HOL I S T I C A P P R OA C H T O PR OB L E M S R E L A T E D

T O EQUI L I B R I UM A ND D Y S F UNC T I ON OF T HE
TE M P OR O- MA ND I B UL A R J OI NT

Dr. Luka Krusic

Rudnik 1,
1235 Radomlje
Slovenia

1
 CONTENT

CONTENT .................................................................................................................. 2

INTRODUCTION ........................................................................................................ 3

TEMPORO-MANDIBULAR JOINT ............................................................................. 6

TEMPORO-MANDIBULAR DYSFUNCTION IN HORSES ....................................... 13

GENETIC FACTORS ........................................................................................................................ 17

TRAUMATIC FACTORS ................................................................................................................... 18

MECHANICAL FACTORS................................................................................................................. 18

EMOTIONAL FACTORS ................................................................................................................... 18

TEMPORO-MANDIBULAR JOINT AND ITS INFLUENCE ON LOCOMOTION ....... 19

LOCAL SYMPTOMS OF TMJ DYSUNCTION ......................................................... 22

CONCLUSION ......................................................................................................... 22

SUMMARY ............................................................................................................... 23

LITERATURE: .......................................................................................................... 25

2
INTRODUCTION

“The whole is more than the

sum of its single parts”

Hippocrates 400 B.C.

“Teeth arcades have a deeper meaning

than their mechanical function represents”

W. Balters

The horse as a supreme athlete has evolved as a grazing herbivore with a specific masticatory
system and continuously growing teeth, which play an important role in all functions of the body and
even in his psychological behaviour.
In exploring the locomotion problems related to TMJ dysfunction, the teeth play an extremely
important role. Horses rely on the proper function of their teeth because of the three aspects that may
be reflected in their role of:

• mechanical digestion, important for growth and the maintenance of all biological functions;
• the normal function of TMJ, i.e. the ability to move the jaw properly affecting the body's
balance and equilibrium; and
• the alteration of behaviour and psychological state.

The role of teeth in mechanical digestion has shown that normal dental occlusion after
correction of teeth may have a significant effect on digestibility of organic matter (Table 1, Gatta et al.,
1995; Ralston et al., 2001) and minerals (Table 2, Gatta et al., 1997) and consequently on overall
health and physical condition.

Before After
diet 1 diet2 Diet1 diet 2
se se se se
mean mean mean mean
Dry matter 47.37 2.98 53.84 2.12 55.26 6.7 56.13 2.27
Organic matter 48.01 2.99 55.54 1.95 56.25 3.2 57.66 2.24
Crude protein 44.39a 4.18 54.35ab 2.99 50.53b 4.98 55.25ab 3.96
Crude fibre 38.47 3.63 44.21 3.57 52.88 3.47 45.72 1.87
ADF 32.84 4.47 36.13 3.84 48.36 4.18 40.29 3.06
NDF 38.55 3.41 41.8 3.26 48.59 3.84 45.58 2.9
Cellulose 45.96 3.83 48.41 3.55 58.81 3.32 52.36 3.19
Hemi cellulose 53.4a 2.33 52.47b 2.35 54.91ab 3.98 55.53b 2.61
N-Free extract 57.59a 2.49 65.04b 1.18 62.42ab 2.57 67.87b 1.78
Gross energy 44.19 3.17 52.95 1.98 53.17 3.25 53.57 2.34
Nit. ret. g/d 14.99 12.9 14.21 4.9 16.57 1.55 17.51 2.03
0,75
Nit. ret. mg/Kg/LW 134.2 84.5 128.7 47.0 144.5 15.5 150.5 19.7
Row with different superscripts differ (P<.05)

Table1: Apparent digestibility coefficients and nitrogen retention of hay (diet 1) and hay and oats (diet
2) prior to and after dental correction (means ± se) (Gatta

3
 Diet Ca-g Mg-g Na-g P-g Mn/mg Se/mg
1-0 58.89±8.92a 0.69±2.71a 1.92±0.99a -0.37±3.23a -83.06±77.72 0.45±0.02
2-0 35.38±6.01b -0.56±1.38a -1.89±1.76b 5.14t2.86ab 237.31±109.52ab 0.37±0.11a
Retained
1+ 87.91±13.10c 5.34±2.06b 1.44±1.20a 6.73±2.09b 421.20±167.91b 0.63±0.04b
2+ 43.99±7b 1.52±2.84a -0.73±1.09b 6.04±0.71b -233.24±80.00a 0.34±0.16a
1-0 0.48±0.05 0.22±0.11 0.47±0.13a -0.02±0.17a -0.15±0.11 0.69±0.03
Apparent 2-0 0.51±0.05 0.22±0.04a -0.32±0.50bc 0.26±0.15ab -0.53±0.25ab 0.75±0.05ab
Digestibility 1+ 0.61±0.09 0.37±0.08b 0.40±0.27ac 0.37±0.12b -0.77±0.31b 0.80±0.04b
2+ 0.60±0.08 0.36±0.09b -0.12±0.23b 0.31±0.04b -0.52±0.18b 0.80±0.01b
*0, before dental correction; +, after dental correction; a, b, P < 0.05.
Table 2: Apparent digestibility and retention of macro- and micro-minerals prior to and after dental correction (Gatta et al.,
1997)

Proper function of the TMJ is of vital importance for a horse’s health and biomechanical
functions of the whole body. In the modern management of horses, regardless of horse disciplines, all
horses are exposed to a number of contributing factors that affect the proper mastication and normal
wear of teeth. Some of these factors include the unnatural feeding of a high proportion of
mechanically and thermally treated grain feeds, wearing of certain types of bit and noseband,
undergoing various kinds of dental work, and a lack of professional standardised dental care. Due to
the above-mentioned factors horses are prone to the condition known as Temporo-Mandibular
Dysfunction (TMD) as a consequence of TMJ problems.
TMJ refers to an area of the cranium where the mandibular bone contacts and articulates with
the temporal bone.
An important principle in a holistic approach to biomechanical or locomotion problems related
to TMD in horses is the interrelation between structure and function as in osteopathy and between a
single part and the rest of the body.
The mandibular movement during mastication is controlled by the form and consummation of
molar and incisor teeth.
The normal function of a mandible depends on the correct position and functional balance of
temporal bones and normal contact of dental tables producing normal occlusion. The dental occlusion
refers to the coming together of the upper and lower teeth, whereas neuromuscular occlusion occurs
when the dental occlusion is synchronized with healthy relaxed masticatory muscles.
It is known that various dental problems can cause through the function of the upper and lower
jaw position a dysfunction of the Cranio-Sacral System (CSS). The basis of cranio-sacral work is the
work and research performed by the osteopath Sutherland, who discovered that cranium bones were
connected through membranes with flexible bone sutures.
The cranio-sacral system is a physiological system that exists in humans as well as in those
animals possessing a brain and spinal cord. Its formation begins in the uterus and its function
continues until death (Upledger, 1983). The cranio-sacral system derives its name from the bones
involved: the skull, face and mouth which make up the “cranium” and extend down the spinal cord to
the “sacrum”.
The cranio-sacral system is a functional unit including the cranium and sacrum with all
meningeal layers, bone structures, ligaments, cerebrospinal fluid and other additional systems such
as nerves, vessels, lymph vessels, endocrine glands, respiratory system and the muscle-skeletal
system. The cranio-sacral system is connected by membranes enclosing a semi-closed hydraulic
system and has a palpable rhythm separate from either heartbeat or respiration rate. The cranio-
sacral rhythm (cranial rhythmic impulse) is created by the formation and absorption of cerebrospinal
fluid within the ventricles of the brain. Due to the faster formation of cerebrospinal fluid than occurs at
its outflow the increased hydrostatic pressure causes a very fine rhythmic dilatation of cranium bones.
One of the essential parts of the CSS in man and horse is the body fascia or soft tissue layer that
covers the entire body from the head to the end of the limbs. This layer is in constant movement with
the corresponding parts of the CSS in the form of the cranio-sacral movement/rhythm that can easily
be disturbed by any tissue pathology (Rossaint, 1996).
The proper functioning of the cranio-sacral system is possible under the normal anatomical and
physiological state of all its parts (Rossaint et al., 1996).

The continuous production and absorption of cerebrospinal fluid causes two movements of the
cranium bones, membranes and soft tissue as dilatation and contraction, that can be palpated in all
parts of the body (Figure 1):

4
 Inspiration = Outer rotation = Flexion Expiration = Inner rotation = Extension

Figure1: Absorption of liquor = dilatation, inspiration, outer rotation or as

flexion; Production of liquor = contraction, expiration, inner rotation or
extension (according to Bäcker & Solomon, 2003)

Flexion “inspiration” and extension “expiration” are the movements of the unpaired cranium
bones: sphenoid, occiput, os ethmoidale and sacrum at the level of the hind limbs.

Figure 2: Flexion movement of inner cranium bones (occiput, sphenoid, ethmoid

and vomer)

The outer and inner rotations are synchronous movements of the paired cranium bones
occurring with the spheno-basilar joint (Figure 2). During flexion of the symphisis spheno-basilaris,
called the inspiration phase, both cranium bones approach and during extension extend in the so-
called expiration phase (Figures 3a, b).
The spheno-occipital or spheno-basilar joint is moved into the convex position, thus enabling
the motion of all head bones.

Figure 3a,b: Flexion and extension movement of inner cranium bones (occiput and sphenoid)

With the flexion of the spheno-basilar joint through the connection of the dura mater the
motion of the head and sacrum occurs, contributing to the movement of the occipital bases posteriorly
and the sphenoid anteriorly, whereas the sacrum is moved posteriorly (Figure 4).

5
 Sacrum

Figure 4: Flexion and extension movement of inner cranium bones in

connection with the sacrum schematically modified according to Evrard (2003)

With extension the opposite movement occurs. Under normal conditions the intensity and the
amplitude of both phases is the same. The measurable amplitude of the cranial wave, felt as a
discreet muscular pulsation, is between 40 microns to 1.5 mm in movement according to different
authorities. In an abnormal or pathological state, where the occipital bone moves to one side, the
same movement of the sacrum is followed (Asche van, 1996). The spheno-basilar joint is not
important only as the centre of cranium bone movement, but it plays an important role as the location
of the hypophysis in the sella turcica. Therefore any lesion of the symphisis spheno-basilaris may
affect, besides the locomotion system, the whole hormonal and immune system.

TEMPORO-MANDIBULAR JOINT

The importance of the normal structure and function of the Temporo-Mandibular Joint (TMJ) is
well known in humans, but very poorly studied in horses (Becker and Solomon, 2004; Evrard, 2004;
Rosenstein et al., 2003; Maierl et al., 2000; Bonin, 2001; Cooper, 1992, 1993, 1996; Thomas and
Cooper, 1989; Schöttl, 1991; Rossaint et al, 1996).
The TMJ is an incongruous joint formed by the temporal bone and the mandible. It contains a
fibrocartilaginous meniscus, which is interposed between the two articular surfaces in the form of a
fixed double cartilaginous layer of the arcus zygomaticus (Figure 5). The articular meniscus divides
the equine TMJ into a more special dorsal compartment (discotemporal articulation) with a
caudodorsal recess and a ventral compartment (discomandibular articulation) with a rostroventral and
a smaller caudoventral recess. Gross dissection may be used for the identity of individual structures
and two pouches filled with synovial fluid.
The temporal bone contains the entrance to the auditory tube (eustachian tube), the place
where balance and equilibrium are registered by the vestibulocochlear nerve. Any abnormal state or
function of the inserting head muscles can therefore influence a horse’s balance and equilibrium. It is
known that the trigeminal nerve branch lies on the side of the temporal bone; one of the trigeminal
nerves contains the motor nerve innervating the muscles for mastication. The second bone of the
TMJ is the mandible consisting of two halves fused together at an early age of two to three months.
The third important bone of the TMJ mechanism is the hyoid bone lying between two mandibular
halves. The hyoid bone is inserted in the tongue muscles rostral and connected to the larynx and
articulates with the temporal bones. This bone is connected with eight short and three long muscles
to the different parts of the head and the breast and has an important role in mastication and the act
of swallowing.
One-sided contraction of laryngeal and hyoid bone muscles can cause a rotation, lateral flexion
or lateral shift of the hyoid bone, thus affecting the equilibrium. There are several muscles involved in
the movement of the upper and lower jaw. The largest muscles are the masseter muscles responsible
for closing the upper and lower jaw. The second major muscles acting together with the masseter
muscles are the temporal muscles, whose function is to close the mandible. The third important pair
of muscles responsible for the lateral excursions of the mandible are the pterygoid muscles,
responsible for closing, left and right side protrusion and contra-lateral excursion of the mandible.
There are a number of muscles in each ear responsible for the movement of the ears that may affect
the normal function of the TMJ.
The majority of horses, except those with acquired and genetically disposed anomalies, have a
maxillary overbite when the head is held parallel to the ground. In a normal upward position the
mandible returns rostrally in the temporo-mandibular joint to its normal position. In a study with 3-
dimensional cinematic analysis of the equine TMJ a 6 mm rostro-caudal movement of the mandible
6
during the chewing cycle of normal light-breed horses was found (Bonin, 2001). The mandibular
mobility and correction of the acquired overbite has always been found after the correction of the last
molar tooth even at an age prior to the eruption of the sixth molar (Gatta et al, 1995; Krusic, 2004).

Figure 5a: TMJ left and right meniscus with surrounding

Figure 5c: Lateral view of temporo-mandibular joint
tissue

Figure 5b: Rostral pouch with the meniscus of the right TMJ Figure 5d: Ventral pouch with the meniscus of the right TMJ

The TMJ is supported and reinforced by ligaments and muscles that co-ordinate the movement
of the mandible for normal lateral excursions and mastication. Any tightness or contraction in the
muscles, tendons or ligaments of the TMJ mechanism will change the normal function of the TMJ. In
the event of these muscles tightening and shortening, the body then negatively compensates for the
imbalance and equilibrium. Any imbalance of tissue structures resulting from incorrect body static can
cause body fascial tightness contributing to TM dysfunction. On the other hand, any dysfunction of the
masticatory apparatus such as dental diseases, anomalies, teeth extractions and TMJ problems may
affect locomotion problems through fascial and muscle tightness. The proper function of the TMJ
mechanism therefore plays an important role in the whole function of the horse including leads, gaits,
balance and equilibrium.
The TMJ is one of the last joints in the body to develop. In contrast to man, the horse mandible
is displaced backwards as the condyles grow in an anterior-superior direction together with the third
premolar tooth. Growth and maturation of the TMJ is not completed till the end of the eruption of the
last, sixth molar tooth. Due to the abnormal height of the incisive teeth, last molar or irregularity of
any other molar tooth, the condyles may be subjected to displacement after unilateral mastication and
occlusion and/or functional interference. The excessive consummation of the cartilaginous meniscus
on the affected TMJ side may be found in young growing foals or older horses with gross
abnormalities of molar teeth (Figures 6a, b).

Figure 6a: Lesion of the left rostral and right ventral side of the meniscus Figure 6b: Lesion of the left rostral meniscus

7
 The lesion of the TMJ cartilaginous meniscus can be the consequence of excessive pressure
of the masticatory muscles due to the abnormal condylar position in horses with occlusal surface
abnormalities in the buccolingual plane as the last molar height difference. The primary lesion of the
TMJ meniscus has not been documented as a possible symptom of orthopaedic bone disease.
It is known that there is a close relationship between the condylar position and the height of the
molar occlusion structure, which may explain the grade of consumption of the occlusal surface of
molar teeth (Lotzmann, 1998). It is said that even small changes of the texture of any molar tooth can
contribute to the condylar displacement (Figures 7a, b). In horses with disorders of wear, especially
with supraeruptions of individual molar teeth (408, 308 or 411, 311 molar teeth) the occlusal surface
on the opposite dental arcade tends to be always extremely worn with a loss of surface texture. The
difference of the position of occlusal surface to condylar inclination can always be detected in horses
with a misalignment of incisors (Figure 7c).

Figure 7a: The position of the occlusal surface to Figure 7b: Condylar Figure 7c: Misalignment of
condylar inclination affects the height of occlusal displacement – schematically incisors and TMJ displacement
texture (Lotzmann, 1998) of a 28-year-old coldblood horse

Excessive wear of the normal occlusal surface of molar teeth and incisors is always found in
the “wave mouth” (undulating appearance of the occlusal surface of the molar arcades in the
rostrocaudalor mesiodistal plane, combined with the abnormally high sixth molar (311 or 411) in older
horses with primary or secondary TMJ dysfunction (Figures 8a, b, c, d).

Figure 8a,b,c,d: Stepped mouth with abnormally high inferior M3 right and left teeth and excessively worn occlusal
surface prior to and after correction of longitudinal grooves of maxillary teeth and the occlusal surface of mandibular
teeth, serrated in a way that presents a mirror image of the serrations of the upper arcade

TMJ is considered from the standpoint of traditional Chinese medicine as the energy centre
(Figure 9). Both joints are located in the network of energy vessels (Gb, Bl, 3-E, St, Si); which may
often be subjected to energy blockades or imbalances. The imbalances of energy vessels may result
from local mechanical displacement of the TMJ or from peripheral disorders of the hind limbs due to
abnormal static or poor conformation.

8
 Figure 9: The temporo-mandibular joint is located in the
network of energy waves

The most evident imbalance may be seen on the SI meridian passing the TMJ and descending
the neck laterally on the front leg down to the hoof. The energy imbalance of this meridian may be
one of the main causes of lower joint lesions after the compensation phase.
The most important energy meridian connecting the head and the hind legs is the Bladder
meridian (Bl), responsible for muscles and a majority of back problems. Any imbalance of energy
flows in this meridian may cause a sore back, asymmetric gate and imbalanced movement of the
entire body. In TMJ dysfunction several diagnostic acupuncture points are indicators of the energy
imbalance on the contra-lateral side of the TMJ lesion (Bl 10, 20,22,23,25, Bl 30). The Gall bladder
meridian (Gb), that connects the head and the hind legs, is responsible for projecting and pushing the
hind limbs forward. In the case of one-sided TMJ displacement this meridian may be blocked at the
level of the head (Gb 20), lumbar or hind limb region (Gb 26, 30, 34) on the opposite side of the trunk.

The TMJ plays the role of a regulator of lateral excursions during mastication, which enables
the horse to have mechanical digestion in the mouth and proper wear of growing teeth.

In horses with dental problems the mandibular bone in connection with the maxilla represent
the primary cause for dysfunction of the cranio-sacral system through temporal bones and the
tentorium cerebelli, which divides the small and big brain and has the function of maintenance of
tension around the basilar cranium bones.
Numerous muscles inserted in the mandibular bone can be contracted due to cranium bone
imbalances resulting from abnormal occlusion.

Mandibular movement is directly connected to the cranio-sacral rhythm (primary rhythmic

impulse). The normal occlusion depends on the balance between the cranio-sacral system and the
mandibular system. The occlusion is the result of the dynamic of several cranium bones and the
dynamic of the sphenobasilar joint. The cranio-sacral and mandibular system are built up from two
main systems: a dynamic, functional and adaptive system, represented by the TMJ, which is
connected with the first cervical vertebra atlas by myofascial tissues and the hyoidal bone, and a
gravitational system representing the osteo-articular Axis-Atlas-Occiput-Sphenoid-Complex (Evrard,
2003).
In holistic dentistry the TMJ is not an independent functional unit, but is interconnected with the
rest of the body through the stomatognathic system. The stomatognathic system includes the parts of
the head, the neck and the upper thorax representing the muscular, osseus, ligamentous, fascial and
nervous system. The stomatognathic system is responsible for the control of biting, chewing and
swallowing (Figure 10).

9
 Figure 10: The Stomatognathic system consisting of the
mandible, temporal bone, condyle, occiput, and atlanto-
axial joint

According to the causes of clinical symptoms found during a holistic examination, two kinds of
pathological changes may be diagnosed: primary or secondary lesions. The primary occlusive lesion
may be manifested as descending pathological changes, that can be initially compensated by the
TMJ and later by the hyoidal bone (os hyoideum) and by C1,C2,-C4, where the local muscle tightness
occurs due to the energy imbalance of four main meridians (Gb, Si, Bl, St).

Secondary C0
occlusive
lesion C1

Descending
lesions

C2
Primary
occlusive
lesion
C3
Descending
lesions
C4

Ascending
lesions

Figure 11: Primary and secondary occlusive lesions

The secondary occlusive lesion may be manifested as the ascending lesion of the occiput-atlas
C0/C1 axis. The ascending pathological lesions (deriving from diverse peripheral trauma or visceral
lesions) are compensated at the level of C1 and transformed into caudo-rostral forces causing the
rostral pression on the mandibular bone and compression of the TMJ.
In horses with dental problems the mandibular bone in connection with the maxilla represents
the primary cause for dysfunction of the cranio-sacral system through temporal bones and the
tentorium cerebelli, which divides the brain from the cerebellum and acts as a spanner to the
sphenobasilar symphisis (Bäcker and Solomon, 2004).
Numerous muscles inserted in the mandibular bone can be contracted due to cranium bone
imbalances resulting from abnormal occlusion. In an abnormal dental occlusion due to a variety of
dental problems the mandibular movement may influence the stability of head bones and cause even
its deformation, recognised in the form of head asymmetry in young horses with retained deciduous
caps or in older horses with chronic changes of the cranio-sacral system (Figures 12a, b).

10
Figure 12a: Head asymmetry in a Figure 12b: Head Figure 12c: Head asymmetry
4-year-old Standardbred asymmetry of 17 years old dressage horse
schematically

The TMJ joint is very sensitive and unstable in conjunction with both temporal bones. The one-
sided shift or displacement of the mandible and consequent muscle tension may occur always in the
case of gross abnormalities of molar teeth (shear mouth, wave mouth and step mouth with a high
inferior sixth molar tooth (411 or 311 according to the Triadan system for numbering the cheek teeth)
or in the case of superior brachignatism (Figures 13a, b)

Figure 13a: Superior brachignatism in a foal Figure 13b: Superior brachignatism in an adult horse

The mandibular bone is a paired cranium bone making lateral excursions in the form of outer
and inner rotation together with the extension and flexion of the sphenobasilar joint. The outer rotation
is influenced by temporal bones (Figures 14a, b), whereas the sphenobasilar symphisis (SBS) is in
flexion and the TMJ moves in a medial, caudal and ventral direction. Since the proportion of vertical
and horizontal mandibular parts in horses is 2:1 (in a human 1:1), TMJ anomalies are consequently
greater in horses than in man.

Figure 14a: Outer end rotation of the temporal bone (right Figure 14b: Inner rotation of the temporal bone (left excursion
excursion of mandible) of mandible)

11
 Figure 14c: Outer rotation of the temporal bone and Figure 14d: Inner rotation of the temporal bone and
mandible (Evrard, 2003) mandible (Evrard, 2003)

The inner rotation is influenced by temporal bones, whereas the sphenobasilar symphisis
(SBS) is in extension – the TMJ moves in a lateral, rostral and dorsal direction (Figures 14b, d).
The correction of the inner and outer mandibular rotation may be performed by osteopathic
treatment (local temporal bone and correction of peripheral lesions), correction of mandibular CSR
mobility (by the indirect or the direct method, or by compression or decompression of the TMJ) and by
correction of the dental occlusion. In most horses and even foals after the eruption of the third
premolar tooth the restricted mandibular rotation may be due to one-sided or both-sided occlusal
change, i.e. excessive >15° angulation of the molar occlusal surface in the buccolingual plane,
termed shear mouth and formed by irregular wear of molar teeth.
The movement of the upper and lower jaw has not been described and evaluated during the
past few decades, except in a recently performed 3-dimensional cinematic analysis of the equine TMJ
during the chewing cycle of normal light- and heavy-breed horses (Bonin, 2001; Carmalt et al., 2003).
The systematic study of the movement of the upper and lower jaw during the chewing cycle was
conducted by German researchers in the early forties (Leue, 1939, 1941).
According to Leue (1938, 1939) the mandibular movement can be monitored and described as
a 4-phase movement corresponding to the outer and inner rotation of the temporal bone and
mandible. During abnormal wear of the molar teeth the occlusal surface formed in the textured
surface is reduced to such an extent that the mandibular movement tends to be changed from the 4-
phase movement to a 3- or even 2-phase movement. It should be mentioned that too many worn
dental surfaces are not efficient enough for chewing properly because the dental arcades slide rather
than grind and turn the food. These changes were described by monitoring the mollograms of horses
showing different colic symptoms (Leue, 1941). During normal chewing the grinding tables of the
molar teeth should have a slight angle of 10-14 degrees, depending on the breed, in order to slide
over and maintain the textured surface. The normal movement of the mandible during the chewing
cycle is graphically presented in Diagram 1.

TOP VIEW
AB – closing and posterior movement of mandible
BC – cutting and pressing movement
CD – rostro-anterior movement
DA – end sliding of dental surfaces
SIDE VIEW
AB – closing and retrusion
CD – cutting and pressing rostro-lateral movement +
rostro-anterior movement
FRONT VIEW
AB – closing and retrusion
BC – cutting and pressing movement
CD – rostro-anterior movement
DA – end sliding of dental surfaces

Diagram 1: 4-phase movement of upper and lower jaw during mastication (modified according to Leue, 1939).

12
TEMPORO-MANDIBULAR DYSFUNCTION IN HORSES

Temporo-mandibular dysfunction is a term used in the field of dentistry meaning a group of

conditions, often painful, that affect the TMJ and the muscles that control chewing. TMD can affect
general health and does not cause only local changes. It is known from human literature that TMD
may be divided into three categories: myofascial pain, manifested in discomfort and pain in the
muscles that control jaw function, neck and shoulder muscles; internal derangement of the joint,
meaning a dislocated jaw or displaced articular meniscus, or injury to the condyle; and degenerative
joint disease which is a form of osteoarthritis rheumatoid arthritis in the TMJ (Metha et al, 1984).
Despite its recognised importance in human medicine, TMJ disorders and dental abnormalities have
been poorly studied. Some early studies on pathological changes of the TMJ in gross abnormalities of
molar teeth were performed in the systematic work of Hollatz (1910). During recent decades only
limited studies of TMJ function and anatomical structure were performed (Meierl et al., 2000; Bonin,
2001; Rosenstein et al., 2003).
The TMJ is one of the most important joints in the horse skeleton. In the horse the TMJ
dysfunction is specific to the TM joint and consists of pain in and around the joint, abnormal
movement of the mandible and even degenerative changes within the joint. Determination of the
range of movement of the mandible is a simple and objective method of assessing the TMJ function
and occlusion. A reduced range of movement to the left or right side may be a sign of disorder of the
musculature and/or of the TMJ mechanism. The lateral inter-incisal opening may be measured by the
opposite incisor movement (three incisors left or right), observing the maximum opening (Figures 14a,
b). The determination of occlusion is based on the fact of pushing laterally as far as possible without
using undue force, to determine the lateral excursion. The contact surfaces of the central incisors are
used as pointers for determination (Rucker, 1995).
Incisor movement (or opening) laterally may indicate an estimation of reduced occlusion to
30%, 2 incisors 66% and 3 incisors with movement laterally may indicate 100% occlusion. Restricted
lateral excursions of the mandible to one or the other side may often reflect the first disharmonies of
the contra-lateral TM joint due to abnormal wear of the occlusal surface or overgrowth of any
mandibular molar teeth on one side and consequently an abnormally high sixth molar tooth (311 or
411) of the opposite arcade.
The TMJ dysfunction may be reflected in any part of the body. The TMJ dysfunction and
consequent changes of other structures may be caused by dental problems, genetic factors,
traumatic factors, mechanical factors and emotional stress.

DENTAL PROBLEMS
The teeth are a part of the mandibular cranio-sacral system and may have a significant effect
on the function of TMJ. They are connected by nerves and energy vessels to the head and other
parts of the body as different organs. According to the detection of corresponding human acupuncture
points to the teeth, corresponding acupuncture points can be found in horses and dogs by controlled
acupuncture (Petermann, 2004). The teeth, identified according to the Triadan system, correspond to
different acupuncture points on the energy vessels of horses and are summarized in Table 2 and
presented in Figure 15. In human dentistry this method is used for the detection of teeth disorder
centres.

Figure 15: The triadan system of dental identification (Dixon at al.,

1999)

13
 Upper jaw:
11 11 10 10 10 10 10 10 10 20 20 20 20 20 20 20 21
Tooth 107 103 203 207 211
1 0 9 8 6 5 4 2 1 1 2 4 5 6 8 9 0
Kd Lu Gb Hr Kd Gb Gb Lu Gb St St Gb Lu Gb Gb Kd Hr Gb Lu Kd
Point
3 1 41 4 7 34 30 7 43 4 4 43 7 30 34 7 4 41 1 3

Lower jaw:
41 40 40 40 40 40 40 40 40 40 30 30 30 30 30 30 30 30 30 31
Tooth 411 311
0 9 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 9 0
Yin Bl Li Kd B Bl Cv Li Bl Bl Li Cv Bl Bl2 Kd Li Bl Yin
Point ? ?
Tang 11 15 6 l26 67 6 4 62 62 4 6 67 6 6 15 11 Tang

Table 2: Corresponding acupuncture points on teeth of the upper and lower jaw of the horse

Dental disease is related to the age and dental development of the horse. It can be basically
divided into four categories: developmental, traumatic, infectious and neoplastic. However, the
division of dental disease to four categories is difficult because developmental problems of occlusion
and tooth growth may predispose to different traumatic and infectious problems (Easly, 1991).
Dental disease with disorders of development and eruption and variation in the position of
cheek teeth, disorders of wear, traumatic damage, idiopathic fractures, periodontal disease, retained
deciduous incisors with subsequent crowding and rostral displacement of the retained incisor, less
common incisor displacement by overcrowding of the permanent incisors in the absence of retained
or supernumerary teeth, dental or bone tumours, supernumerary permanent incisors and
miscellaneous dental abnormalities have been evaluated by Dixon et al. (1999 a, b, c; 2000) on a
large number of horses of different breeds and different ages (Table 3). An interesting approach with
improved diagnostic criteria and retrospective examination of case records, dental specimens and
radiographs was applied in the light of improved knowledge.
Cases Bitting
Age Cases Cases
involving problems/
(years) No teeth involving involving Weight Facial Periodonta No clinical
No cases mandibular Quidding abnormal Halitosis
Median involved mandibular maxillary loss swelling l disease signs
& maxillary head
(range incisors incisors
incisors carriage

11 2 3 8 2 2 6 2 3
Traumatic fractures 23 0 0 0
25% (1-9) 27.3% 72.7% 18.2% 18.2% 54.5% 18.2% 27.3%

5
5 1 2 2 1 1 1 3
Retained deciduous incisors 11,4% 13 0 0 0
(3-5) 20% 40% 40% 20% 20% 20% 60%

3
3.5 1 3 1 1 1 2 1
Developmental displacement 6.8% 12 0 0 0
(0.5-17) 31.3% 100% 33.3% 33.3% 33.3% 66.7% 33.3%

4 6,5 4 1 1 3
Brachygnathia 0 0 0 0 0 0 0
9.1% (2-10) 100% 25% 25% 75%

Prognathia 0 0 0 0 0 0 0 0 0 0 0 0 0

4 5 2 2 4
Supernumerary incisors 18 0 0 0 0 0 0 0
9.1% (3-6) 50%) 50% 100%

3 14 2 1 3
Dental tumour 10 0 0 0 0 0 0 0
6.8% (1-14) 66.7% 33.3% 100%

3 1 2 3
Abnormalities of wear 5 16 0 0 0 0 0 0 0
6.8% 33.3% 66.75% 100%

3 14 1 2 2 2 3
Primary periodontal disease 17 0 0 0 0 0
6.8% (11-21) 33.3% 66.7% 66.7% 66.7% 100%

3 11.5 1 2 1 2
Idiopathic fractures 3 0 0 0 0 0 0
6.8% (9-14) 33.3% 66.7% 33.3% 66.7%

3 5 1 2 1
Apical infection 3 0 0 0 1 1 0 0
9.1% (4-10) 33.3% 66.7% 33.3%

Table 3: Dental diseases and clinical symptoms of 42 horses with equine incisor disorders (Dixon et al., 1999)

In older literature there are some important studies on equine dental disorders in German
literature summarized in the publications of Ostertag, (1903) as inherited dental disorders, abnormal
dental number (oligodonty, pleodonty, heterotropic pleodonty, abnormal dental position, jaw
anomalies such as gross brachygnathia or “parrot mouth”, prognathia or “undershot”, abnormal
structure of hard dental substances, abnormal change of deciduous teeth, abnormal wear of the
occlusal surface and individual cheek teeth (“shear mouth”, “wave mouth”, “step mouth”, prominent
overgrowth of the lingual aspect of mandibular cheek teeth and the buccal aspect of maxillary teeth,
the abnormal early wear of the whole occlusal surface, ruminant occlusal surface and “scissor mouth”
as bevelling of the molars, and prolongation of the molar crown (exsuperantia dentium).
Further original extensive research work on dental diseases is limited to a few authors in the
German language, dealing with the terminological system of Ostertag (1903), Joest et al., (1922),
Joest (1926), and Günther and Günther (1859). Relatively detailed scientific research on periodontal

14
disease and its possible aetiology during a period of 14 years on clinic patients and separately on
abattoir specimens was performed by Kurtzwig (1912). The most representative source of information
on normal anatomy and dental diseases with the numerous citations of original publications are
considered to be the original research work of several authors at the beginning of last century
(Klingemann, 1906; van der Veen, 1908; Ehlers, 1911; Weiss, 1911; Niklas, 1915; Finger, 1920;
Meyer, 1921; Spinner, 1922; Bruder, 1922; Westman, 1922; Chorin, 1922; Bruhns, 1931; Ruprecht,
1936; Schlack, 1938; Obiger, 1939; Leue, 1941).
The neglect of equine dental studies can be found in French literature, where only a few
authors are known (Magitot, 1873, 1875; Goubeaux et Barrier, 1884). The scarcity of dental studies in
past centuries was noted also in English literature (Dixon et al., 1999). In the last century in English
literature only a few important dental studies have been performed mainly on horse cadavers from
abattoirs (Colyer, 1906; Baker, 1979; Wafa, 1988).
Dental disorders are of major clinical importance in the horse with a British survey of equine
diseases presented by Anon (1965). In a survey of dental abnormalities found in horses with no signs
of dental disease and a group of horses with clinical symptoms of dental disease Uhlinger (1987)
found 24% of horses with dental abnormalities, suggesting that proper dental examinations have
often been neglected due to the dangers and difficulties associated with such examination. During
recent years in the USA equine dental disorders were ranked as the third most common medical
problem encountered in large animal practice (Traub-Dargatz et al., 1991).
Different dental abnormalities, manifesting in the form of abnormal wear of the occlusal
surface, may contribute to abnormal movement of the upper and lower jaw and thus affect the TMJ.
Overgrowths due to the disorders of wear are a major cause of dental disorder in hypsodont species,
to which belongs the domesticated horse (Becker, 1962). It is still unclear whether these overgrowths
of enamel are the result of abnormal chewing activity due to primary periodontal disease or due to
TMJ discomfort. It is known that enamel overgrowths regularly develop on the medial or lingual
aspects of the mandibular, and on the lateral or buccal aspect of the maxillary molar teeth. From the
early studies of Leue (1939) and Leue (1941) measuring the lateral excursion of grinding movements
in horses chewing grass, oats or chaff, excursions of 60 mm, 38 mm and 23 mm, respectively, were
found. Leue (1941) proposed that fibrous food such as hay or grass could readily be maintained on
the occlusal surface of the mandibular teeth as they moved laterally to their full extent, thereby
allowing a complete horizontal grinding movement. However, just a limited quantity of particulate food
could be retained on the narrow mandibular occlusive surface. Therefore a primary vertical
mandibular movement, with minimal latero-medial excursion, was required to maintain particulate
food between the occlusal surfaces. Diets high in concentrates, especially flaked or semi-ground, also
greatly reduce the length of time horses chew forage and so further predispose to such enamel
overgrowths (Dixon, 1999).

Diseases of the equine molar tooth crown are considered to be found with increasing frequency
(Dixon et al., 1999). These include diasthemata, traumatic or idiopathic fractures of the crown,
abnormalities of wear such as transverse ridges, wave-, step-, shearmouth, and supernumerary or
missed numbers of molar teeth (polydontia, hypodontia). The inflammation with consequent carries
and root inflammation of any molar tooth may cause one-sided overload and different muscle and
ligament tightness, contractions and abnormal function of the TMJ. The removal of cheek teeth in
mature horses can cause the primary occlusal problem due to the continued dental eruption of the
opposing tooth. The extraction of cheek teeth may cause the migration of a caudal tooth to the space
left by a removed tooth leaving a diasthema (open space), representing a source of periodontal
disease. Further complications after surgical tooth extraction, fractured cheek teeth, sequestration
and fistula formation may influence the normal functioning of TMJ. An important cause of the
abnormal occlusion and function of TMJ is the retarded deciduous teeth change during the age of two
and half and four years. During retained deciduous teeth several observations can be made regarding
the function of the TMJ, general health, body weight maintenance, equilibrium or balance problems.
In Standardbred horses a change in normal and specially retarded deciduous teeth can cause
severe symptoms of exercise intolerance, body weight loss and locomotion problems? In a long-term
study performed under a controlled nutrition programme, body weight monitoring, orthopaedic control
and exercise testing the majority of horses showed reduced aerobic and anaerobic capacity,
significant weight loss and several locomotion problems in the form of asymmetric stride during the
period of deciduous teeth change (Graph 1).

15
 540
540

520
520

500
500
Body weight [kg]

480

Body weight [kg]

480

460
460

440
440

420
420

400
400

380
380
Aug 02
Sept 02
Oct 02
Nov 02
Dec 02
Jan 03
Feb 03
March 03
April 03
May 03
June 03
July 03
Aug 03
Sept 03
Oct 03
Nov 03
Dec 03
Jan 04
Feb 04
March 04
May 04
June 04

Feb 03

March 03

April 03

May 03

June 03

July 03

Aug 03

Sept 03

Oct 03

Nov 03

Dec 03

Jan 04

Feb 04

March 04

May 04

June 04
M o n th Month

Graph 1a: Body weight changes during a training period in a Graph 1b: Body weights during a training period in a group of
group of 3-year-old Standardbreds after dental corrections 3-year-old Standardbreds after dental corrections

The results of a clinical examination and dental correction with the treatment of corresponding
neck and dorsal muscle soreness showed the normalisation of physical capacity, body weight
recovery and normalisation of gait within a 4-week period of time. In contrast, horses with a problem
of retarded deciduous teeth change have shown neither performance improvement nor body weight
gain during this period. These changes may be found in the form of painful maxillar and mandibular
swellings that persist over a period of change in normal deciduous teeth and eruption of permanent
teeth (Figures 16a, b, c, d).

Figure 16b: Retained 108 and 408 molar teeth with

Figure 16a: Retained 108 and 408 molar teeth with mandibular
maxillar swellings (cysts) with a 4-year-old
swellings (cysts) with a 4-year-old Standardbred
Standardbred

Figure 16c: Retained 107

and 407 molar teeth with
maxillar swellings (cysts)
with a 3-year-old
Standardbred

Figure 16d: Retained

107 and 407 molar teeth
with maxillar swellings
(cysts) with a 3-year-old
Standardbred

16
 Molar tooth alveolitis (tooth root infections, periapical disease or apical infections) is a relatively
common but not so easily diagnosed dental condition. In a recent study on the appearance of dental
diseases of the horse by Archer et al. (2003) it was revealed that periapical infection is likely to be
identified by the scintigraphic method as shown in previous reports (Metcalf et al., 1989; Boswell et
al., 1999; Gayle et al., 1999; Semevolos et al., 1999; Weller et al., 2001). In older horses the affected
horses may present very large swellings in chronic periapical disease, even with periodically purulent
discharge and symptoms of digestive disorders and weight loss (Figures 17a, b, c, d, e). Alveolitis
can occur in young horses during the deciduous teeth change, in the case of incomplete removal of
milk caps affecting the TMJ mechanism by overloading the opposite TMJ side. In older horses
alveolitis may occur after dental damage, consequent feed impaction and periodontal disease.

Figure 17a: Mandibular swelling due to Figure17b: Occlusal surface prior to Figure 17c: Occlusal surface after
309M chronic apical infection correction and extraction of 309 M correction and extraction

Figure 17d: X-ray picture

of the 309M affected tooth
with secondary
granulomatous reaction

Figure 17e: X-ray

picture of the 309M
missing apical part of the
tooth root

GENETIC FACTORS
Genetic factors such as an inherited abnormal proportion between the upper and lower jaw, too
big or too small teeth, supernumerary incisor and molar teeth on one side (Figures 18a,b), occlusion
anomalies, brachignatia and prognatia in some horse breeds may contribute to abnormal mastication
and prominent overgrowth of molar teeth with signs of TMJ dysfunction. The most frequent occlusal
anomaly in the form of brachygnathia of the upper jaw can be found in thoroughbred horses.

Figure 18a: Supernumerary

Figure 18b: Ten permanent supernumerary maxillary
maxillary molar teeth
incisors

17
TRAUMATIC FACTORS
Traumatic factors like different traumatic lesions of the upper or lower jaw and mandibular
fractures can cause severe abnormal function of the TMJ mechanism, manifested in abnormal wear
of molar and incisive teeth. In extreme cases of jaw injuries and poor teeth care the TMJ dysfunction
may cause an overgrowth of the upper molars and reduced mechanical function with symptoms of
changed body condition and dramatic weight loss (Figures 20a, b, c, d).

Figure 20a: Acquired shear mouth in a 9-year-old stallion Figure 20b: Acquired shear mouth in a 9-year-old stallion
(mandibular fracture) prior to first and third correction of the (mandibular fracture) after first and third correction of the
occlusal surface occlusal surface

Figure 20c Misalignment of incisors of a 9-year-old stallion prior Figure 20d: Misalignment of incisors of a 9-year-old stallion after
to first and second correction first and second correction

MECHANICAL FACTORS
The most important mechanical factors contributing to TMJ dysfunction may be static changes
of the skeleton due to inherited factors such as normal conformation of legs and hooves and due to
acquired abnormalities as abnormally high or too low hooves. The most frequent mechanical factor
can be considered different shoeing errors that can affect the hip and sacroiliac joints and through the
spinal cord the TMJ. Any primary peripheral joint pathology due to genetically acquired orthopaedic
bone disease (OCD) or direct trauma of the peripheral joints may cause TMD. The primary
peripherallesion can cause, through the unequal distribution of body weight on four legs, a contra-
lateral overload and consequent contraction and compression of the TMJ. The abnormal position of
the hyoid bone, which is connected with eight principle muscles to the mandible and breast and thus
with the whole static and locomotion system, can affect the function of the TMJ. The hyoid bone is
considered in osteopathy as a mediator between body and head facial tissues acting as a neutralising
mechanism during extreme forces (Bäcker and Solomon, 2004). Therefore the hyoid bone may be
frequently involved in restrictions of different parts of the body manifesting in asymmetric stride and
equilibrium problems.

EMOTIONAL FACTORS
Since the horse is an animal with a very strong emotional body constant emotional stress
caused by painful situations or mishandling can provoke myofascial contractions causing
compression on the TMJ and contraction of the hyoid bone and its abnormal position. Trauma within
the mouth can often create painful physical conditions locally and possibly in any other parts of the
horse’s body. Unfortunately, the horse has an enormous ability to compensate for his dental problems
because they arise so slowly and they adapt to the painful situation. The physical pain that extends
beyond the time of the actual dental problem may be compensated for to a certain stage, as
emotional discomfort becomes predominant and the horse changes his behaviour. This is often the
reason why emotional pain as a consequence of long-lasting physical pain is not recognised by the
owner. If the horse has been compensating for his painful situation over several years, the memory of
the pain can last much longer than the pain itself. During the long-term experience of proper dental
treatment of horses it has been shown that younger horses improve their function of the TMJ and
their locomotion problems within a short period of time. The improvement of gait asymmetry may be
18
supported by acupuncture, acupressure, chiropractic and cranio-sacral therapy. In older horses that
have been compensating for more than six years by abnormal carriage of the head, holding their neck
and vertebral column in a position of minor discomfort, their emotional state and behaviour have
remained abnormal for a longer period of time, whereas their locomotion problems have improved
significantly in a relatively short period of time.

Symptoms indicating a blockade of C1 - Headshaking, uncontrolled head movements

Mastication problems and unknown weight loss
- Head/bit problems
- Stiff, sore neck muscles
- Abnormal head carriage,
- Problems in turning and/or stretching the neck
- Abnormal chewing of the feed –
- Quidding, dropping of food from the mouth
- Horse masticates very slowly (less than 20 circles
per min.), mostly due to dental problems
- The faeces contains undigested feeds and forage
particles longer than 5 mm (Gatta et al., 1995)
- Increased salivation with dense saliva during
mastication

Abnormal position of upper and/or lower jaw
Abnormal wear of teeth (incisor and molars)
Problems occurring during riding or driving the horse
Table 4: Summary of symptoms indicating TMJ dysfunction in the horse.
- In all occlusion problems the TMJ is overloaded
- All kinds of irregularly consumed or deformed teeth
may be the consequence of TMJ problems
- Stretching of the tongue out of the mouth
- Balance and equilibrium problems
- Pulling the bit; excessive salivation
- The horse tends to hold the head upwards or
sideways rigidly according to the affected TMJ side
- Rigid reaction of the back tending to take an
abnormal position in order to avoid the painful
situation
- Unwilling to take a bit
- The horse will not turn the neck to the left or right;
the side which is easier to handle or to turn to is
affected by sternocleidomastoideus muscle
contraction; the horse can turn to the affected side
due to painful muscles
- The muscle over the C1 on one or both sides may
be stiff or even swollen;
- stiff and sore muscles on the contra lateral side
from the last breast or lumbal vertebra; painful
reaction on Shu acupuncture points (Bl30);
- reduced extension of the contra-lateral hind leg
muscles and shorter stride – asymmetric stride
-

TEMPORO-MANDIBULAR JOINT AND ITS INFLUENCE ON LOCOMOTION

Head and neck movements are one of the most obvious and reliable diagnostic signs in
detecting mandible position changes and TMJ dysfunction. Traditionally it has been assumed that
lowering the head moves the centre of gravity forward and vice versa. Through computer modelling, it
has been shown that these static effects on the centre of gravity are minimal. It is the dynamic effect
of pivoting the head and neck around a rotational point at the base of the neck, resulting in an inertial
interaction between the trunk and the head/neck segments, that shifts weight from a lame limb to the
diagonal and contra-lateral limbs (Vorstenbosch et al., 1997). This reaction of the body balance may
be clinically detected in every horse with a TMJ dysfunction and mandibular posture change.

The mastication system with perfect occlusion and central regulatory TM joints play an
important role in maintaining the body balance and proper locomotion.
The influence of abnormal occlusion regarding the height and eruption state of the 311 or 411
molars during the period of deciduous teeth change and later on after eruption of the inferior sixth
molar teeth may be manifested by problems of locomotion and maintenance of body balance.
The incidence of temporo-mandibular joint (TMJ) dysfunction after uneven wear of the last
molar teeth can be manifested in a series of biomechanical problems such as stride asymmetry or as
different lameness symptoms.
19
 The first important atlanto-occipital joint, constructed from two ellipsoid joints that enable the
movement of the head in vertical directions (stretched and lower position), is exposed to numerous
abnormal blockades, manifested in different symptoms of head reactions. It also represents the initial
symptom of TMJ derangements and dysfunction in the horse. The second head joint, the atlanto-
epistrophicus or axial vertebral joint, which supports the atlas, is connected with three joint surfaces,
partly concave and partly convex, and enables the axial movement of atlas and head (Nickel et al.,
1961). Since all three joint surfaces remain in constant contact, only a small deviation of the normal
position suffices to affect the joint integrities. These two cranio-cervical joints are responsible for all
head movements and maintenance of the forward head position and body equilibrium.
In one-sided TMJ imbalance (dislocation, compression) a side inclination of the atlas C1 and
consequent tension of atlanto-occipital joint muscles and ligaments occurs (Figures 21a, b).

Figure 21a: Dislocation of C1 vertebra Figure 21b: C1 muscle swelling

The neck muscles (sternocleidomastoideus and sternocleidotransversarius) of the affected side

tend to be contracted due to the decreased energy flow in the Bl, Gb, St, Si and 3-E meridians (the
diagnostic points Bl10,Gb20 are painful). The upper and lower neck muscles are painful on the
affected side and cannot be extended or stretched to the opposite side during work or manual
manipulation. The front leg of the affected side has a shorter stance and lower swing phase during
the adaptation phase, whereas during the compensation phase lameness may appear.
Regardless of the type of horse’s activity (dressage, spring or race horses), abnormal head
carriage and locomotion problems occur as the laterality disorders always cause the dysfunction of
TMJ, affected by the prominent overgrowth of 311 or 411 molar teeth. The symptoms of head
carriage and locomotion problems can be interpreted as energy imbalance in meridians or changes at
the level of the nervous system as shown in the reflex block of the ganglion in laterality disorder.
During a clinical examination, the horse with the laterality problem demonstrates a painful reaction in
the affected TMJ with the contraction of the sternocleidomastoideus and the
sternocleidotransversarius muscle. In veterinary medicine the symptom of inversion is well known in
horses and dogs. It represents the reflex block of the ganglion stelatum or a mechanical block of the
first rip, causing a change in the reflective reaction between the sympathetic and the parasympathetic
nervous system (Roesti, 1997). The horse, standing on four limbs, with a consequently horizontal
position of the spine and lacking clavicular bone, is predisposed to relatively frequent inversion. The
incidence of inversion is predisposed also by a heavy head and long neck ligament on the upper side
and clavicular band, which is bound with pars cleidomastoidea to the mastoid and with pars
cleidotransversaria to the atlas. There is a clear evidence of the manifestation of the inversion of
ganglion stelatum and diagnostic acupuncture points Gb20/Bl10, which represent the sympathic and
parasympathic basis (Zeitler and Bahr, 1987).

In order to maintain the body balance the contra-lateral hind leg is subjected to take and carry
an excessive load during the adaptation phase. The contra-lateral hind leg cannot be stretched
completely (100%) due to the blocked energy path (Bl30 positive) and consequent reduced gluteal
muscle elasticity.
After a longer compensation period of TMJ dysfunction and consequent laterality problem
different joint pathologies may develop. It is interesting that pathologic changes of the contra-lateral

20
leg appear after a short compensation period first in the form of hyperextension of knee ligaments
and later in the form of degenerative joint disease of the tarsal joint.

The asymmetric stride can be detected either in riding horses as well as in trotters during this
adaptation period. In Sweden considerable work on trotting Standardbreds has been done. One of
the interesting findings in relation to normal gait is that, at the start of training, the majority of
Standardbreds already show left/right asymmetries in the lengths and durations of the left and right
steps, with individual horses differing in the direction of the asymmetries. These asymmetries become
more pronounced as training progresses (Drevemo et al., 1987).
In horses, the asymmetrical stride of the hind legs can often be observed during the first
“compensatory phase” of body balance problems with evident TMJ dysfunction and last molar teeth
irregularities. As the horse teeth continuously grow as permanent teeth almost until the age of twenty
years from 4 to 7 mm per year, the unilateral mastication can easily cause a different consumption of
the teeth on the working side of the upper and lower jaws. Clinically, the height difference between
the left and the right sixth inferior molar tooth, whose eruption occurs earlier than the eruption of the
superior tooth, can easily be detected by regular monitoring of the teeth with a digital camera. In
young race horses, which have to perform at a higher speed, the irregular stride, asymmetrical
extension of the hind legs or even lameness symptoms occur in cases of unequally high last molar
teeth and the consequently affected TMJ (Krusic and Marcolini, 2002)

Changes in the TMJ position are due to the abnormal appearance of the occlusal surface of
molar teeth rows in the rostro-caudal (mesiodistal) plane as in higher ones (311 or 411 molar tooth,
which causes the anterior-superior condylar displacement and restricted movement of the mandible).
In palpation of the TMJ the intra-articular space will be decreased. If the condition worsens, the
posterior attachment will become even more stretched, thinner and weaker, and the condyle will
migrate anteriorly. The lateral excursions of the mandible become more reduced and the mastication
frequency differs from one side to the other. The evidence of changes in the condylar position are
local pains in the joint and subsequent compensatory pains along the vertebral spine causing an
abnormal position or even vertebral subluxation.

Both side TMJ imbalances may be manifested in a variety of symptoms of altering asymmetric
locomotion and abnormal shoulder position.
An abnormal conformation or changed body static due to the errors in shoeing or peripheral
trauma of the limbs can lead to TMJ problems.
Any joint trauma of a hind leg as in traumatic arthritis or joint lunation can cause overloading of
the opposite leg, subsequent contraction of pelvic muscles and ligaments, muscles of the vertebral
spine, shoulder, neck and compression of the TMJ with symptoms of dysfunction. Several important
neck vertebral problems are summarized in Table 6.

Manifestations Changes of organs,

Important nerves Structural
Vertebra during riding , behaviour, other
of the segment symptoms
driving disturbances
Neck cannot be turned
N.cervcalis innervating: to the left or right side;
m.rectus cap., obliq. cannot hold the head Behavioural changes
cap., M.splenius and and even tail straight, Painful neck and head
C1 block – dislocation
longus cap., body balance problems, Thyroidal dysfunction (Ram.
TMJ problems
C1 N.occipitalis innervating
CS-lesions
contra-lateral blocked N.cervical.)
the ear breast and/or lumbar Dental problems, retained
L1 block
N.hypoglosus (tongue) muscles; caps, abnormal occlusion,
Ganglion cervical des asymmetric gate of the etc.
sympaticus hind legs

N.cervicalis II (sensile Hyoid bone block

The horse will not take Dental problems, occlusion
asts to M.sternocephal. TMJ problems
a bit, head shaking and anomalies, retained
C2 N.auriculus mag. and Neck muscles blocked
abnormal head carriage deciduous caps, very slow
caudalis C2 block very often
during mastication or quick mastication
N. facialis combined with L4 block
Cannot hold on line Muscle soreness
C3 block is often
during gallop, changing (sternocleido-mastoideus,
C3 N.cervicalis III combined with the L3
of gallop, trotter can not sternocleido-trnsversarius
block
go straight, on the blocked side;
Rigid and painful neck The horse is stiff in the Horse is not willing to follow
N.cervicalis IV (Mm
muscles – on one side mouth, tends to hold the leads, painful reaction of
C4 longus capitis, longus
more, by palpation of the head and neck to lower neck muscles (as in
colli, scaleni)
lower m.sterno- one side, cannot be C3)

21
 cleidomast. Turns the turned to the opposite
neck to side side
Table 6: Vertebral problems (blockades) and their

LOCAL SYMPTOMS OF TMJ DYSUNCTION

A painful reaction of the affected TMJ in the intra-articular space and dorsally to the joint can be
palpated (Si-19). The palpable joint space between the mandibular condyle and the arcus
zygomaticus may be different in the affected joint due to the contracted masseter muscles and
displacement of the mandibular condyle (TMJ-block). In some horses a painful reaction of the TMJ
can be manifested by panic head-shaking and distressed behaviour.
The space between the mandibular bone and the wing of the C1-atlas is significantly
reduced or even closed (Figures 22a, b). The swelling of the C1 muscles is almost always present in
the case of dislocation of the atlas, accompanied by biting problems and abnormal head carriage and
quidding (dropping of food) or masticatory problems.

Figure 22b: Reduced distance between vertical part of

Figure 22a: Normal distance between vertical part of mandible and lateral
mandible and lateral wing of atlas on horse with TMJ
wing of atlas
disorder

CONCLUSION

The TMJ is one of the most relevant parts in the examination of dental problems in horses. In
humans it is known that TMJ dysfunctions may often cause the asymmetrical position of the hips and
consequent muscle contractions and differences in the length of the legs (Stracham and Robins,
1965). In horses the TMJ function and disorders have only been recently described by two authors of
cranio-sacral therapy and osteopathy as the most important joint of the horse skeleton (Bäcker and
Solomon, 2004; Evrard, 2003; Evrard, 2004). Successful correction of different restrictions of the TMJ
mechanism (occurring after the compensation phase) by proper correction of the occlusal surface has
demonstrated the important role of the TMJ in the normalisation of masticatory function and
locomotion.
In the past, balancing of the horse during a performance has mainly been done by utilising
different harness accessories and orthopaedic shoe correction. The limited knowledge of TMJ
function, its role in the maintenance of body balance and a lack of proper dental work have been the
principle causes for the poor success of balancing horses in all areas of activity. The consequences
of the short- or long-term balance problems caused by TMD may be weight-bearing form of lameness
after the compensation phase of maintenance of body equilibrium. The clinical symptoms of
lameness should be considered as a consequence of insufficient compensation of the locomotion
system and not as primary lesions of the affected limbs.

Due to the high incidence of locomotion disorders in sport and race horses during the period of
intense teeth growth and formation of normal occlusal surfaces, it is necessary to regularly examine
the function of TMJ and occlusion of dental arcades. The practical work has shown that a very high

22
percentage of the orthopaedic problems including gait alterations, stride asymmetry and different
symptoms of leg lameness are directly related to the TMJ and teeth problems.

SUMMARY

Three aspects of the role of teeth are presented in the holistic approach to TMJ dysfunction in
horses: the aspect of mechanical digestion, important for the growth and maintenance of all biological
functions; the aspect of the role of teeth in the normal function of TMJ, i.e. the ability to move the jaw
properly affecting the body's balance and equilibrium; and the aspect of dental problems affecting the
alteration of behaviour and the psychological state.

The role of teeth in mechanical digestion after dental correction has shown a significant effect
on digestibility of organic matter and some macro- and micro-minerals. Normal function of the TMJ as
the central regulator of teeth function during mastication is of vital importance for the horse’s health
and biomechanical functions of the whole body.
Dental problems and diseases can cause through improper function and position of the upper
and lower jaw a dysfunction of the cranio-sacral system. The cranio-sacral system is a functional unit
including the cranium and sacrum with all meningeal layers, bone structures, ligaments, cerebro-
spinal fluid and other additional systems such as nerves, vessels, lymph vessels, endocrine glands,
the respiratory system and the muscle-skeletal system. It is housed within the bones of the skull and
face down through the spinal column and into the sacrum area, representing a semi-closed hydraulic
system with a palpable rhythm separate from either heartbeat or respiration rate. Moreover, it is
intimately related to the central nervous system, therefore a restriction within this system can give rise
to many sensory, motor or neurological symptoms.
The importance of the normal structure and function of the temporo-mandibular joint (TMJ) is
described in the light of present and past knowledge. The TMJ is an incongruous joint formed by the
temporal bone and the mandible, containing a fibro-cartilaginous meniscus, which is interposed
between the two articular surfaces in the form of a fixed double cartilaginous layer of the arcus
zygomaticus. When these bones are misaligned and not articulating properly due to primary or
secondary occlusal lesions, the TMJ mechanism cannot function optimally. This condition is known as
Temporo-mandibular Dysfunction (TMD) and is used in dentistry as a diagnosis for people with
tightness and dysfunction of the TMJ mechanism. Any imbalance of tissue structures resulting from
incorrect body static can give rise to body fascia tightness and contribute to TM dysfunction.
Inversely, any dysfunction of the masticatory apparatus due to dental diseases, anomalies, teeth
extractions and TMJ problems may affect locomotion problems through the body fascia and muscle
tightness. The proper function of the TMJ mechanism therefore plays an important role in the whole
function of the horse including leads, gaits, balance and equilibrium. Due to dental abnormalities and
abnormal wear of the occlusal surface an excessive consummation of the cartilaginous meniscus on
the affected TMJ side may be found in young growing foals or older horses. There is a close
relationship between the condylar position and the height of the molar occlusion structure that may
explain the grade of consumption of the occlusal surface of molar teeth.
The excessive wear of the normal occlusal surface of molar teeth and incisors is always found
in “step mouth” and “wave mouth” in older horses with primary or secondary TMJ dysfunction.
TMJ can be considered as the energy centre located in the network of energy vessels (Gb, Bl,
3-E, St, Si), that may be subjected to energy blockades or imbalances in the case of TMD.
Locomotion problems such as stride asymmetry, abnormal head carriage and laterality problems can
be explained and diagnosed by diagnostic acupuncture points.
The cranio-sacral and mandibular system are connected together and built up from two
systems: a dynamic, functional and adaptive system, represented by TMJ, connected with the first
cervical vertebra atlas by myofascial tissues and the hyoidal bone, and a gravitation system
represented by the osteo-articular Axis-Atlas-Occiput-Sphenoid-Complex. TMJ is a functional unit,
interconnected with the rest of the body through the stomatognathic system including the head, neck
and upper thorax with the muscular, osseus, ligamentous, fascial and nervous system. It is
responsible for the control of biting, chewing and swallowing. In horses with TMD two kinds of lesions
can be recognised. The primary occlusive lesion may be manifested as descending pathological
changes with local muscle soreness and local blockades of C1-C3 vertebrae due to the energy
imbalance of four main meridians (Gb, Si, Bl, and St). The secondary occlusive lesion may be
manifested as an ascending lesion of the occiput-atlas axis resulting from peripheral trauma or
visceral lesions.

23
 The mandibular bone is a paired cranium bone making lateral excursions in the form of outer
and inner rotation together with the extension and flexion of the sphenobasilar joint. The outer rotation
is influenced by temporal bones, whereas sphenobasilar symphisis (SBS) is in flexion and the TMJ
moves in a medial, caudal and ventral direction. The inner rotation is influenced by temporal bones,
whereas sphenobasilar symphisis (SBS) is in extension – the TMJ moves in a lateral, rostral and
dorsal direction. Restricted mandibular rotation may be due to one- or both-sided occlusal change
because of abnormal wear of the molar occlusal surface.
The systematic study of the movement of the upper and lower jaw during the chewing cycle
performed by German researchers during the previous century and recently a 3-dimensional
kinematic analysis of the equine TMJ during the chewing cycle of normal light- and heavy-breed
horses have shown the influence of normal and abnormal jaw movement on the efficiency of grinding
and wearing the occlusal surface.
Temporo-mandibular dysfunction is a term used in the field of dentistry meaning a group of
conditions, often painful, that affect the TMJ and the muscles that control chewing. TMD can affect
not only local changes, but overall health. The condition known as TMD occurs in all horses
regardless of discipline and breed. The TMJ dysfunction and consequent changes of other structures
may be caused by dental problems, genetic factors, traumatic factors, mechanical factors and
emotional stress.
The teeth are a part of the mandibular cranio-sacral system. They represent according to
controlled acupuncture the electronic valves in energy vessel circuits and may have a significant
effect on the function of TMJ and other body regions.
Dental disease with disorders of development and eruption, disorders of wear, traumatic
damage, idiopathic fractures, periodontal disease, tooth root infections, periapical disease or apical
infections, retained deciduous incisors with subsequent crowding and rostral displacement of the
retained incisor, incisor displacement by overcrowding of the permanent incisors in the absence of
retained or supernumerary teeth, dental or bone tumours, supernumerary permanent incisors and
other dental abnormalities may contribute to abnormal movement of the upper and lower jaw and
thus affect the TMJ.
Genetic factors such as an abnormal proportion between the upper and lower jaw, too big or
too small teeth, supernumerary incisor and molar teeth, brachignatia and prognatia may give rise to
abnormal wear and prominent overgrowth of molar teeth with signs of TMJ dysfunction.
Traumatic factors like different traumatic lesions of the upper or lower jaw and mandibular
fractures can cause severe abnormal function of the TMJ mechanism, manifested in abnormal wear
of molar and incisor teeth.
The mechanical factors contributing to TMJ dysfunction can be static changes of the skeleton
due an abnormal conformation of legs and hooves and acquired abnormalities (hoof imbalances)
such as shoeing errors that can affect the hip and sacroiliac joints as well the TMJ through the spinal
cord.
The horse is known as an animal with very strong emotions. Therefore constant emotional
stress caused by painful situations or mishandling can provoke the myofascial contractions causing
compression on the TMJ and contraction of the hyoid bone and its abnormal position. The trauma
within the mouth can often create painful physical conditions locally and possibly in any other part of
the body. The physical pain that extends beyond the time of the actual dental problem may be
compensated for to a certain extent, as emotional discomfort becomes predominant and the horse
changes his behaviour. The proper dental treatment of horses has shown that younger horses
improve their behaviour, their function of TMJ and their locomotion problems within a relatively short
time.
The incidence of temporo-mandibular joint (TMJ) dysfunction after the uneven wear of the last
molar teeth can be manifested in a series of biomechanical problems such as stride asymmetry or as
different lameness symptoms. In one-sided TMJ imbalance (dislocation, compression) a side
inclination of the atlas C1 and consequent tension of atlanto-occipital joint muscles and ligaments
occurs. The upper and lower neck muscles are painful on the affected side and cannot be extended
or stretched to the opposite side during work or manual manipulation. In order to maintain the body
balance the contra-lateral hind leg is overloaded during the adaptation phase and cannot be extended
completely due to the blocked energy vessel (Bl30 positive) and reduced gluteal muscle elasticity.
After a longer-lasting compensation of TMJ dysfunction and consequent laterality problem
different joint pathologies may develop. Initially, pathological changes of the contra-lateral leg appear
after a short compensation period first in the form of hyperextension of knee ligaments and later in the
form of degenerative joint disease of lower limb joints. Both side TMJ imbalances may be manifested
in a variety of symptoms of locomotion disorders and even an abnormal shoulder position. Any
peripheral leg trauma can cause the overloading of the opposite leg, subsequent contraction of pelvic
muscles and ligaments, of the vertebral column, shoulder, neck and compression of the TMJ with
symptoms of dysfunction.

24
 Local symptoms of painful reaction of the affected TMJ can be palpated in the intra-articular
space and dorsally to the joint. In some horses local pain reactions can be manifested by hyper
sensible head-shaking and distressed behaviour.

LITERATURE:

• Anon (1965): British Equine Veterinary Association Survey of Equine Diseases. Vet. Rec., 77, 528-538

• Archer, DC, Blake, CL, Singer, ER, Boswell, JC, Cotton, JC, Edwards, GB and Proudman CJ (2003):
Scintigraphic appearance of selected diseases of the equine head. Eq. Vet. Educ. 15, (6) 305-313

• Assche van, R (1996): Cranio-sakrale Therapie und Physioenergetik. In: Rossaint, A, Lechner, J, und van
Assche R (Edits): Das cranio-sakrale System. Hüttig Verlag, 2. Aufl. Heidelberg

• Bäcker B. und Salomon W. (2003): Kraniosakrale Therapie bei Pferden. Grundlagen und Praxis. Sonntag
Verlag in MSV Medizinverlage Stuttgart GmbH&Co.KG

• Becker, E. (1962): Zähne. In Doberstei, J., Pallaske, G. und Stunzi, H. (Hrsg): Handbuch der speziellen
Pathologischen Anatomie der Haustiere, Bd. V, Verlag Paul Parey, Berlin,

• Bonin, SJ (2001): Three dimensional kinematics of the equine temporomandibular joint. MS Thesis,
Michigan State University

• Boswell, JC, Schramme, MC, Livesely, LC, and Butson, RJ (1999): Use of scintigraphy in the diagnosis of
dental disease in four horses. Eq. Vet. Educ., 11, 294-298

• Bruhns, K (1931): Untersuchungen über die Ätiologie von Erkrankungen der maxillaren Backenzähne des
Pferdes. Inaug. Diss., Schwierin i.M.

• Bruder, K (1912): Über einen fall von Odontoma durum beim Pferde. Inaug. Diss., Giessen

• Carmalt, JL, Townsend, HGG, Allen, AA (2003): A preliminary study to examine the effect of dental
flotation on the rostro-caudal movement of the equine mandible. J. Am. Vet. Med. Ass. In Press.

• Cooper, B (1992): Recognition and Management of Craniomandibular Disorders. In Kimmelman, C.P.

(ed.): Otolaryngologic Clinics of North America (Otolaryngologic Office Evaluation and Management
issue), Philadelphia, W.B. Saunders Company, 25 (4), 867-887

• Cooper, BC, Cooper, DL (1993): Recognizing Otolaryngologic Symptoms in Patients with

Temporomandibular Disorders. J. Craniomand. Pract. 11 (4), 260-267,

• Cooper, BC (1996): Chronic Pain and Temporomandibular Disorders, in A Practical Approach to Pain
Management, Lefkowitz, M. and Lebovits, A., eds. Little, Brown and Co. Boston, New York, Toronto,
London, Chapter 28, 248-254.

• Dixon, P.M., Tremaine, W.H., Pickles, K., Kuhns, L., Hawe, C., McCann, J., McGorum, B.C., Railton, D.I.
and Brammer, S. (1999a) Equine dental disease Part 1: a long-term study of 400 cases: disorders of
incisor, canine and first premolar teeth. Equine Vet. J. 31, 369-377.

• Dixon, P.M., Tremaine, W.H., Pickles, K., Kuhns, L., Hawe, C., McCann, J., McGorum, B.C., Railton, D.I.
and Brammer, S. (1999b) Equine dental disease Part 2: a long-term study of 400 cases: disorders of
development and eruption and variations in the position of cheek teeth. Equine Vet. J. 31, 519-528.

• Dixon, P.M., Tremaine, W.H., Pickles, K., Kuhns, L., Hawe, C., McCann, J., McGorum, B.C., Railton, D.I.
and Brammer, S. (2000) Equine dental disease Part 4: a long term study of 400 cases: apical infections
of cheek teeth. Equine Vet. J. 32, 182-194.

• Dixon, PM (1999): Dental anatomy. In: Equine Dentistry, eds: Baker, GJ and Easly, J, W.B. Saunders,
London, 3-28.

• Drevemo, S., Fredricson, I., Dalin, G., & Bjorne, K. (1980). Equine locomotion. 2. The analysis of
coordination between limbs of trotting Standardbreds. Equine Vet J., 12(2), 66-70.

25
• Drevemo, S., Fredricson, I., Dalin, G., & Bjorne, K. (1980). Equine locomotion. 2. The analysis of
coordination between limbs of trotting Standardbreds. Equine Vet J., 12(2), 66-70.

• Drevemo S, Fredricson I, Hjerten G, McMiken D ( 1987): Early development of gait asymmetries in trotting
Standardbred colts. Equine Vet J., 19: 189-191.

• Easly, J (1991). Recognition and Management of the diseased equine tooth. 37 th. Proc. Am. Eq. Pract.,
San Francisco, 129-139

• Ehlers, K (1908): Die Hypoplasie des Schmelzeinstülpungen am ersten Molaren im Oberkiefer des
Pferdes, ihre Ursachen und Folgen. Inaug. Diss., Bern

• Evrard, P. (2003): Kranioskrale Pferdeostheopathie für Tierärzte. Sonntag Verlag in MSV Medizinverlage
Stuttgart GmbH&Co. KG

• Evrard P. (2003): Lehrbuch der Strukturellen Osteopathie beim Pferd, Enke Verlag, Berlin

• Gayle, JM, Redding, WR, Vacek, JR and Bowmann, KF (1999): Diagnosis and surgical treatment of
periapical infection of the third mandibular molar in five horses. J. Am. Vet. Med. Ass., 215, 829-832

• Gatta, D., L. Krusic, L. Casini and B. Colombani (1995): Influence of corrected teeth on digestibility of two
types of diets in pregnant mares, 14th Proceed. of Equine Nutr. Physiol. Soc., Ontario, CA

• Gataa, D., L. Krusic, L. Cassini, B. Colombani (1995): Influence of teeth correction on digestibility of
macro-micro minerals of two different diets in pregnant mares. Trace Elements in Man and animals-9:
proceed. of the ninth internat. symp. on trace elements in man and animals., nrc research press, Otawa,
Canada, 326-328, 1997

• Goubeaux et Barrier (1884): De lexterieur du cheval. Paris

• Günther, F. und Günther, K (1859): lehre von den gesunden und kranken Zähnen als Anfang zu “Exterieur
des Pferdes”

• Hollatz, J (1910): Untersuchungen über die Veränderungen des Kiefergelenkes bei Zahn-,
Gebissanomalien des Pferdes. Diss., Leipzig

• Joest, E, Chorin, A, Finger, H, Westman, O (1922): Studien über das Backenzahngebiss des Pferdes.
Verlagsbuchhandl. R-Schoess, Berlin

• Joest, E (1926): Verdauungswege (Mund- und rachenhöhle mit Speicheldrüsen, Zähne, Speiseröhre,
Vormagen der Wiederkäuer, Magen, Darm) in Joest, E.(Hrsg): Handbuch der speziellen pathologischen
Anatomie der Haustiere. I. Bd. 2. Aufl., Berlin, 134-284.

• Klingemann, D. (1906): Zahnuntersuchungen bei 514 Militärpferden. zeitschrift f. Veterinärkunde, 47-59;

• Krusic, L, e Marcolni, G (2002): Controllo del allenamento, del stato fisico e della capacita sportiva di
cavalli trottatori. La ricercha preliminare della scuderia Lotus, Poggio

• Kurtzwig, H. (1909): Über Peridentitis (Periostitis alveolaris) beim Pferde, mit besonderer
Berücksichtigung der Erkrankung des M1 im Unterkiefer. Monatshefte f. praktische tierheilkunde, Berlin,
Bd. 20, 1-57

• Leue, P (1938): Kaubildkunde. Deutsche Tierärztl. Wochenschr. 47, 737-740

• Leue, P (1939): Kauzeichner (Molograph) und kaubilder (Mologramme). Berliner & Münchener Tierärztl.
Wochenschr. 12, 182-186

• Leue, G. (1941): Beziehungen zwischen zahnanomalien und Verdauungsstörungen beim Perd unter
Heranziehung von Kaubildern. Diss., TiHo, Hannover

• Lindberg, JE and Jacobson, KG (1992): Effects of barley and sugarbeet pulp on digestibility, urine
excretion and blood parameters in horses. 1. Europ. Konferenz ueber die Pferdeernaehrung, 16,
Hannover.

• Lotzmann, U (1998): Die Prinzipien der Okklusion. verlag Neuer Merkur GmbH, München

• Magitot, E. (1877): Traite des anomalies du systeme dentaire chez l homme et les mammifiers., Paris
26
• Maierl, J., Weller, R., Zechmeister, R. and Liebich, H-G (2000): Arthroscopic anatomy of the equine
temporomandibular joint. 23rd Congress of the European Ass. of Vet. Anatomists, Olsztyn (Poland),
Polish J. Vet. Sci. 3 (Suppl.), 28

• Mayer, W (1921): Zahnfehler und Zahnkrankheiten als Gewährsmangel bei Viehhandel, insbes.
Pferdehandel, Dis., Dresden

• Metcalf, MR, Tate, LP, and Sellett, LC (1989): Clinical use of MTC-MDP Scintigraphy in the equine
mandible and maxilla. Vet. Radiol., 30, 80-87

• Metha NR et al. (1984) TMJ triad of dysfunction: a biologic basis of diagnosis and treatment. J. Mass.
Dent. Soc, 33, 4, 173-213.

• Nickel, R, Schummer, A und Seiferle, E (1961): Lehrbuch der Anatomie der Haustiere,
Bewegungsapparat. Paul Parey, Berlin, Hamburg

• Nicklas, M (1915): Über die Spontanfrakturen der Backenzähne des Pferdes. Berlin, TiHo, Diss

• Ostertag V.R (1903): Die Krankheiten der Zähne. Handbuch der tierärztlichen Chirurgie und Geburtshilfe
von bayer-Fröhner, 1 Teil, 3. Band, Berlin

• Petermann, U. (2004): Kontrollierte Akupunktur für Hunde und Pferde. Praxis Lehrbuch. Sonntag Verlag in
MSV Medizinverlage Stuttgart GmbH&Co. KG

• Ralston, SL, Foster, DL, Divers, T, Hintz, HF (2001): The effect of dental correction on feed digestibility in
horses. Equine Vet. J., 33(4), 90-393

• Rocobado, M (1983): Physical therapy and dentistry: an overview. J. Craniomandib. Prac., 4, 46

• Roesti, A (1997): Kontrollierte akupunktur und komplementäre Heilmethoden in ganzheitlichem

Zusammenhang. A.M.I.Verlag, Giessen

• Rosenstein, DS, Bullock, MF, Ocello, PJ, Clayton, HM (2003): Computed tomography of the equine
temporo-mandibular joint. Abstract

• Rossaint, A (1996): Das Cranio-sakrale system und die cranio-sakrale Therapie. In: Rossaint, A, Lechner,
J, und van Assche R (Edits): Das cranio-sakrale System. Hüttig Verlag, 2. Aufl. Heidelberg

• Rucker, A. (1995): Modified procedure for incisor reduction. proc. Am. Ass. Eq. Pract., 41, 42-44

• Ruprecht, K (1936): Statistische Erhebungen über die Häufigkeit von gebisanomalien beim Pferd. Iaug.
Diss., Vet. Fakultät, Leipzig

• Semevolos, SA, Hacket, RP and Scrivani, PV (1999): Nuclear scintigraphy as a diagnostic aid in the
evaluation of tooth root abscessation. Proc. Am. Ass. Equine Practnrs. 45, 103-104

• Schöttl, W. (1991): Die cranio-mandibuäre Regulation: interdisciplinäre betrachtung des neuromuskulären

Relexgeschens. Hüttig Verlag, Heidelberg

• Spinner, J. (1922): vergleichende Forschungen über Zahnkaries bei Mensch und Pferd. Diss. Berlin

• Stracham, F and Robinson, MJ (1965): Short leg linked to malocclusion. Ostheopathic News, April

• Thomas, M. and Cooper, B. (1989): Recognition of Craniomandibular Disorders. New York State Dental
Journal, 55, (10) 26-28,

• Traub-Dargatz, JL, Salman, MD and Voss, JL (1991): Medical problems of horses as ranked by equine
practitioners. J. Am. Vet. Med. Ass., 198, 1745-1747

• Uhlinger, C. (1987): Survey of selected dental abnormalities in 233 horses. Proc. Am. As. Eq. Pract., 33,
577-583

• Upledger, JE, Vredevoogd, D (1983): Cranio-sacral Therapy. Eastland Press, Chicago

• Vorstenbosch MATM, Buchner HHF, Savelberg HHC, Meal ((1997): Modeling of compensatory head

movments in lame horses. Am J Vet Res.; 58: 713-718.

27
• Weller, R., Livesey, L., Maierl, J., Nuss, K., Bowen, I.M., Cauvin, E.R.J., Weaver, M., Schumacher, L. and
May S.A. (2001): Comparison of radiography and scintigraphy in the diagnosis of dental disorders in the
horse. Eq. Vet. J., 33, 49-58

• Zeitler, H und Bahr, FR (1987): Meridiane, ihre Punkte und Indikationen. Vieweg&Sohn
Verlagsgesellschaft mbH, Braunschweig, Wiesbaden

28