Oral Orthotics in Treating Tic Disorders

Studies continue in an effort to treat tic disorders, or Tourettes, without the use of drugs. It is thought that compression caused by TMD contributes to tics often seen in patients with Tourettes. There may not be pain associated with the TMJ, which may cause this possible issue to be overlooked.sunrise

My sister recently became interim chair for the Tourettes Association and asked me what I knew about reports that a “splint” can be effective treatment for some Tourettes sufferers.

A study published in 2009 in Cranio® outlined the author’s case reports and proposed mechanisms showing how a specific orthotic reduced the symptomatic tics in a few patients and set forth a sound neurologic mechanism for why it appeared to have helped.

I attended the meeting where the authors presented their case reports, and have kept the article over the years. Tourettes Syndrome: A Pilot Study for Discontinuance of a Movement Disorder: Sims,A , Stack,B. ; Journal of Craniomandibular & Sleep Practice, Jan 2009, 27, number 1

Tourettes has no known cause and is believed to be inherited. There are some articles linking onset in children to severe strep infections but it cannot be proven definitively. The only treatments to date are a variety of central nervous system drugs that depress brain function in an attempt to lessen tics. These tics usually begin in childhood as coughs, sniffles, shoulder shrugs, neck twitches, lip mouth or tongue tics and sometimes vocalizations. The tics subside in adolescence and can re-occur in adulthood with chronic stress, sleep disturbances (possibly due to apnea), hormonal changes, or lack of sleep due to work/life.

The theory of the orthotic efficacy is based on the interconnectedness of all cranial nerves in the brainstem, some more than others. Areas of nerve convergence are like “coffee shops” within the CNS. All the nerves stop there to pick up “gossip” from other nerves to take to the brain or, provide “gossip” to other nerves heading to the brain.

The trigeminal nerve ­– the largest and the one associated with the TMJ – the mouth, and the majority of the head obviously carries a lot of “cross talk” in the “coffee shop” of the brainstem. Consider the TMJ nerve (trigeminal) one of the bigger “gossips” in certain parts of the brainstem. The trigeminal system also manifests most of the symptoms of Tourettes- primarily oral, tongue, lips, facial, jaw, neck and shoulder twitches, etc. The authors suggest that in some patients with underlying TMJ syndrome and perhaps a genetic tendency or a bad childhood strep infection, the “spillover” of neurologic excitement crossed to those nerves that control the jaw, mouth and neck; thereby contributing to the “tics”.

Eliminating or calming the input from the TMJ can lower the activity to all the other nerves, thereby lessening or stopping the tics of Tourettes. The TMJ doesn’t have to be painful to the patient for it to be involved- the TMJ joint just has to be compressed.

If you know of someone suffering from Tourettes and interested in evaluating this alternative therapy, they should consider evaluation by a well-experienced TMJ dentist; not someone who equilibrates tooth necessarily, as that worsens TMJ compression.

My practice is 100% focused on Orofacial Pain (TMJ) and Oral appliances for Sleep Apnea. I can evaluate whether the TMJ is compressed and discuss the possibility of using an orthotic to suppress Tourettes symptoms. Contact our office to schedule an evaluation or share this post with someone you think may benefit.




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