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The Relationship Between the Stomatognathic System and Body Posture
Antonino Cuccia
Corresponding author
cucciaam@odonto.unipa.it

Tel.: 0039-091-6811287
, Carola Caradonna
Department of Oral Sciences, University of Palermo – Palermo/Italy
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Correlation between craniofacil parameters and back shape profiles&#58; patients with distal and vertical craniofacial patterns present higher than normal upper thoracic&#44; lumbar-lordotic&#44; and pelvic angles&#59; patients with mesial and horizontal craniofacial pattern present smaller than normal upper thoracic&#44; lumbar-lordotic&#44; and pelvic angles&#46; Figure modified from Lippold <span class="elsevierStyleItalic">et al&#46;</span> &#40;1971&#41;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Posture refers to the position of the human body and its orientation in space&#46; Posture involves muscle activation that&#44; controlled by the central nervous system &#40;CNS&#41;&#44; leads to postural adjustments<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#46; Postural adjustments are the result of a complex system of mechanisms that are controlled by multisensory inputs &#40;visual&#44; vestibular&#44; and somatosensory&#41; integrated in the CNS&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Through mechanisms of feed-back and feed-forward&#44; postural adjustments play a critical role in orthostatic and dynamic postural control&#44; influencing the ability to perform daily living activities&#46; As with reflexes&#44; postural adjustments improve through exercise and learning&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> These adjustments are evoked by several types of afferent inputs&#58; exteroceptive &#40;skin sensitiveness of feet&#41;&#44; proprioceptive &#40;especially from the cervical&#44; hip&#44; ankle&#44; and knee joints&#41;&#44; vestibular &#40;utriculus&#44; sacculus&#44; semicircular canals&#41;&#44; and visual &#40;movement of the surrounding environment&#41;&#46; These afferent inputs can be modulated by many factors&#44; such as mood state and anxiety&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a></p><p id="para30" class="elsevierStylePara elsevierViewall">The stomatognathic system &#40;SS&#41; also plays an important role in postural control&#46; The SS is a functional unit characterized by several structures&#58; skeletal components &#40;maxilla and mandible&#41;&#44; dental arches&#44; soft tissues &#40;salivary glands&#44; nervous and vascular supplies&#41;&#44; and the temporomandibular joint and masticatory muscles &#40;MM&#41;&#46; These structures act in harmony to perform different functional tasks &#40;to speak&#44; to break food down into small pieces&#44; and to swallow&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> In particular&#44; the temporomandibular joint makes muscular and ligamentary connections to the cervical region&#44; forming a functional complex called the &#8220;cranio-cervico-mandibular system&#46;&#8221; The extensive afferent and efferent innervations of the SS are reflected in the extensive representation of the orofacial district in the motor and sensory areas of the cerebral cortex&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para40" class="elsevierStylePara elsevierViewall">The main disorders of the cranio-cervico-mandibular system&#44; which often affect human posture&#44; are the temporomandibular disorders &#40;TMD&#41;&#46; These are a group of diseases affecting the MM&#44; temporomandibular joint&#44; and surrounding structures&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">Patients with TMD report bilateral or unilateral pain as their primary symptom&#44; typically triggered by jaw movements or by palpation&#44; where the pain sometimes radiates to the temples or to the neck&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Although an increasing amount of information is available on the effects of SS on the postural body&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib8">8</a> its mechanisms remain unclear&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">The aim of this literature review is to increase awareness of the fact that a postural disorder is an alteration with both medical and dental implications&#46; A secondary goal is to promote an interdisciplinary approach to treating patients with postural disorder&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">LITERATURE SEARCH STRATEGY AND INCLUSION CRITERIA</span><p id="para70" class="elsevierStylePara elsevierViewall">A search of the databases Medline&#44; PubMed&#44; Embase&#44; Web of Sciences&#44; Cochrane Library&#44; Cinahl&#44; and Health Star was conducted for all publications related to the topic&#44; with no limitations of language or time period&#46; Relevant information was also derived from reference lists of the publications retrieved&#46; The key words used in the search were body posture&#44; temporomandibular joint&#44; temporomandibular disorders&#44; masticatory muscles&#44; craniofacial pain&#44; malocclusion&#44; trigeminal system&#44; and fascial system&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">STOMATOGNATHIC SYSTEM AND BODY POSTURE</span><p id="para80" class="elsevierStylePara elsevierViewall">Evidence continues to accumulate that untreated diseases of SS&#44; in particular temporomandibular disorders and malocclusion&#44; carry a risk of the development of postural disorders&#46; Recent studies emphasize the potential role of dental occlusion and of trigeminal afferents in maintaining postural control&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib10">10</a> Several studies indicate that different mandibular positions induce variations in body posture&#46; For example&#44; a change in the mandibular position&#44; which can lead to changes in the proprioceptive and periodontal afferents&#44; may affect the center of foot pressure &#40;COP&#41; position and gait stability&#46;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib12">12</a> Conversely&#44; changes in body posture may affect mandibular position&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#44;<a class="elsevierStyleCrossRef" href="#bib14">14</a></p><p id="para90" class="elsevierStylePara elsevierViewall">An influence of periodontal receptors on body posture is hypothesized by Gangloff and Perrin &#40;2002&#41;&#44; who found a significant alteration of postural control after unilateral truncular anesthesia of the mandibular nerve&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> In fact&#44; unilateral anesthesia of the trigeminous causes a shift in body weight onto the contralateral limb&#44; which leads the homolateral inferior limb to contract&#46; A more symmetric mandibular position also results in a more symmetric contraction pattern of the sternocleidomastoid muscle &#40;SCM&#41; and it reduces body sway&#46;<a class="elsevierStyleCrossRef" href="#bib16">16</a> Other studies further suggest that dental occlusion may influence body posture and spine curvature &#40;e&#46;g&#46;&#44; scoliosis and lordosis&#41;&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">Positive correlations between different craniofacial morphologies and postural attitudes have been reported&#44; such as an anteriorly displaced posture in class II malocclusion&#44; and a posteriorly displaced posture in class III malocclusion&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> Lippold <span class="elsevierStyleItalic">et al&#46;</span> &#40;2006&#41; have shown correlations between craniofacial parameters and back shape profiles&#58; patients with distal and vertical craniofacial patterns present higher than normal upper thoracic&#44; lumbar-lordotic&#44; and pelvic angles &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib18">18</a> Furthermore&#44; patients with idiopathic scoliosis show higher frequencies of malocclusion than control patients&#59; these include Angle Class II malocclusions&#44; lateral crossbites&#44; lower midline deviations&#44; and facial asymmetries&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib21">21</a></p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para110" class="elsevierStylePara elsevierViewall">When the occlusal relationship is lost either unilaterally or bilaterally&#44; the body posture may take on an unusual position&#44; causing neck or shoulder pain&#46; In these cases&#44; a dental splint restores a balanced occlusion and determines a more symmetric maxillomandibular position and muscular activity&#44; thereby reducing the range of body oscillation&#46;<a class="elsevierStyleCrossRef" href="#bib22">22</a> In edentulous subjects&#44; the reconstruction of occlusal support improves reaction time&#44; based on an index of physical quickness&#46;<a class="elsevierStyleCrossRef" href="#bib23">23</a> In females with deep-bite&#44; isometric strength of the cervical flexors and deltoids varied significantly&#44; which affected the vertical dimension of occlusion&#46;<a class="elsevierStyleCrossRef" href="#bib24">24</a></p><p id="para120" class="elsevierStylePara elsevierViewall">Studies have also demonstrated a relationship between TMDs and posture&#46; Patients with TMD show greater changes in the body&#8217;s center of gravity&#46;<a class="elsevierStyleCrossRef" href="#bib25">25</a> Several studies have shown that patients with TMD present an excessively forward head position&#44;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#44;<a class="elsevierStyleCrossRef" href="#bib27">27</a> usually associated with the shortening of the posterior cervical extensor muscles &#40;suboccipital&#44; semispinalis&#44; splenii&#44; and upper trapezius muscles&#41;&#44; as well as shortening of the SCM&#46;<a class="elsevierStyleCrossRef" href="#bib28">28</a> Anterior displacement of the head lowers the field of vision and&#44; in the attempt to improve the field of vision&#44; cervical lordosis increases&#46;<a class="elsevierStyleCrossRef" href="#bib29">29</a>&#44;<a class="elsevierStyleCrossRef" href="#bib30">30</a> An anterior position of the head also influences the position of the center of gravity&#44; which confirms the relationship between body posture and TMD&#46;<a class="elsevierStyleCrossRef" href="#bib31">31</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib34">34</a> In the same way&#44; the postural changes of the cervical region can cause TMD&#44; modifying the orientation of the head and consequently the mandibular position&#46;<a class="elsevierStyleCrossRef" href="#bib35">35</a> Previous investigations using posturography have described a correlation between body posture and gaze balancing in subjects whose trigeminal afferents were suppressed by unilateral anesthesia&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a>&#44;<a class="elsevierStyleCrossRef" href="#bib36">36</a></p><p id="para130" class="elsevierStylePara elsevierViewall">All of the above studies suggest that portions of the trigeminal system strongly influence the coordination of posture and sight&#46; However&#44; not all studies in the literature support a relationship between posture and SS&#46; Ferrario <span class="elsevierStyleItalic">et al&#46;</span> &#40;1996&#41; did not observe modification of foot COP in healthy women&#44; women with asymmetric malocclusion or different dental positions&#44; or women with temporomandibular disorders&#46;<a class="elsevierStyleCrossRef" href="#bib37">37</a> In another study&#44; Ferrario <span class="elsevierStyleItalic">et al&#46;</span> &#40;2001&#41; demonstrated that the muscular performances of the biceps brachii muscle were not influenced by a morphologically altered occlusion or by different jaw positions&#46;<a class="elsevierStyleCrossRef" href="#bib38">38</a> Michelotti <span class="elsevierStyleItalic">et al&#46;</span> &#40;2006&#41; examined adolescents with unilateral posterior crossbite and age-matched patients with normal occlusion&#44; and they failed to detect differences in how the subjects distributed their body weight on their foot area&#44; or in how quickly their bodies swayed&#46;<a class="elsevierStyleCrossRef" href="#bib39">39</a> Furthermore&#44; the unilateral posterior crossbite does not appear to be associated with leg length differences in young adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib40">40</a></p><p id="para140" class="elsevierStylePara elsevierViewall">A recent review suggests an association linking the cervical spine&#44; the stomatognathic system&#44; and craniofacial pain&#44; but most of this information is inconclusive and comes from poor-quality studies&#44; rated as levels 3b&#44; 4&#44; and 5 based on Sackett&#8217;s classification&#46; We believe that better designed studies are needed in order to clarify the actual influence that the cervical spine has on the stomatognathic system and craniofacial pain&#46;<a class="elsevierStyleCrossRef" href="#bib41">41</a></p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONNECTIONS BETWEEN THE TRIGEMINAL SYSTEM AND NERVOUS STRUCTURES INVOLVED IN MAINTAINING POSTURE</span><p id="para150" class="elsevierStylePara elsevierViewall">Numerous anatomical connections have been described between trigeminal systems and the nervous structures involved in maintaining posture&#46; The mesencephalic nucleus of the trigeminus &#40;MNT&#41;&#44; which extends itself from the dorsal portion of the spinal trigeminal nucleus to the caudal part of the superior colliculus&#44; is a sensorial nucleus with unique characteristics&#46; The cells of this nucleus are not central neurons&#44; but protoneurons with the function of ganglionic cells&#46; Kandel &#40;1991&#41; showed that this nucleus can be considered the equivalent of a sensitive peripheral ganglion&#46; They are pseudounipolar neurons that send the axon externally to the NCS&#44; while the other connections establish intra-axial contacts&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> This may explain the sensitivity of SS patients to different descendant stimuli &#40;stress&#44; anxiety&#44; etc&#46;&#41; or ascendant stimuli &#40;proprioceptive inputs from spine&#44; feet&#44; legs&#41;&#46; <a class="elsevierStyleCrossRef" href="#bib42">42</a></p><p id="para160" class="elsevierStylePara elsevierViewall">In the MNT&#44; neurons associated with extraocular muscles are present as along with the primary afferent neurons associated with muscles of MM&#44; tooth pulp&#44; and periodontal ligaments&#46;<a class="elsevierStyleCrossRef" href="#bib43">43</a>&#44;<a class="elsevierStyleCrossRef" href="#bib44">44</a> From the MNT&#44; the neural pathways connect with the cerebellum and with the reticular formation and the medial&#44; inferior&#44; lateral&#44; and superior vestibular nuclei&#46;<a class="elsevierStyleCrossRef" href="#bib44">44</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib46">46</a> They then continue to the spinal motor neurons and the extra-ocular efferents&#46;<a class="elsevierStyleCrossRef" href="#bib47">47</a></p><p id="para170" class="elsevierStylePara elsevierViewall">Indirect evidence suggests a functional connection between the vestibular and trigeminal systems&#46; For example&#44; painful trigeminal stimulation can trigger or modulate auditory and vestibular symptoms&#44; such as spontaneous nystagmus&#44; in patients with migraine headaches&#46;<a class="elsevierStyleCrossRef" href="#bib48">48</a>&#44;<a class="elsevierStyleCrossRef" href="#bib49">49</a> Buisseret <span class="elsevierStyleItalic">et al&#46;</span> &#40;1990&#41; used peroxidase injection into the oculomotor muscles as a marker to observe diffusion into several areas of the nervous system&#58; the Gasser node&#44; the interpolaris and the caudalis portion of the spinal trigeminal nucleus&#44; the paratrigeminal nucleus&#44; and the dorsal horn of the cervical spinal cord &#40;C1 - C2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib45">45</a></p><p id="para180" class="elsevierStylePara elsevierViewall">Studies have also revealed connections between the main nucleus of the trigeminus and the oral&#44; interpolar and caudal portion of the spinal trigeminal nucleus on the one hand&#44; with the vestibular nucleus and the prepositus nucleus of the hypoglossus on the other&#46;<a class="elsevierStyleCrossRef" href="#bib46">46</a> The prepositus nucleus is part of a small group of nervous cells adjacent to&#44; but not connected with&#44; the nucleus of the hypoglossus&#46; It is also an important nerve center for controlling the position and movement of the eyes&#44; due to its strict relationship with the vestibular nuclei&#44; the cerebellum&#44; and the oculomotor nuclei&#46;<a class="elsevierStyleCrossRef" href="#bib50">50</a></p><p id="para190" class="elsevierStylePara elsevierViewall">The MNT also makes connections with lobes IX and X of the cerebellum&#46;<a class="elsevierStyleCrossRef" href="#bib44">44</a> Bilateral trigeminocollicular connections have been described in pigs&#44; rats&#44; and cats&#44; where these connections involve the principal trigeminal nucleus and MNT&#46;<a class="elsevierStyleCrossRef" href="#bib51">51</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib53">53</a> The superior colliculus is a relay center in the midbrain that receives visual&#44; somesthetic&#44; and proprioceptive afferent fibers&#59; it is involved in postural&#44; motor&#44; and gait control&#44; as well as gaze movements&#46; In fact&#44; the lateral SC region is part of the neuronal circuits that are involved in eye movements&#44; and the region is associated with eyelid movements and lid saccades&#46; This lateral superior colliculus region receives trigeminal somatic afferent information&#46;<a class="elsevierStyleCrossRef" href="#bib52">52</a></p><p id="para200" class="elsevierStylePara elsevierViewall">Studies have shown the relationship between among dental occlusion&#44; the oculomotor system&#44; and visual stabilization&#46; Evidence of a correlation between eye and dental occlusion came from the use of mandibular orthopedic repositioning appliances &#40;MORAs&#41;&#44; which simultaneously modify mandibular position and visual focusing tests using the Maddox rod and the Berens prismatic bars&#46; These phenomena gradually disappear after removal of the appliance&#46;<a class="elsevierStyleCrossRef" href="#bib54">54</a></p><p id="para210" class="elsevierStylePara elsevierViewall">Associations also exist between TMD and oculomotor function&#46; Recently&#44; Monaco <span class="elsevierStyleItalic">et al&#46;</span> &#40;2003&#44; 2004&#41; suggested a much higher prevalence of ocular convergence defects in TMD adults presenting limited maximal opening&#44; myofascial pain&#44; and pain in the neck shoulder area&#44; as well as in children with functional mandibular latero-deviation<a class="elsevierStyleCrossRef" href="#bib55">55</a>&#44;<a class="elsevierStyleCrossRef" href="#bib56">56</a> compared with healthy individual&#46; In addition&#44; TMD patients showed significantly lower binocular function&#44; measured as convergence and positive fusional vergence&#44; than did control healthy subjects&#46;<a class="elsevierStyleCrossRef" href="#bib57">57</a> Connections were also observed with the cerebellum&#44; and with many brainstem nuclei &#40;nucleus of the solitary tract&#44; dorsal reticular formation&#44; cuneate nucleus&#41;&#44; with the dorsal horn of the spinal cord &#40;from C1-C5&#41; and with the trigeminal primary afferent neurons&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib44">44</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib46">46</a>&#44;<a class="elsevierStyleCrossRef" href="#bib58">58</a>&#44;<a class="elsevierStyleCrossRef" href="#bib59">59</a></p><p id="para220" class="elsevierStylePara elsevierViewall">All of these anatomical connections suggest that portions of the trigeminal system strongly influence the coordination of posture and sight&#46; It seems likely that sensory information from SS proprioceptive receptors is processed in tandem with information from the vestibular and oculomotor systems&#46; Changes in trigeminal stimulations can cause an imbalance in the vestibular and oculomotor systems&#46; <a class="elsevierStyleCrossRef" href="#bib15">15</a></p><p id="para230" class="elsevierStylePara elsevierViewall">Nociceptive inputs from TMJ&#44; MM&#44; posterior cervical muscles&#44; and neck and shoulder muscles can produce a continuous afferent bombardment onto the spinal trigeminal nucleus&#46;<a class="elsevierStyleCrossRef" href="#bib60">60</a> Such repeated nociceptive activation of the caudalis nucleus can produce central sensitization&#44; which refers to increased excitability of brainstem nociceptive neurons&#46; Two other types of stimulation leading to increased excitability of nociceptive neurons&#44; individually or together&#44; are temporal summation and activation of glial cells &#40;microglia and astrocytes&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib61">61</a></p><p id="para240" class="elsevierStylePara elsevierViewall">The temporal summation is an increase in the intensity of pain experienced as a consequence of repeated stimulation&#46; For example&#44; efforts to maintain correct eye movement when the trigeminal nociceptive afferent stimulus is changing in intensity &#40;trigeminotectal pathways&#41; can lead to increased sensitivity &#40;central fatigue&#41;&#44; which causes progressive reduction in motoneuron recruitment and neurotransmitter synthesis&#44; and concomitant loss of muscular force&#46; Such central fatigue can be more severe in TMD patients than in healthy subjects&#44; and it may explain the occurrence of ocular convergence defects&#46;<a class="elsevierStyleCrossRef" href="#bib57">57</a> Moreover&#44; if SS proprioceptive information is inaccurate&#44; the control of the head position may be affected&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">If confirmed by other studies&#44; these hypotheses may explain why patients with dento-musculo-skeletal pathologies are predisposed to postural problems&#46; By using stimuli of different intensity and duration&#44; further studies should ascertain the threshold at which oculomotor and vestibular problems occur&#44; and how the treatment of the TMDs affects posture&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">CONNECTIONS BETWEEN THE TRIGEMINAL SYSTEM AND MUSCLE-FASCIAL CHAINS</span><p id="para260" class="elsevierStylePara elsevierViewall">Another basic element of the correlation between SS and human posture is the existence of muscle-fascial chains &#40;MFC&#41;&#46; Fasciae are dense&#44; fibrous connective tissues that interpenetrate and surround the human body to protect&#44; nourish and hold organs in place&#46;<a class="elsevierStyleCrossRef" href="#bib62">62</a>&#44;<a class="elsevierStyleCrossRef" href="#bib63">63</a> Three layers of fasciae exist&#58; superficial&#44; deep and visceral&#46; Deep fasciae surrounds muscles&#44; bones&#44; nerves and blood vessels and is densely populated with myofibroblasts and several types of receptors &#40;nociceptors&#44; proprioceptors&#44; mechanoreceptors&#44; chemoreceptors&#44; thermoreceptors&#41;&#46; Myofibroblasts are fascial cells that are created as a response to mechanical stress and actively contract in a smooth&#44; muscle-like manner&#46;<a class="elsevierStyleCrossRef" href="#bib64">64</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib66">66</a></p><p id="para270" class="elsevierStylePara elsevierViewall">The fascial system is important not only because it can passively distribute tension in the body muscles when mechanically stimulated&#44; but also because it contains mechanoreceptors and possesses an autonomous contractile ability that influences the tension of the fasciae&#46; The stimulation of intrafascial mechanoreceptors &#40;mostly interstitial and Ruffini endings&#41; causes the vegetative nervous system and the CNS to change the tension in intrafascial myofibroblasts and regulate fascial pre-tension&#46;<a class="elsevierStyleCrossRef" href="#bib67">67</a> These tensions are transmitted along the MFC&#44; thereby influencing the posture of the entire body&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">An MFC is a group of muscles that are connected through the fasciae and are longitudinally positioned in the human body&#46; They run in the same direction and overlap in a continuous chain&#44; like tiles on a roof&#44; which efficiently conducts tension&#46;<a class="elsevierStyleCrossRef" href="#bib68">68</a>&#44;<a class="elsevierStyleCrossRef" href="#bib69">69</a> All of the muscles in the chain are mutually dependent and behave as if they were a single muscle&#46; The existence of MFC may explain why disorders of the MM functions such as chewing and swallowing&#44; can be transmitted to distal musculature&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">Cervical posture may also be influenced by stimuli from the lower limbs&#46; Tecco <span class="elsevierStyleItalic">et al&#46;</span> &#40;2007&#41; have compared cervical posture in lateral skull radiographs between healthy subjects and subjects who had anterior cruciate ligament injury of the left knee&#46; They found that the latter group showed significant head extension compared to the healthy subjects&#46;<a class="elsevierStyleCrossRef" href="#bib70">70</a> Dvorak and Dvorak &#40;1990&#41; injected a hydro-saline solution into the transverse processes of C7 and used electromyography to observe muscle contraction in zones distal from the spinal metamer where the injection was made&#46;<a class="elsevierStyleCrossRef" href="#bib71">71</a> This seems to indicate that&#44; because of the connections within the fascial system&#44; change in any part of the body may create a disorder in another&#46; For example&#44; a contracted masseter muscle transmits its tension to homolateral SCM&#44; and such connections may explain the influence of the SCM on mandibular movements&#46;<a class="elsevierStyleCrossRef" href="#bib72">72</a> The MFC may also explain why an anterior cruciate ligament injury influences muscular electromyography activity of masseter&#44; anterior temporalis&#44; posterior cervicals&#44; sternocleidomastoid&#44; and upper and lower trapezius&#46;<a class="elsevierStyleCrossRef" href="#bib73">73</a></p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">CONCLUSION</span><p id="para300" class="elsevierStylePara elsevierViewall">According to the literature reviewed&#44; we believe that there are real correlations between posture and the SS&#46; However&#44; due to the complexity of the factors involved&#44; existing studies have left important gaps in understanding&#46; Therefore&#44; further controlled investigations of the long-term clinical effects of different stomatognathic inputs are necessary&#46;</p><p id="para310" class="elsevierStylePara elsevierViewall">Postural alterations may reflect a general lack of equilibrium in the individual&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> Consequently&#44; the various signals that reach the CNS&#44; and the importance that each signal is given&#44; will no longer be perfectly balanced with the motor responses&#44; and the motor responses may no longer be adequate&#46;<a class="elsevierStyleCrossRef" href="#bib74">74</a> In this way&#44; an increase in postural swaying may indicate a general malaise caused by problems in the SS&#46; Our clinical experience suggests that an interdisciplinary approach is reliable and sufficient for making diagnoses and developing treatment plans&#46; This approach should involve a variety of experts in postural rehabilitation&#44; including physiatrists&#44; orthopedists&#44; psychologists&#44; physical therapists&#44; dentists&#44; oculists&#44; optometrists&#44; and ear&#44; nose&#44; and throat specialists&#46;</p></span></span>"
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          "titulo" => "INTRODUCTION"
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          "titulo" => "LITERATURE SEARCH STRATEGY AND INCLUSION CRITERIA"
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          "titulo" => "STOMATOGNATHIC SYSTEM AND BODY POSTURE"
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        4 => array:2 [
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          "titulo" => "CONNECTIONS BETWEEN THE TRIGEMINAL SYSTEM AND NERVOUS STRUCTURES INVOLVED IN MAINTAINING POSTURE"
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        5 => array:2 [
          "identificador" => "cesec50"
          "titulo" => "CONNECTIONS BETWEEN THE TRIGEMINAL SYSTEM AND MUSCLE-FASCIAL CHAINS"
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        6 => array:2 [
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          "titulo" => "CONCLUSION"
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            0 => "Body posture"
            1 => "Temporomandibular joint"
            2 => "Temporomandibular disorders"
            3 => "Trigeminal system"
            4 => "Fascial system"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><p id="spara20" class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; many researchers have investigated the various factors that can influence body posture&#58; mood states&#44; anxiety&#44; head and neck positions&#44; oral functions &#40;respiration&#44; swallowing&#41;&#44; oculomotor and visual systems&#44; and the inner ear&#46; Recent studies indicate a role for trigeminal afferents on body posture&#44; but this has not yet been demonstrated conclusively&#46; The present study aims to review the papers that have shown a relationship between the stomatognathic system and body posture&#46; These studies suggest that tension in the stomatognathic system can contribute to impaired neural control of posture&#46; Numerous anatomical connections between the stomatognathic system&#8217;s proprioceptive inputs and nervous structures are implicated in posture &#40;cerebellum&#44; vestibular and oculomotor nuclei&#44; superior colliculus&#41;&#46; If the proprioceptive information of the stomatognathic system is inaccurate&#44; then head control and body position may be affected&#46; In addition&#44; the present review discusses the role the myofascial system plays in posture&#46; If confirmed by further research&#44; these considerations can improve our understanding and treatment of muscular-skeletal disorders that are associated with temporomandibular joint disorders&#44; occlusal changes&#44; and tooth loss&#46;</p></span>"
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Correlation between craniofacil parameters and back shape profiles&#58; patients with distal and vertical craniofacial patterns present higher than normal upper thoracic&#44; lumbar-lordotic&#44; and pelvic angles&#59; patients with mesial and horizontal craniofacial pattern present smaller than normal upper thoracic&#44; lumbar-lordotic&#44; and pelvic angles&#46; Figure modified from Lippold <span class="elsevierStyleItalic">et al&#46;</span> &#40;1971&#41;</p>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos