Dr. Martin Rosen:

Hello, this is Dr. Martin Rosen and today we’ll be mapping TMJ on the 15-Minute Matrix.

Andrea Nakayama:

Welcome to the 15-Minute Matrix. I’m Andrea Nakayama functional medicine nutritionist and your host. This is the podcast that brings you bite-sized insights and lessons on the clinical relevance of the functional nutrition matrix, the most important tool in functional medicine and functional nutrition.

The matrix is so important not only because it invites us to stop and assess, but also because it reminds us of three very important factors in our care, recommendations and outcomes. Everything is connected. We are all unique and all things matter. Be sure to head over to this episode’s show notes at 15minutematrix.com if you’d like to see today’s topic mapped on a downloadable matrix to remind you of these critical aspects of care.

Today on the 15-Minute Matrix, I’ll be talking with Dr. Martin Rosen. Martin Rosen, DC is a 1981 summa cum laude graduate of Life Chiropractic College. He practices with his wife, Nancy Watson and daughter Erin Rosen in Wellesley, Massachusetts. For the past 38 years, Dr. Rosen has run a successful family-oriented wellness care practice. He is the president emeritus of SOTO-USA, chairman of their pediatric committee and the past president of the SORSI research committee. He has written, produced, and contributed his expertise to numerous magazine articles, research papers, educational videos, and technique manuals. His latest book, Second Edition of Pediatric Chiropractic Care, is in its third printing.

As a post-graduate instructor for several chiropractic colleges, as well as lead instructor for a variety of organizations, he has taught chiropractic technique, philosophy and practice management nationally and internationally since 1980. And you’re sure to hear why in today’s episode.

Dr. Rosen, welcome to the 15-Minute Matrix.

Dr. Martin Rosen:

Hi, it’s great to be here. I really appreciate you giving me a call and I’m excited to be talking to all these people and to you as well, Andrea.

Andrea Nakayama:

Yeah, me too. And I’m excited to talk to you about TMJ because it’s something we hear more and more about in our practices, no matter what modality we are practicing. Can you just kick us off, Dr. Rosen with an explanation of what TMJ is?

Dr. Martin Rosen:

I’m going to steal a little bit of an explanation from a friend of mine who worked at the Tufts Craniofacial Pain Clinic. He was the head of that clinic and he did a brilliant lecture on TMJ. And the bottom line function of it is the TMJ is a defensive mechanism for the cranium. It also is something that the body sets up a whole method of compensation patterns that usually end up in somaticizing our issues, our problems. And so the temporomandibular joint, once fired basically is a whole body mechanism.

Every part of the temporomandibular joint relates to the cranium, which of course, relates then to our parasympathetic and sympathetic nervous system. And there are Lovett Brother relationships between the cranium, the temporomandibular joint, and our pelvis. And what makes that so functionally disconnecting or so functionally disconcerting is that the base of our brainstem, the TMJ and that transverse spatial plane at the base of the skull, the tentorium, and also then in the upper cervical region and the thoracic region, all those transverse fascial planes going to the diaphragm, then the pelvic diaphragm, they maintain tension within the central nervous system.

So once the temporomandibular joint starts to dysfunction, then what happens is the occlusion changes, but it also changes our head posture. And then once our head posture changes, then we change where we put our self in space and then the pelvis has to respond. So two things happen with the temporomandibular joint, we have either ascending or descending patterns, and what I mean by that is an ascending pattern is the upper cervical spine, the temporomandibular joint, the cranium are the firing off point where the body starts to compensate. Can be from trauma, could be anything from bad dental work to head trauma, to someone who has a lot of tension. They relieve the tension in the sutural system is by grinding their teeth. And that functions or that focus is downward. It creates a downward spiral where the body starts to make compensatory changes in cervical spine, thoracic spine, and then eventually, the pelvis.

There’s also an ascending pattern, which is the exact opposite, where the pelvis under stress, biomechanical stress, physiological stress, ligament laxity, instability, nutritional deficiency, anything that affects the ligaments in the joints of the pelvis starts to cause the pelvis to become, in many cases, hypermobile first. And the hypermobility fires off the proprioceptive system. The body has to try and find itself in space by changing its weight-bearing. And when it does that, of course, the head, just like a chimney of the house, has to shift back and forth to compensate for that. And that is firing the process and that works its way up from the pelvis, lumbar spine, thoracic, cervical spine, eventually, into the cranium.

Andrea Nakayama:

There’s so much in what you just said, Dr. Rosen. I have words scribbled on my page because it sounds like it’s just a complete cascade, which is really the whole purpose of this podcast, that we can never look at anything in isolation. When we think about those triggers, you mentioned a lot, tension, trauma, physiological trauma, the stress as we know, is such a big deal. Are there other big triggers? Are there genetic triggers? Is there anything else we should be thinking about as a trigger for TMJ in this cascade of problems?

Dr. Martin Rosen:

So it’s funny you said that because you said something about genetics. And so I don’t know any particular genetic anomalies, but what we’re finding now is the tongue-tie epidemic. So what’s happening with that is a true tongue-tie, which would be like an anterior tongue-tie that actually affects the function of the tongue itself, affects several things. It affects the ability of the mandible to move forward and backward. It affects the way the palate grows because the tongue can’t run the palate equally.

So those kind of dysfunctions will start to set up a temporomandibular joint problem as well as a cranial problem because you’re not getting the proper growth, you’re not getting the proper development of the craniofacial structures.

So that’s the closest congenital anomaly that I could think of that gets translated all the way through life. And the way I say that is we’ve had patients recently who’ve come in who are older. I had a woman who was in her fifties, a younger man who was in their twenties, and both of them had been through basically years and years of TMJ work and TMJ balancing and all this stuff, and when we came to evaluate them, we found out that both of them had an anterior tongue-tie that nobody ever told them about.

And with an anterior tongue-tie, as I said, you can’t protrude your mandible and basically you can’t create a normal jaw motion. So that’s one of the things. The other thing is where you hold your stress. So there’s a kinematic chain, I guess is the best way to call it, between the temporal bones or the temporalis muscle, the masseter, the buccinator, the anterior scalenes, the SCM’s and the trapezius. So that is a kinematic chain.

So every time you clench, which is 2,500 to 3000 times a day, you open and close your mouth, it fires that chain off. And there’s so much happening with the temporomandibular joint and how it affects the temporal bone, which then affects the occipital bone, which then affects the jugular foramen, which then affects the spinal accessory nerve glossopharyngeal and the vagus nerve. So once you start to fire into the vagus nerve and the spinal accessory nerve, then you start to create autonomic imbalances in the sympathetic and parasympathetic system.

Andrea Nakayama:

Yeah, we’re going to have gut issues, we’re going to have immune issues, we’re going to have neurohormone issues. Right?

Dr. Martin Rosen:

Absolutely. And then the other piece is obviously dentition and that’s affected by nutrition or heavy loads of sugar. I mean, that creates tension in the musculoskeletal system. Actually, sugar basically works as acid to help eat away the joints. So think about it as an ascending pattern where you have someone who eats a lot of sugar, gets a lot of weakness in the joints, the ligament of the sacroiliac joint, the posterior ligaments of the sacroiliac joint tend to get hypermobile, and so that creates an ascending pattern because sugar will fire into that, adrenal glands. There are chains in chiropractic, neurological chains and musculoskeletal triangulation patterns, so from different vertebral levels that are fired off by different organ systems.

The big ones for TMJ that we find that really trigger it besides the gut biome, which we all know about now, is the pancreas and the adrenal glands, and then of course, you have the HPA axis that starts to fire off once the adrenals start to go, then you have the pituitary and the thyroid that have to make up for that. So that’s why true TMJ patients who have had long-term TMJ problems are often some of the most difficult to manage because if you just chase their symptoms, you’ll go insane.

Andrea Nakayama:

Yeah. So speaking of insane, I’m sitting here wondering how you know all that you just shared with me, with us, and you still hold your jaw? I mean, it’s something we don’t think about. What does it mean for you in how you are working with your own body and your own stresses and how you teach others to just be a different way and a more functional way with our jaw bones and muscles?

Dr. Martin Rosen:

So the first thing you have to do is, let’s start with other people because in my world, probably my two strengths for dealing with myself is going into denial and then getting angry.

Andrea Nakayama:

Which is great for all of that cycle.

Dr. Martin Rosen:

I think it’s, what is it? Do as I say, not as I do I think would be my motto.

Andrea Nakayama:

Yes, tell us what to do?

Dr. Martin Rosen:

So what to do is this, first of all, so depending on what type of healer you are, or, so if you’re manual, if something you do is manual, then the first thing to really determine is if it’s an ascending or descending pattern. And why that’s important is because if you’re on the wrong end of the seesaw, you’re not going to balance the system. It’ll constantly fire.

So let’s say for example, just for the basis of this particular talk that it’s a descending pattern coming from the cranium and the TMJ. The next thing that you really have to determine from the TMJ is what type of dysfunction is in the TMJ.

So there’s three ranges of motion in the TMJ that we evaluate. There’s the occlusion, when you bite it all the way down. Then there’s called the rotational phase as the jaw starts to open. And then the third phase is the translational phase, which when the jaw literally kind of dislocates slightly from the condyle and is literally hung out there by the ligaments, the posterior disc ligament, the stylohyoid ligament, the omohyoid. So that’s a ligamentous issue.

Why that’s important is because if it’s an occlusal problem, so let’s say you get a forty-year-old who’s been grinding and clenching their teeth for the last 20 years, stress, that’s how they deal with it. If you can’t get the occlusion balanced, then the functionality will never work because every time they close, it’s kind of like if someone has a bad knee or a limp or a short leg, every time they walk, they create a compensation.

Andrea Nakayama:

Right.

Dr. Martin Rosen:

So the temporomandibular joint is an occlusal problem. In my office, one of the things, the occlusion is driving it, then I will seek the help of a qualified dentist so that we could put some kind of occlusal appliance in to balance the bite first.

If it’s a functional issue, then I need to determine if it’s rotational or translational because in my world, I’m a craniopath and I work with cranial adjustments, depending on which of those are dysfunctional, that will depend on which part of the cranium I’m going to start my work on.

The third piece around that, and this is something I also learned from my friend, whose name was Dr. Mehta, who worked for the Oral Facial Pain Clinic, Tufts, is that the focus of the muscular attachments when the jaw is clenching and opening is around the second cervical vertebrae. So you have to make sure that the cervical spine is stabilized. Most TMJ patients who have a posterior mandible, which is what we call a Class II bite, will start to pull into the cervical spine and lose a normal cervical curve. And that will create tension all the way through the cervical musculature and the trapezius.

So if you’re dealing with a TMJ patient that has a forward head posture or a loss of the normal curve, the next thing you want to work at is starting to restore that curve because that reduces tension, not only in the muscular system, but in the dural meningeal system. When you stress the cervical curve, you could stress the dural meningeal tissue anywhere from five to seven centimeters, and that changes the tension of the nervous system. So you want to restore the cervical curve, determine which of the rotational, translational or occlusal factors it is, and if it’s a ascending or descending pattern, that’s if you’re dealing with the physical aspect of it.

If you’re dealing with the nutritional aspect of it, depending on how long the person’s had the TMJ, as you all know, you can have someone with a very depleted immune system. You can have someone who’s sympathetic dominant and have a TMJ problem. They can have sugar overloads, they get adrenal overloads. So that’s something that you have to evaluate, given your particular art form.

And again, my philosophy is what I call linchpin adjusting, a linchpin taking care of, I want to find the trigger that’s going to make the greatest difference instead of trying to treat every single aspect of it. So if you find the linchpin that’s going to shift the system, whether it be the nervous or immune system, that is the most effective way, because once you start to calm the system down, then what’s really going on or how deep you have to go, how somaticized the issue is, will expose itself.

Andrea Nakayama:

Yeah, so much gold in there, Dr. Rosen. I have two more questions for you. I mean, you talked about the curvature of the spine. In the trajectory of your career, are you seeing TMJ on the rise because of how we are sitting more working over devices? Is this on the increase?

Dr. Martin Rosen:

So I don’t know if I could say it’s on the increase, only because in my practice, I’ve been in practice 38 years now. So like all healthcare practitioners, or all people in life, I go through different phases and what I tend to attract into my practice. So there was a period of time where I was very much involved in TMJ. I worked with five different dentists, so I saw tons of TMJ because that’s what I was attracting to my practice. Now I’m spending a lot of time working with kids.

Andrea Nakayama:

I was going to ask you, that was my next question, kids and TMJ?

Dr. Martin Rosen:

So what we’re finding more than the TMJ, with the tongue-tie, definitely finding TMJ issues. And I’ve been working with a couple of dentists who understand the value of either making sure that the tongue-tie needs to be revised if it does, and then the value of proper cranial and chiropractic care, whether you revise it or not. But we are finding obviously many, many more kids who are getting cervicogenic issues because they’re losing the cervical curve earlier, even as early as four years old because of their looking down all the time on phones or even desktop computers if they don’t have the screen up. So they’re spending so much more of their life down.

So in a lot of them, it hasn’t gone into a TMJ problem yet, but I would bet if I track it, to track those kids, if they don’t get proper care, you’ll absolutely see more of that at this point in time. But definitely changes in the cervical spine, a lot more cervical cranial issues we see over these years. Definitely. I can’t say I see more TMJ in my practice only because I’ve changed my focus and my direction, and I’m not looking to attract as many of those people. But the numbers are there, and I always wonder what the whole tongue-tie thing is. I’ve been, like I said, practiced for a long time and all of a sudden, every third kid is born with a tongue-tie.

Andrea Nakayama:

Yeah, that’s a topic I’m thinking as I’m talking to you for another podcast. We could map tongue-ties, figure out that genetic underpinning and why that’s coming to the fore more.

Also, when I’m talking to you, Dr. Rosen, I’m thinking about how you have clearly a specialty, but also a lot of us don’t do hands-on work, and we have to partner and we have to find people who do the work.

Dr. Martin Rosen:

Absolutely.

Andrea Nakayama:

Just like you’re talking about partnering with a dentist and you’re recognizing the nutritional aspects of managing TMJ. And then also what other issues might be going on in the body that you’re seeing occurring with the TMJ. So this is really speaking to the fact that there’s likely not going to be one provider giving all the answers. We each find our own linchpin. Is that right?

Dr. Martin Rosen:

So a perfect example is that I just had a new patient come in who’s a TMJ patient, referred to me by another chiropractor. And the gentleman had been, I guess the best way around the block. He was seeing chiropractors, osteopaths, acupuncturists, nutritionists. He was doing so much work that his body was not able to take in that much input, so he was overloaded. Matter of fact, he came in and he goes, he said, “Dr. Rosen,” he goes, “I just stopped doing everything and stopped focusing. I’m just seeing now and I already start to feel better.” So you have to be careful about overworking a nervous system that’s sensitive.

I think stress reduction, whether it be through therapy or anything like EMDR, any particular therapy, because a lot of the TMJ problem, especially if someone’s a night grinder, is because of tension. And what’s happening is they’re so tense during the day that the sutures in their cranium are literally starting to fuse up, they’re somaticizing so much tension, and at night when they go to sleep, they literally are grinding their teeth using the temporomandibular joint to try and free up their sutures.

So if you can get the crux to what that stress pattern is, why they’re holding themselves so tight, why they’re focusing all their energy and stress into that area, that helps significantly in reducing the overload on the system. Most TMJ patients, in my experience, are sympathetic dominant type patterns. So people dealing with sympathetic dominant patterns, whether it be through nutrition, stress management, yoga, exercise.

But again, the only thing I caution people, and I do talk to my patients about it, is not to overload the system. So I- Andrea Nakayama:

Yep. Couldn’t agree more.

Dr. Martin Rosen:

Refer to practitioners, but at different points. So I’ll say to somebody, and my friend in Tufts used to do the same thing. He’d say, “Look, right now, you have a primary functional structural issue, so I want you to see Dr. Rosen for six weeks and then come back here and then I will make an appliance for you because I know that the care is going to give you, is going to change your bite plane and change a bunch of mechanics.” So often I will do that, I say, look, ‘Give me four to six weeks to start to make changes. Then when I get to the point where I think I’ve gotten some stability in my world, then let’s take on the next thing.”

Andrea Nakayama:

Yeah, I couldn’t agree more, Dr. Rosen. I mean, this is some of the issues with how functional medicine, functional nutrition are practiced these days, doing too many tests at once, giving people too much to do at once. And if we do the core work, other things will shift. We won’t need to do all those interventions.

We really need to recognize where we need to sequence and what we need to sequence for somebody to get into their healing potential, and that’s the primary concern. Thank you so much. That was so much wisdom you shared with us today, and I’m so grateful to have the conversation with you.

Dr. Martin Rosen:

Oh, thank you. It was fun. I enjoyed it.

Andrea Nakayama:

The 15-Minute Matrix is brought to you by me, Andrea Nakayama, and the Functional Nutrition Alliance. Check out the latest in functional nutrition at functionalnutritionlab.com/blog. The 15-Minute Matrix is produced mixed and edited by Rowan Bradley, with production support from Natalie Merrill, and the team at the Functional Nutrition Alliance.

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