRefGoogle Scholar
  18. 18.
    Tecco S, Tetè S, D’Attilio M, Perillo L, Festa F. Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy. Eur J Orthod. 2008;30:592–7.CrossRefGoogle Scholar
  19. 19.
    Bolton S, O’Shaughnessy CT, Goadsby PJ. Properties of neurons in the trigeminal nucleus caudalis responding to noxious dural and facial stimulation. Brain Res. 2005;1046:122–9.CrossRefGoogle Scholar
  20. 20.
    Di Lazzaro V, Restuccia D, Nardone R, Tartaglione T, Quartarone A, Tonali P, Rothwell JC. Preliminary clinical observations on a new trigeminal reflex: the trigemino-cervical reflex. Neurology. 1996;46:479–85.CrossRefGoogle Scholar
  21. 21.
    Dostrovsky JO, Hu JW, Sessle BJ, Sumino R. Stimulation sites in periaqueductal gray, nucleus raphe magnus and adjacent regions effective in suppressing oral-facial reflexes. Brain Res. 1982;252:287–97.CrossRefGoogle Scholar
  22. 22.
    Durham P, Garret F. Emerging importance of neuron-satellite glia interactions within trigeminal ganglia in craniofacial pain. Open Pain J. 2010;3(1):3.CrossRefGoogle Scholar
  23. 23.
    Wyman RJ. Neurophysiology of the motor output pattern generator for breathing. Fed Proc. 1976;35:2013–23.PubMedGoogle Scholar
  24. 24.
    Frumker SC, Kyle MA. The dentist’s contribution to rehabilitation of cervical posture and function: orthopedic and neurological considerations in the treatment of craniomandibular disorders. Basal Facts. 1987;9:105–9.Google Scholar
  25. 25.
    Davidson AG, Buford JA. Bilateral actions of the reticulospinal tract on arm and shoulder muscles in the monkey: stimulus triggered averaging. Exp Brain Res. 2006;173:25–39.CrossRefGoogle Scholar
  26. 26.
    Sims A, Stack B. Tourette’s syndrome: a pilot study for the discontinuance of a movement disorder. Cranio. 2009;27:11–8.CrossRefGoogle Scholar
  27. 27.
    Solinas SMG, Maex R, De Schutter E. Dendritic amplification of inhibitory postsynaptic potentials in a model Purkinje cell. Eur J Neurosci. 2006;23:1207–8.CrossRefGoogle Scholar
  28. 28.
    Chan J, Brin MF, Fahn S. Idiopathic cervical dystonia: clinical characteristics. Mov Disord. 1991;6:119–26.CrossRefGoogle Scholar
  29. 29.
    Jankovic J, Leder S, Warner D, Schwartz K. Cervical dystonia: clinical findings and associated movement disorders. Neurology. 1991;41:1088–91.CrossRefGoogle Scholar
  30. 30.
    Ho BC, Lee EH, Singh K. Epidemiology, presentation and management of congenital muscular torticollis. Singap Med J. 1999;40:675–9.Google Scholar
  31. 31.
    Canale ST. Congenital muscular torticollis. In: Canale ST, Daugherty K, Jones L, editors. Campbell’s operative orthopaedics. 9th ed. St Louis, MO: Mosby-Year Book; 1998. p. 1064–7.Google Scholar
  32. 32.
    Samii A, Pal PK, Schulzer M, Mak E, Tsui JK. Post-traumatic cervical dystonia: a distinct entity? Can J Neurol Sci. 2000;27:55–9.CrossRefGoogle Scholar
  33. 33.
    Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop. 1994;14:802–8.CrossRefGoogle Scholar
  34. 34.
    Cheng JC, Tang SP, Chen TM, Wong MW, Wong EM. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants: a study of 1,086 cases. J Pediatr Surg. 2000;35:1091–6.CrossRefGoogle Scholar
  35. 35.
    Siegel JM, Tomaszewski KS. Behavioral organization of reticular formation: studies in the unrestrained cat. I. Cells related to axial, limb, eye, and other movements. J Neurophysiol. 1983;50:696–716.CrossRefGoogle Scholar
  36. 36.
    Jiang T, Yang Z, Zhang Z, Feng H. Electromyography activities of the head, neck and upper trunk muscles with mandibular movement in normal adults. Zhonghua Kou QiangYi Xue Za Zhi. 2002;37:431–4.Google Scholar
  37. 37.
    Ten Donkelaar HJ, De Boer-Van Huizen R. Ascending projections of the brain stem reticular formation in a nonmammalian vertebrate (the lizard Varanus exanthematicus), with notes on the afferent connections of the forebrain. J Comp Neurol. 1981;200:501–28.CrossRefGoogle Scholar
  38. 38.
    Marner L, Knudsen GM, Madsen K, Holm S, Baaré W, Hasselbalch SG. The reduction of baseline serotonin 2A receptors in mild cognitive impairment is stable at two years follow up. J Alzheimers Dis. 2011;23:453–9.CrossRefGoogle Scholar
  39. 39.
    Puente Maestu L, Garcia de Pedro J. Lung function tests in clinical decision-making. Arch Bronconeumol. 2012;48:161–9.CrossRefGoogle Scholar
  40. 40.
    Sims AB, Clark VP, Cooper MS. Suppression of movement disorders by jaw realignment. Pain Med. 2012;13:731–2.CrossRefGoogle Scholar
  41. 41.
    Holstege G, Cowie RJ. (1989) projections form the rostral mesencephalic reticular formation to the spinal cord. An HRP and autoradiographical tracing study in the cat. Exp Brain Res. 1989;75:265–79.CrossRefGoogle Scholar
  42. 42.
    Müller J, Wissel J, Masuhr F, Ebersbach G, Wenning GK, Poewe W. Clinical characteristics of the geste antagonist in cervical dystonia. J Neurol. 2001;248:478–82.CrossRefGoogle Scholar
  43. 43.
    Lebensohn JE. Photophobia: mechanism and implications. Am J Ophthalmol. 1951;34:1294–300.CrossRefGoogle Scholar
  44. 44.
    Thalakoti S, Patil VV, Damodaram S, Vause CV, Langford LE, Freeman SE, Durham PL. Neuron-glia signaling in trigeminal ganglion: implications for migraine pathology. Headache. 2007;47:1008–23.CrossRefGoogle Scholar
  45. 45.
    Prakash MV, Radhakrishnan M, Yogeshwari A, Nazir W, Maragatham K, Natarajan K. Inverse marcus gunn phenomenon. Indian J Ophthalmol. 2002;50:142–4.PubMedGoogle Scholar
  46. 46.
    Sano K. Trigemino-oculomotor synkinesis. Arch Neuro. 1959;1:29–57.Google Scholar
  47. 47.
    Jordan DR, Patrinely JR, Anderson RL, Thiese SM. Essential blepharospasm and related dystonias. Surv Ophthalmol. 1989;34:123–32.CrossRefGoogle Scholar
  48. 48.
    Torvik A. Afferent connections to the sensory trigeminal nuclei, the nucleus of the solitary tract and adjacent structures. An experimental study in the rat. J Comp Neurol. 1956;106:51–142.CrossRefGoogle Scholar
  49. 49.
    Amini A, Digre K, Couldwell WT. Photophobia in a blind patient: an alternate visual pathway. Case report. J Neurosurg. 2006;105:765–8.CrossRefGoogle Scholar
  50. 50.
    Eckhardt B, McClean JM, Goodell H. Experimental studies on headache: the genesis of pain from the eye. Proc Assoc Res Nerv Ment Dis. 1943;23:209–27.Google Scholar
  51. 51.
    Levy M, et al. Principles of physiology. 4th ed. Philadelphia, PA: Elsevier; 2005.Google Scholar
  52. 52.
    Cady RJ, Glenn JR, Smith KM, Durham PL. Calcitonin gene-related peptide promotes cellular changes in trigeminal neurons and glia implicated in peripheral and central sensitization. Mol Pain. 2011;7(94). 1744-8069-7-94CrossRefGoogle Scholar
  53. 53.
    Proctor LD, Knighton RS, Jasper HH. Efferent functions of the reticular formation. In: Ward A, editor. Reticular formation of the brain (Henry Ford Hospital International Symposium); 1958. p. 263–73.Google Scholar
  54. 54.
    Jacobs L, Gossman MD. Three primitive reflexes in normal adults. Neurology. 1980;30:184–8.CrossRefGoogle Scholar
  55. 55.
    Robin NH. Congenital muscular torticollis. Pediatr Rev. 1996;17:374–5.CrossRefGoogle Scholar
  56. 56.
    Pinto ML, Olyntho-Tokunaga HH, Souccar C, Schoorlemmer GH, Lapa Rde C. The interstitial system of the trigeminal spinal tract projects to the red nucleus in mice. Somatosens Mot Res. 2007;24:221–5.CrossRefGoogle Scholar
  57. 57.
    Grantyn A, Grantyn R. Reticular substrates for coordination of horizontal eye movements and their relationship to tectal efferent pathways. In: Grantyn A, Grantyn R, editors. The reticular formation revisited: specifying function for a nonspecific system. New York: Raven Press; 1980. p. 211–25.Google Scholar
  58. 58.
    Pryor JA. Physiotherapy for airway clearance in adults. Eur Respir J. 1999;14:1418–24.CrossRefGoogle Scholar
  59. 59.
    Bracco P, Deregibus A, Piscetta R. Effects of different jaw relations on postural stability in human subjects. Neurosci Lett. 2004;356:228–30.CrossRefGoogle Scholar
  60. 60.
    Darling DW, Draus S, Glasheen-Wray MB. Relationship of head posture and the rest position on the mandible. J Prosthet Dent. 1984;2:111–5.CrossRefGoogle Scholar
  61. 61.
    Moylan KC, Binder EF. Falls in older adults: risk assessment, management and prevention. Am J Med. 2000;120:493–6.Google Scholar
  62. 62.
    Ott MM, Nuding SC, Segers LS, Lindsey BG, Morris KF. Ventrolateral medullary functional connectivity and the respiratory and central chemoreceptor-evoked modulation of retrotrapezoid-parafacial neurons. J Neurophysiol. 2011;105:2960–75.CrossRefGoogle Scholar
  63. 63.
    Buisseret-Delmas C, Compoint C, Delfini C, Buisseret P. Organisation of reciprocal connections between trigeminal and vestibular nuclei in the rat. J Comp Neurol. 1999;409:153–68.CrossRefGoogle Scholar
  64. 64.
    Walker HK, Hall WD, Hurst JW. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990.Google Scholar
  65. 65.
    McGovern ST, Crompton JL, Ingham PN. Trigemino-abducens synkinesis: an unusual case of aberrant regeneration. Aust N Z J Ophthalmol. 1986;14:275–9.CrossRefGoogle Scholar
  66. 66.
    Andy OJ, Pavlov J. Chronic pain as a reticular formation syndrome. J Biol Sci. 1986;21:50–9.Google Scholar
  67. 67.
    Basbaum A. Pain control: a new role for the medullary reticular formation. In: Hobson J, editor. The reticular formation revisited. New York: Raven Press; 1980. p. 329–48.Google Scholar
  68. 68.
    Villa G. Temporomandibular joint inflammation activates glial and immune cells in both the trigeminal ganglia and in the spinal trigeminal nucleus. Mol Pain. 2010;6(89). 1744-8069-6-89 CrossRefGoogle Scholar
  69. 69.
    Milani RS, De Periere DD, Lapeyre L, Pourreyron L. Relationship between dental occlusion and posture. J Craniomandib Pract. 2000;18:127–34.Google Scholar
  70. 70.
    Lo SE, Gelb M, Frucht SJ. Geste agtagonistes in idiopathic lower cranial dystonia. Mov Disord. 2007;22(7):1012.CrossRefGoogle Scholar
  71. 71.
    St. John WM, Bledsoe TA. Genesis of rhythmic respiratory activity in pons independent of medulla. J Appl Physiol. 1985;59:684–90.CrossRefGoogle Scholar
  72. 72.
    Berger WE, Cline DC. Asthma COPD: definitions, epidemiology, and treatment guidelines. Postgrad Med. 2005;118:2–8.CrossRefGoogle Scholar
  73. 73.
    Pullicino PM, Jacobs L, McCall WD Jr, Garvey M, Ostrow PT, Miller LL. Spontaneous palpebromandibular synkinesia: a localizing clinical sign. Ann Neurol. 1994;35:222–8.CrossRefGoogle Scholar
  74. 74.
    Parks MM. Binocular vision. In: Tasman W, Jaeger EA, editors. Duane’s ophthalmology. 15th ed. Philadelphia, PA: Lippincott Williams & Wilkins., Chapter 5.; 2009.Google Scholar
  75. 75.
    Pagliardini S, Janczewski WA, Tan W, Dickson CT, Deisseroth K, Feldman JL. Acive expiration induced by excitation of ventral medulla in adult anesthetized rats. J Neurosci. 2011;31:2895–905.CrossRefGoogle Scholar
  76. 76.
    Hobson JA, Brazier M. The reticular formation revisited: specifying function for a nonspecific system. Int Brain Res Org Monogr Ser. 1980;6:265.Google Scholar
  77. 77.
    Mainero C, Zhang WT, Kumar A, Rosen BR, Sorensen AG. Mapping the spinal and supraspinal pathways of dynamic mechanical allodynia in the human trigeminal system using cardiac-gated fMRI. Neuroimaging. 2007;35:1201–10.CrossRefGoogle Scholar
  78. 78.
    St. John WM. Influence of reticular mechanisms upon hypoglossal, trigeminal and phrenic activities. Respir Physiol. 1986;66:27–40.CrossRefGoogle Scholar
  79. 79.
    Glebovskiĭ VD, Sukhova GK. Effect of trigeminal nerve block on respiration in vagotomized cats. Fiziol Zh SSSR Im I M Sechenova. 1983;69(9):1207–15.PubMedGoogle Scholar

Suggested Readings

  1. Video 6.1 Case 1 Tourette’s Syndrome. Tourette’s Syndrome: A Different Treatment. November 19, 2007.
  2. Video 6.4 Case 4 Blepharospasm. “Blepharospasm” Focal Dystonia. June 16, 2008
  3. Video 6.5 Case 5 Blepharospasm Part 1. Blepharospasm (Focal Dystonia Treatment) TMJ Connection Dr. Demerjian. June 28, 2012 9:13 p.m.
  4. Video 6.6 Case 5 Blepharospasm Part 2. Blepharspasm Focal Dystonia Treatment TMJ Connection (2). Aug 14, 2012 9:15 p.m.
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  6. Video 6.11 Case 8 Parkinson’s Disease Part 2. Parkinson’s Disease Treatment: Balance, Gait (Walk) and Tremors stayed Improved: Update Part 2. Jan 24, 2012 11:43 p.m.
  7. Video 6.12 Case 9 Parkinson’s Disease Part 1. Parkinson’s Disease Symptoms Improve with Non-Surgical TMJ Treatment: Part 1 Dr. Gary Demerjian. Apr 1, 2011 5:01 p.m.
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  9. Video 6.15 Case 10 Chronic Obstructive Pulmonary Disease Part 2. Chronic COPD and Migraines corrected using oral appliance. September 4, 2010.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anthony B. Sims
    • 1
  • G. Gary Demerjian
    • 2
  1. 1.Maryland Center for Craniofacial, TMJ and Dental Sleep DisordersColumbiaUSA
  2. 2.Center for TMJ & Sleep TherapyGlendoraUSA

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