The influence of dental occlusion on the body balance in unstable platform increases after high intensity exerciseSonia Julià-Sánchez (a), Jesús Álvarez-Herms (a), Hannes Gatterer (b), Martin Burtscher (b), Teresa Pagès (a), Ginés Viscor (a)
(a) Departament de Fisiologia i Immunologia, Universitat de Barcelona (UB). (b) Department of Sport Science, Medical Section, University Innsbruck
Highlights
• The relationship between dental occlusion and balance control remains unclear.
• 10 physically active subjects were analyzed prior to and following a maximal exercise.
• Body balance was evaluated in stable and unstable levels with occlusion in ICP and CR.
• Body balance was significantly better when dental occlusion was set in CR.
• Dental occlusion strongly influenced balance control in fatigue.
Abstract
Existing evidence suggests that body balance ability is associated with dental occlusion. The purpose of this study was to determine whether: (i) there are differences in balance between opposed dental occlusion (intercuspal position, ICP; cotton rolls, CR) for two extreme levels of stability and (ii) the influence of dental occlusion on the balance control gets stronger under fatigue conditions. To this aim, various measures for assessing postural control in ten physically active subjects were obtained prior to and following a maximal lower limbs exercise consisting in six sets of fifteen seconds stretch-shortening cycle jumping. Balance control at stable and unstable condition was evaluated on an unstable platform Balance System SD for both dental occlusion conditions at random order. Metabolic and psychological measurements ensured the high intensity of the exercise. At unstable level, balance control was significantly improved in the CR condition, for both rest (p = 0.03) and fatigue (p < 0.001). Whereas at stable level, the influence of dental occlusion only reached significance in fatigue condition (p = 0.04). It could be concluded that the sensory information linked to the dental occlusion for the balance control comes strongly into effect when more difficult conditions for the balance control are present (i.e., unstable conditions, fatigue).
Introduction
Postural control is a complex system that involves different sen-sory and motor components, such as sensory inputs from the visual,somatosensory and vestibular systems, that must be integrated atthe central nervous system in order to regulate orientation andstabilization of the body segments [1]. Over the last few years, a growing interest has focused onthe potential correlation between the stomatognathic system andthe body balance. Recently, it has been proposed that the stom-atognathic system may contribute (∼2%) to the postural balanceregulation [2]. In particular, the presence of some specific mal-occlusal traits seems to negatively influence the balance control[3]. From a neurophysiological perspective, the motor influencesbetween the masticatory and cervical muscles may explain theinfluence of dental occlusion on the body balance [4]. The observa-tion of a beneficial effect of balancing occlusion on several posturalmuscles [5,6] leads to speculate that dental occlusion may affectthe whole body. The neuronal links of the trigeminal nerve to thevestibular nuclei, which are responsible of the masticatory functionand equilibrium control respectively [7,8], reinforce the argument for this relationship. Most literature in the topic have evaluatedthe influence of proprioceptive information of dental occlusion onthe body balance in stable conditions reporting contrasting con-clusions in favor [9–11] or against [12–14]. However, less researchhas focused in assessing the relationship between dental occlusionand balance in unstable conditions, even though unstable platformsare more sensitive [15]. Moreover, a different contribution of theafferent signals for the process of balance control occurs dependingon the stability of the support base [16], thus evidencing a highercontribution of other sources of sensory information when moredifficult conditions for the balance control are present. To data,there is no available literature investigating the influence of den-tal occlusion in fatigue conditions at stable and unstable supportsurface conditions.Therefore, we hypothesized that dental occlusion may con-tribute differently on the body balance control depending on thestability condition (stable versus unstable) and that influence mightbe more evident in fatigue conditions due to reorganization of thesensory information sources. Then, the aim of the present studywas to determine whether: (i) dental occlusion influences bodybalance for two extreme levels of stability (stable/unstable), and(ii) the influence of dental occlusion on the balance control comesstrongly into effect under fatigue conditions.
Conclusions
Our main findings were that: (i) the body balance was sig-nificantly better when dental occlusion was set in CR, and moreespecially, at unstable level measurements; and (ii) the influenceof dental occlusion on the balance control came strongly intoeffect under fatigue conditions. These results lead to speculate thatthe afferent signals from dental occlusion may contribute mosteffectively in the process of balance control when more externalperturbations are present, in this case surface instability and musclefatigue.
References
[1] S.R. Lord, D.L. Sturnieks, The physiology of falling: assessment and preventionstrategies for older people, J. Sci. Med. Sport 8 (2005) 35–42.
[2] E.A. Solovykh, O.G. Bugrovetskaya, L.N. Maksimovskaya, Information value offunctional status of the stomatognathic system for postural balanceregulation, Bull. Exp. Biol. Med. 153 (2012) 401–405.
[3] S. Julià-Sánchez, J. Álvarez-Herms, H. Gatterer, M. Burtscher, T. Pagès, G.Viscor, Dental occlusion influences the standing balance on an unstableplatform, Motor Control 19 (2015) 341–354.
[4] R.W. Pallegama, A.W. Ranasinghe, V.S. Weerasinghe, M.A. Sitheeque,Influence of masticatory muscle pain on electromyographic activities ofcervical muscles in patients with myogenous temporomandibular disorders, J.Oral Rehabil. 31 (2004) 423–429, http://dx.doi.org/10.1111/j.1365-2842.2004.01266.x.
[5] M. Bergamini, F. Pierleoni, A. Gizdulich, C. Bergamini, Dental occlusion andbody posture: a surface EMG study, Cranio 26 (2008) 25–32.
[6] C. Sforza, G.M. Tartaglia, U. Solimene, V. Morgun, R.R. Kaspranskiy, V.F.Ferrario, Occlusion, sternocleidomastoid muscle activity, and body sway: apilot study in male astronauts, Cranio 24 (2006) 43–49.
[7] L. Devoize, S. Domejean, C. Melin, P. Raboisson, A. Artola, R. Dallel,Organization of projections from the spinal trigeminal subnucleus oralis tothe spinal cord in the rat: a neuroanatomical substrate for reciprocalorofacial-cervical interactions, Brain Res. 1343 (2010) 75–82, http://dx.doi.org/10.1016/j.brainres.2010.04.076.
[8] G. Pinganaud, F. Bourcier, C. Buisseret-Delmas, P. Buisseret, Primarytrigeminal afferents to the vestibular nuclei in the rat: existence of a collateralprojection to the vestibulo-cerebellum, Neurosci. Lett. 264 (1999) 133–136.[9] P. Bracco, A. Deregibus, R. Piscetta, Effects of different jaw relations onpostural stability in human subjects, Neurosci. Lett. 356 (2004) 228–230,http://dx.doi.org/10.1016/j.neulet.2003.11.055.
[10] K. Sakaguchi, N.R. Mehta, E.F. Abdallah, A.G. Forgione, H. Hirayama, T.Kawasaki, et al., Examination of the relationship between mandibularposition and body posture, Cranio 25 (2007) 237–249.
[11] A. Cuccia, C. Caradonna, The relationship between the stomatognathic systemand body posture, Clinics (Sao Paulo) 64 (2009) 61–66.
[12] D. Manfredini, T. Castroflorio, G. Perinetti, L. Guarda-Nardini, Dentalocclusion, body posture and temporomandibular disorders: where we arenow and where we are heading for, J. Oral Rehabil. 39 (2012) 463–471, http://dx.doi.org/10.1111/j.1365-2842.2012.02291.x.
[13] G. Perinetti, J. Primozic, D. Manfredini, R. Di Lenarda, L. Contardo, Thediagnostic potential of static body-sway recording in orthodontics: asystematic review, Eur. J. Orthod. 35 (2013) 696–705, http://dx.doi.org/10.1093/ejo/cjs085.
[14] A. Baldini, A. Nota, D. Tripodi, S. Longoni, P. Cozza, Evaluation of thecorrelation between dental occlusion and posture using a force platform,Clinics (Sao Paulo) 68 (2013) 45–49.
[15] R.W. Baloh, T.D. Fife, L. Zwerling, T. Socotch, K. Jacobson, T. Bell, et al.,Comparison of static and dynamic posturography in young and older normalpeople, J. Am. Geriatr. Soc. 42 (1994) 405–412.
[16] R.J. Peterka, Sensorimotor integration in human postural control, J.Neurophysiol. 88 (2002) 1097–1118.
[17] B. Akhbari, I. Ebrahimi Takamjani, M. Salavati, M. Ali Sanjari, A 4-week biodexstability exercise program improved ankle musculature onset, peak latencyand balance measures in functionally unstable ankles, Phys. Ther. Sport 8(2007) 117–129, http://dx.doi.org/10.1016/j.ptsp.2007.03.004.
[18] M.R. Hinman, Factors affecting reliability of the biodex balance system: asummary of four studies, J. Sport Rehabil. 9 (2000) 240–252.
[19] B.L. Arnold, R.J. Schmitz, Examination of balance measures produced by thebiodex stability system, J. Athl. Train. 33 (1998) 323–327.
[20] N. Vuillerme, C. Burdet, B. Isableu, S. Demetz, The magnitude of the effect ofcalf muscles fatigue on postural control during bipedal quiet standing withvision depends on the eye-visual target distance, Gait Posture 24 (2006)169–172, http://dx.doi.org/10.1016/j.gaitpost.2005.07.011.
[21] C. Bosco, P. Luhtanen, P.V. Komi, A simple method for measurement ofmechanical power in jumping, Eur. J. Appl. Physiol. Occup. Physiol. 50 (1983)273–282.[22] N. Hori, R.U. Newton, N. Kawamori, M.R. McGuigan, W.J. Kraemer, K. Nosaka,Reliability of performance measurements derived from ground reaction forcedata during countermovement jump and the influence of sampling frequency,J. Strength Cond. Res. 23 (2009) 874–882, http://dx.doi.org/10.1519/JSC.0b013e3181a00ca2.
[23] Z.G. Fox, J.P. Mihalik, J.T. Blackburn, C.L. Battaglini, K.M. Guskiewicz, Return ofpostural control to baseline after anaerobic and aerobic exercise protocols, J.Athl. Train. 43 (2008) 456–463, http://dx.doi.org/10.4085/1062-6050-43.5.456.
[24] N. Vuillerme, F. Hintzy, Effects of a 200 W-15 min cycling exercise on posturalcontrol during quiet standing in healthy young adults, Eur. J. Appl. Physiol.100 (2007) 169–175, http://dx.doi.org/10.1007/s00421-007-0419-6.
[25] D.C. Dickin, J.B. Doan, Postural stability in altered and unaltered sensoryenvironments following fatiguing exercise of lower extremity joints, Scand. J.Med. Sci. Sports 18 (2008) 765–772, http://dx.doi.org/10.1111/j.1600-0838.2007.00760.x.
[26] C. Tardieu, M. Dumitrescu, A. Giraudeau, J.L. Blanc, F. Cheynet, L. Borel, Dentalocclusion and postural control in adults, Neurosci. Lett. 450 (2009) 221–224,http://dx.doi.org/10.1016/j.neulet.2008.12.005.
[27] V. D’Ermes, M. Basile, A. Rampello, C. Di Paolo, Influence of occlusal splint oncompetitive athletes performances, Ann. Stomatol. (Roma) 3 (2012) 113–118.
[28] P. Gangloff, J.P. Louis, P.P. Perrin, Dental occlusion modifies gaze and posturestabilization in human subjects, Neurosci. Lett. 293 (2000) 203–206.