THE PSYCHOSOMATICS OF NOCTURNAL ORAL TRAUMA

TABLE 1

ORAL SIGNS AND SYMPTOMS OF MUSCULO SKELETAL FATIGUE
AND TRAUMA AS HYPOTHESIZED BY THE THEGOTIC MODEL
Physiological events leading to symptoms of fatigue:

1. Prolonged clenching: masticatory muscle fatigue, tempromandibular joint symptoms from meniscus compression and tension headache.

2. A spate of thegotic activity without thegotic trauma but where the activity is beyond the fitness level of the system. Symptoms of masticatory muscle fatigue and/or joint tenderness and tension headache.

Thegotic trauma:
3. Trauma to and from teeth when the mandible moves in a thegotic excursion from centric occlusion laterally (and diametrically opposite to the masticatory stroke) to the canine edge-to-edge position.

4. Trauma that occurs to and from teeth during the thegotic stroke from the canine edge-to-edge position, further laterally, to the limit of the thegotic excursion.

5. Trauma to other anatomical structures towards and at the limit of the thegotic stroke:

– trauma to the ascending ramus of the mandible from the most disto-buccal cusp of a maxillary molar

– trauma to the interposed tissues between the coronoid process and the zygomatic process of the maxilla

– trauma to the interposed tissue between the styloid process and the body of the mandible

– trauma to the temporomandibular joint and surrounding structures when the mandible slips beyond the thegotic stroke limit

– for other hypothesized trauma to other structures see Every (3).

Psychological factors:
6. The traumatic psychological event that provokes a clenching or thegotic response are often central to the cranio-mandibular symptoms, both fatigue and thegotic injury. These can be conscious and accessible to counseling, or unconscious and may be accessible to other psychological therapies.

TABLE 2
HOW THEGOTICS INTEGRATES CONTEMPORARY MODELS FOR THE ETIOLOGY OF CRANIO-MANDIBULAR DISORDERS
FUNCTIONAL MODEL PSYCHOLOGICAL MODEL THE THEGOTIC MODEL

FUNCTIONAL MODEL

Discrepancies between centric occlusion and centric relation produce micro-trauma to the joint and muscle splinting. This explains the patient’s symptoms.

Interferences from centric occlusion to the canine edge-to-edge position and their avoidance set up muscle symptoms (myositis) and joint symptoms (arthralgia)

PSYCHOLOGICAL MODEL

Occlusion has no place in the genesis of symptoms.Craniomandibular disorders are largely stress induced.

Occlusion is largely irrelevant

THE THEGOTIC MODEL

The thegotic model integrates these two disparate and competing contemporary models for the etiology of cranio-mandibular disorders: CMD (TMJ Pain Dysfunction Syndrome, Myofascial Pain Dysfunction Syndrome).

Tooth interferences are considered relevant since they inhibit free thegotic excursions. These excursions are from centric occlusion to the canine edge-to-edge position and beyond to the anatomical limit. The first phase of the excursion sharpens the posterior teeth. The second phase sharpens the anterior teeth. Sharpening the posterior and anterior teeth is an appropriate biological response to a variety of stressors from honing the teeth for masticatory and incisive function to honing the anterior teeth as a segmentive biting dental weapon. But there are additional interferences from anatomical relationships. For example, when thegotic excursions are considered in the relatively unabraded contemporary dentition, third molar teeth can be viewed as ‘space occupying’ and an acquired anatomical abnormality since they can inhibit anterior tooth honing by limiting the lateral excursions necessary to sharpen them.

Other anatomical variations become preconditions for thegotic trauma: long styloid processes, variations in the location of the foramen spinosum, for example. (For detail of this see Every (3)) The symptoms and signs are extensive and varied and may result in:

1 Tooth damage: enamel fracture, cusp fracture, pulpitis, and mobility.

2 Tempromandibular joint damage: meniscus damage and derangement, ligament tearing, straining and spraining.

3 Myositis.

4 Parotitis.

5 Headache: tension, cluster and migraine.

6 Non specific facial pain, and masticatory muscular tenderness.

With a full understanding of thegosis and its clinical relevance many conditions now considered as discrete will likely be understood as having a common etiology.