Difference between revisions of "Occlusion and Posture"

Posture is understood as the position of the human body and its orientation in space which requires the analysis and integration of stimuli from three systems: vision, vestibular and proprioception.<ref>Guez G. The Posture. In: Kandel E., Schwartz J., editors. Principles of Neural Science. Elsevier; Amsterdam, The Netherlands: 1991. pp. 612–623.</ref><ref>Czaprowski D., Stoliński L., Tyrakowski M., Kozinoga M., Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018;13:6. doi: 10.1186/s13013-018-0151-5.</ref> Over the years, numerous observations have been made on the factors influencing postural stability. <ref>Iwanenko J., Gurfinkel V. Human postural control. Front. Neurosci. 2018;12:17. </ref><ref>Guerraz M., Bronstein A.M. Ocular versus extraocular control of posture and equilibrium. Neurophysiol. Clin. 2008;38:391–398. doi: 10.1016/j.neucli.2008.09.007.</ref><ref>Hamaoui A., Frianta Y., Le Bozec S. Does increased muscular tension along the torso impair postural equilibrium in a standing posture? Gait Posture. 2011;34:457–461. doi: 10.1016/j.gaitpost.2011.06.017.</ref><ref>Kolar P., Sulc J., Kyncl M., Sanda J., Neuwirth J., Bokarius A.V., Kriz J., Kobesova A. Stabilizing function of the diaphragm: Dynamic MRI and synchronized spirometric assessment. J. Appl. Physiol. 2010;109:1064–1071. doi: 10.1152/japplphysiol.01216.2009.</ref><ref>Szczygieł E., Fudacz N., Golec J., Golec E. The impact of the position of the head on the functioning of the human body: A systematic review. Int. J. Occup. Med. Environ. Health. 2020;33:559–568. doi: 10.13075/ijomeh.1896.01585.</ref> The role of the craniomandibular system is now being increasingly analyzed in relation to it. <ref>Tardieu C., Dumitrescu M., Giraudeau A., Blanc J.L., Cheynet F., Borel L. Dental occlusion and postural control in adults. Neurosci. Lett. 2009;450:221–224. doi: 10.1016/j.neulet.2008.12.005.</ref><ref>Munhoz W.C., Hsing W.T. Interrelations between orthostatic postural deviations and subjects’ age, sex, malocclusion, and specific signs and symptoms of functional pathologies of the temporomandibular system: A preliminary correlation and regression study. Cranio. 2014;32:175–186. doi: 10.1179/0886963414Z.00000000031.</ref><ref>Pérez-Belloso A.J., Coheña-Jiménez M., Cabrera-Domínguez M.E., Galan-González A.F., Domínguez-Reyes A., Pabón-Carrasco M. Influence of dental malocclusion on body posture and foot posture in children: A cross-sectional study. Healthcare. 2020;8:485. doi: 10.3390/healthcare8040485.</ref><ref>Amaricai E., Onofrei R.R., Suciu O., Marcauteanu C., Stoica E.T., Negruțiu M.L., David V.L., Sinescu C. Do different dental conditions influence the static plantar pressure and stabilometry in young adults? PLoS ONE. 2020;15:e0228816. doi: 10.1371/journal.pone.0228816.</ref> Many theories attempt to explain the association between the masticatory organ and posture, including myofascial chains, trigeminal nerve activation or deactivation, and subsequent interaction in the brainstem.<ref name=":0">Cabrera-Domínguez M.E., Domínguez-Reyes A., Pabón-Carrasco M., Pérez-Belloso A.J., Coheña-Jiménez M., Galán-González A.F. Dental malocclusion and its relation to the podal system. Front. Pediatr. 2021;9:654229. doi: 10.3389/fped.2021.654229.</ref><ref>Myers T.  Anatomy Trains: Myofasziale Leitbahnen (für Manual- und Bewegungstherapeuten) Elsevier Health Sciences; Berlin, Germany: 2015.</ref><ref>Pinganaud G., Bourcier F., Buisseret-Delmas C., Buisseret P. Primary trigeminal afferents to the vestibular nuclei in the rat: Existence of a collateral projection to the vestibulo-cerebellum. Neurosci. Lett. 1999;264:133–136. doi: 10.1016/S0304-3940(99)00179-2. [PubMed] [CrossRef] [Google Scholar] [Ref list]</ref> However, this is a controversial topic in the scientific community. There is both evidence to support that relationship<ref name=":1">Bracco P., Deregibus A., Piscetta R. Effects of different jaw relations on postural stability in human subjects. Neurosci. Lett. 2004;356:228–230. doi: 10.1016/j.neulet.2003.11.055.</ref><ref name=":2">Manfredini D., Castroflorio T., Perinetti G., Guarda-Nardini L. Dental occlusion, body posture and temporomandibular disorders: Where we are now and where we are heading for. J. Oral Rehabil. 2012;39:463–471. doi: 10.1111/j.1365-2842.2012.02291.x. </ref><ref name=":3">Sakaguchi K., Mehta N.R., Abdallah E.F., Forgione A.G., Hirayama H., Kawasaki T., Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007;25:237–249. doi: 10.1179/crn.2007.037. </ref><ref name=":4">Cuccia A., Caradonna C. The relationship between the stomatognathic system and body posture. Clinics. 2009;64:61–63. doi: 10.1590/S1807-59322009000100011.</ref><ref name=":5">Marchena-Rodríguez A., Moreno-Morales N., Ramírez-Parga E., Labajo-Manzanares M.T., Luque-Suárez A., Gijon-Nogueron G. Relationship between foot posture and dental malocclusions in children aged 6 to 9 years. A cross-sectional study. Medicine. 2018;97:e0701. doi: 10.1097/MD.0000000000010701</ref><ref name=":6">Iacob S.M., Chisnoiu A.M., Buduru S.D., Berar A., Fluerasu M.I., Iacob I., Objelean A., Studnicska W., Viman L.M. Plantar pressure variations induced by experimental malocclusion—A pilot case series study. Healthcare. 2021;9:599. doi: 10.3390/healthcare9050599.</ref> and to refute it.<ref name=":7">Michelotti A., Buonocore G., Farella M., Pellegrino G., Piergentili C., Altobelli S., Martina R. Postural stability and unilateral posterior crossbite: Is there a relationship? Neurosci. Lett. 2006;392:140–144. doi: 10.1016/j.neulet.2005.09.008.</ref><ref name=":8">Perinetti G., Contardo L., Silvestrini-Biavati A., Perdoni L., Castaldo A. Dental malocclusion and body posture in young subjects: A multiple regression study. Clinics. 2010;65:689–695. doi: 10.1590/S1807-59322010000700007.</ref><ref name=":9">Scharnweber B., Adjami F., Schuster G., Kopp S., Natrup J., Erbe C., Ohlendorf D. Influence of dental occlusion on postural control and plantar pressure distribution. Cranio. 2017;35:358–366. doi: 10.1080/08869634.2016.1244971.</ref><ref name=":10">Isaia B., Ravarotto M., Finotti P., Nogara M., Piran G., Gamberini J., Biz C., Masiero S., Frizziero A. Analysis of dental malocclusion and neuromotor control in young healthy subjects through new evaluation tools. J. Funct. Morphol. Kinesiol. 2019;4:5. doi: 10.3390/jfmk4010005.</ref>  

The authors of the scientific reports, who recognize the associations between the systems in question, give two indications for the possible interactions. The first, i.e. ascending disturbances, refers to the situation in which bad posture and disturbances of the peripheral structures (e.g. lower limbs), through myofascial neuromotor activities and the dura mater, functionally condition the cranio-mandibular structures. Conversely, a chain of descending disorders is present when anomalies of the craniomandibular region affect posture and body areas located more distally, including the pelvis and lower extremities.<ref name=":0" /><ref name=":11">Michalakis K.X., Kamalakidis S.N., Pissiotis A.L., Hirayama H. The Effect of clenching and occlusal instability on body weight distribution, assessed by a postural platform. BioMed Res. Int. 2019;2019:7342541. doi: 10.1155/2019/7342541.</ref><ref name=":12">Julià-Sánchez S., Álvarez-Herms J., Cirer-Sastre R., Corbi F., Burtscher M. The influence of dental occlusion on dynamic balance and muscular tone. Front. Physiol. 2020;10:1626. doi: 10.3389/fphys.2019.01626.</ref><ref>Pacella E., Dari M., Giovannoni D., Mezio M., Caterini L., Costantini A. The relationship between occlusion and posture: A systematic review. Orthodontics. 2017;8:WMC005374.</ref><blockquote>[[File:Question 2.jpg|left|50x50px]]And on this nothing to say because no one can deny an anatomical-functional correlation between vestibular systems, cerebellum, trigeminal and peripheral neuromotor system. This is not an opinion but a proven scientific observation already reported somewhere in Masticationpedia.

VEMPs, translated into Myogenic Vestibular Evoked Potentials are proof of this. Acoustic stimuli can evoke EMG reflex responses in the masseter muscle called Vestibular Evoked Myogenic Potentials (VEMPs). Although these findings have previously been attributed to activation of cochlear (high-intensity sound) receptors, these may also activate vestibular receptors. Because anatomical and physiological studies in both animals and humans have demonstrated that the masseter muscles are a target for vestibular inputs, the authors of this study reevaluated the vestibular contribution for masseter reflexes. This is a typical example of a basic level 'Complex System' as it consists of only two cranial nervous systems but, at the same time, they interact by activating monosynaptic and polysynaptic circuits (Figure 1).</blockquote>

It has been shown that changes in the temporomandibular joint (TMJ) can have a direct impact on muscle activity in terms of posture, stability and physical performance.<ref name=":2" /><ref>Moon H.J., Lee Y.K. The relationship between dental occlusion/temporomandibular joint status and general body health: Part 1. Dental occlusion and TMJ status exert an influence on general body health. J. Altern. Complement. Med. 2011;17:[tel:995–1000 995–1000]. doi: 10.1089/acm.2010.0739.</ref><ref>Souza J.A., Pasinato F., Correa E.A., da Silva A.M. Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: A preliminary study. J. Manip. Physiol. Ther. 2014;37:407–414.</ref>  However, there is a lack of high-quality studies using advanced measurement tools to better understand the phenomenon under investigation.<ref>Ferrillo M., Marotta N., Giudice A., Calafiore D., Curci C., Fortunato L., Ammendolia A., de Sire A. Effects of occlusal splints on spinal posture in patients with temporomandibular disorders: A systematic review. Healthcare. 2022;10:739. doi: 10.3390/healthcare10040739.</ref> The study authors evaluated the impact of masticatory abnormalities on postural control and focuses on evaluating individuals with specific malocclusions that determine the anteroposterior position of the mandible. According to some researchers, malocclusion, like TMD, can affect the osteoarticular system of the whole body and become a source of persistent pain and favor the development and  to become chronic of some postural defects. According to the cited authors, occlusal disturbances can lead to an altered stimulation of the periodontal proprioceptors, causing changes in the tension of the neck muscles and postural muscles and changes in the position of the head, followed by compensatory changes in the anatomical regions in their immediate vicinity. Over time, this can affect the posture, center of gravity position, or foot contact with the ground.<ref name=":0" /><ref name=":11" /><ref name=":12" /><ref>Saccucci M., Tettamanti L., Mummolo S., Polimeni A., Festa F., Tecco S. Scoliosis and dental occlusion: A review of the literature. Scoliosis. 2011;6:1–15. doi: 10.1186/1748-7161-6-15. </ref><ref>Sforza C., Tartaglia G.M., Solimene U., Morgan V., Kaspranskiy R.R., Ferrario V.F. Occlusion, sternocleidomastoid muscle activity, and body sway: A pilot study in male astronauts. Cranio. 2006;24:43–49. doi: 10.1179/crn.2006.008</ref>

Angle suggested a classification of occlusion and malocclusion based on the anteroposterior position of the first molar and the position of the canines.<ref>Bernabé E., Sheiham A., de Oliveira C.M. Condition-specific impacts on quality of life attributed to malocclusion by adolescents with normal occlusion and Class I, II and III malocclusion. Angle Orthod. 2008;78:977–982. doi: 10.2319/091707-444.1</ref><ref name=":13">Okeson J.P.  Management of Temporomandibular Disorders and Occlusion.Mosby; Maryland Heights, MO, USA: 2019.</ref>Malocclusion is often a congenital condition, resulting from hereditary or environmental factors. It is also caused by local factors, such as an abnormal pattern of breathing or postural defects, as well as oral parafunctions such as nail biting or teeth grinding (bruxism).<ref name=":13" />According to Lombardo's analyses, occlusal anomalies occur on average in 56% of the general population.<ref name=":14">Lombardo G., Vena F., Negr P., Pagano S., Barilotti C., Paglia L., Colombo S., Orso M., Cianetti S. Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis. Eur. J. Paediatr. Dent. 2020;21:115–122.</ref> Their prevalence increases with age. Given their increasing prevalence in later age groups and the consequences they entail, it is reasonable to expect a large number of adult patients who will require complex and expensive multidisciplinary treatment.<ref name=":14" /><ref>Kawala B., Szumielewicz M., Kozanecka A. Are orthodontists still needed? Epidemiology of malocclusion among polish children and teenagers in last 15 years. Dent. Med. Probl. 2009;46:273–278</ref>

As far as the authors contesting the correlation between occlusion and posture are concerned, we can report the results of Giuseppe Perinetti et al.<ref name=":8" /> of 122 subjects, including 86 males and 36 females (age range 10.8 to 16.3 years) who tested negative for temporomandibular disorders or other conditions affecting the stomatognathic systems, with the exception of malocclusion. An assessment of dental occlusion included dentition stage, molar class, overjet, overbite, anterior and posterior crossbite, scissor bite, mandibular crowding, and dental midline deviation. Furthermore, body posture was recorded through static posturography using a vertical force platform. Recordings were performed under two conditions:  

#dental intercuspid position (ICP).