Dental Occlusion as One Cause of Tinnitus

Jose Luiz Villaça Avoglio
Private practice of Orthodontics, Guaratingueta, Brazil
https://doi.org/10.1016/j.mehy.2019.109280

Abstract
There is large support in literature linking tinnitus to dental occlusion and temporomandibular joint disorders (TMD). However, there is no model to explain such a link. This hypothesis explains how the fusimotor system of the muscles innervated by the trigeminal motor nucleus is affected by inadequacies in the occlusion of the teeth that cause changes in posture and movement of the mandible. Reptile to mammal evolution shows that stomatognathic structures underwent changes related to mastication. Among several changes, there was the appearance of a new articulation between the mandible and skull: the temporomandibular joint. The bones of the old reptile joint, quadrate-articular, have detached from the mandible and are part of the middle ear bone chain. The former becomes the incus and the latter the malleus. This bone change also carried the tensor tympani and its trigeminal motor innervation. Inadequate occlusal contacts give rise to an adapted function of the mandible and the most common compensatory muscular response is hypertonia involving all mandibular muscles, including the tensor tympani. A fundamental clinical feature that demonstrates the involvement of the trigeminal fusimotor system is the characteristic pain by palpation, but no pain on the mandibular movement. Muscle pain is always felt in the dermatome innervated by the mandibular branch of the trigeminal nerve, which carries the motor fibers, reported as tightening, similar to cramp, and has regular behavior in intensity, duration and frequency. In addition, the patient has increased musculature volume, detected by palpation of certain anatomical landmarks, but with loss of functional efficiency. The neuromotor control of the mandibular movements is poor and when asked to make lateral jaw movement touching the teeth, it is common to observe that the patient moves the lips, eyes, and even turns the head in the same direction as the movement. There is also difficulty eating hard foods and talking fast. Tongue biting while chewing is frequent, meaning that these non-physiological events surpass protective reflex circuits. The report of ear pain, tinnitus, blocked ear sensation and sudden hearing loss is common in such patients, compatible with the tonic contraction of the tensor tympani. The fusimotor system hypothesis is able to explain all events related to the symptoms and helps to establish a correct diagnosis for certain types of hearing disorders.

 

I'll send this to my jaw surgeon.

Thank you @Frédéric.

 

What’s your jaw like @Melike?

I can’t open my mouth properly as I have limited opening, had this for 4 years, prior to that still TMJ with more opening but more pain. No pain now though, just tinnitus.

 

Hey, my jaw clicks all the time and sometimss get stuck, but there is no pain at all.

However my Tinnitus is completely changable by my jaw movements and I can stop some of my tones if I apply pressure around my TMJ area.

 

Amazing, I can’t do any of that despite years of jaw problems. I have such little movement I can’t even test the jaw. Where do you apply the pressure to test? At least you know yours is somatic... I’ve got about 5 possible causes!

 

I explored this in the beginning. My dental occlusion is pretty bad. I had braces as a child, but apparently some teeth I had pulled back then may be causing me problems now. It’s lead to jaw issues and enlarged musculature in the muscles on the right side of my jaw. My jaw continues to be painful and noisy. An oral surgeon who made me a splint had me see an orthodontist to see if we could move some stuff around. The teeth require too much repositioning to be safely done with braces. She says the only way to fix my occlusion is to have oral surgery that extends my lower jaw. That comes in at $50,000-60,000 dollars. She told me there aren’t any guarantees that it would help my tinnitus. I’m kinda stuck. I’d gladly pay and endure the surgery if I knew it would get rid of this tinnitus.

 

Before getting tinnitus I was seriously considering jaw surgery. I consulted with some well known surgeons. Now, I'm too busy and I'm also a little afraid of what double jaw surgery would do to my tinnitus. Even though you are knocked out for the procedure, cutting the bones in your skull can't be quiet.

 

All I can say is I worked with a guy that had jaw surgery and he got tinnitus.

 

I don’t think surgery would help. On another forum someone had work done to his jaw with no improvement.

My realignment was just shaving of teeth at the time but it was for an improved bite.
The maxillo facial person made a bite guard which was not that comfortable and she herself said can make the jaw better or not...

Would be interesting to know what the article suggests the remedy was, anyone understood?

 

I am still not sure about my cause because lots of jaw surgeons told me that my TMJD is minor and not even one jaw surgeon / TMJ specialist / dentist said that my TMJD might actually cause my tinnitus.

I apply pressure directly to where my joint is, right on the auraculotemporal nerve.

 

It’s still somatic though so Dr. Susan Shore’s treatment might help you...
Mine on the contrary does not appear to be somatic despite my jaw issues... go figure.
The mystery of this condition is enough to drive a thinking person mad.

 

As a result of the surgery? How bad was it? It's something I wanted to do in the past, but now I just don't care as much.

 

Interesting. I can move my jaw etc. and have no changes in tinnitus, but if I press on my zygomatic process my main tinnitus tone gets much worse as I apply pressure. It's like I'm poking at a pissed off nerve.

 

@Ken219 Do you know what kind of jaw surgery? I need to have TMJD surgery, but am afraid of it worsening my tinnitus.

 

Exactly my thoughts. Couldn't agree more. Sometimes the theories that I have to come up with and then the continuation of zero improvement state of this ailment with a never ending trial and error cycle makes me more tired than the noise itself.

 

As far as I know majority of the people with tinnitus can change their tone / volume with jaw movements to some extent, but I feel like mine is just hypersensitive to even the smallest change in my jaw position.