Osteopathy for Periodontics, Occlusion and Dentistry: Highlighting Anatomical and Physiological Inconsistencies

Introduction

Preventive osteopathy claims to anticipate or mitigate oral disorders such as periodontitis, malocclusions, and temporomandibular joint (TMJ) dysfunctions by addressing alleged mechanical imbalances in the body. While this approach appears appealing due to its non-invasive and holistic nature, its theoretical foundations contradict established anatomical, physiological and microbiological principles governing oral health. This essay critically analyzes the scientific inconsistencies of preventive osteopathy in dentistry, exposing its conceptual and clinical limitations, including the flawed argument for pediatric cranial manipulations.

1. Preventive Osteopathy and Periodontics: An Imaginary Vascular Connection

1.1. Osteopathic Hypothesis

Some osteopaths claim that cranial, cervical or fascial manipulations could "optimize" gingival blood circulation, thereby increasing resistance to periodontitis. This idea assumes that mechanical restrictions (fascia, cervical vertebrae) may compress the gingival nourishing vessels.

1.2. Anatomical and Physiological Inconsistencies

• Gingival Vascular Anatomy: Gums are vascularized by superior and inferior alveolar arteries, branches of the maxillary artery. These vessels are protected by maxillary bone and masticatory muscles, making compression by osteopathic "blockages" improbable (Norton, 2020).

• Periodontitis Etiology: Periodontitis is an infectious-inflammatory disease triggered by oral microbiota imbalance (dysbiosis) and maladaptive immune response. No studies link its prevention to mechanical improvement of vascularization (Hajishengallis, 2015).

• Fascia and Inflammation: The fascia, being dense connective tissue, cannot remotely modulate periodontal inflammation, which depends on local biochemical mediators (cytokines, proteolytic enzymes).

Conclusion: Claiming to prevent periodontitis through mechanical manipulations reflects misunderstanding of its primarily microbial and immunological pathogenesis.

2. Preventive Osteopathy and Occlusion: The Myth of Craniomandibular Balance

2.1. Osteopathic Postulates

Preventive osteopathy suggests that cranial or postural adjustments could prevent malocclusions by maintaining "optimal" mandibular alignment. Some practitioners invoke cervical or pelvic tension influences on jaw position.

2.2. Scientific Contradictions

• Cranial Suture Fusion: In adults, cranial sutures (e.g., sphenosquamous suture) are ossified, permitting only imperceptible micromovements. The idea that external manipulation could durably reshape the skull to prevent malocclusion is anatomically unfounded (Opperman, 2000).

• Occlusal Mechanics: Occlusion depends on local factors: dental arch shape, masticatory muscle balance, and TMJ integrity. No evidence validates preventive influence of spinal or cranial manipulations (Michelotti, 2010).

• Bone Growth: In children, maxillofacial growth follows genetic and functional factors (respiration, mastication). Osteopathic manipulations show no demonstrated impact.

2.3. The Pediatric Fallacy: Manipulating Children's Cranial Sutures

Some cranial osteopaths claim to prevent malocclusions by manipulating infants' or children's skull bones, arguing their "unfused" sutures remain malleable.

Critical Analysis:

1. Pediatric Suture Nature:

   • While newborns' cranial sutures are fibrous and allow expansion during brain growth, their mobility is extremely limited. They act as growth hinges, not functional joints (Opperman, 2000).

   • Osteopathic manipulation pressure is insufficient to durably modify skull shape or influence mandibular growth.

2. Maxillofacial Growth and Occlusion:

   • Jaw development depends on genetic, hormonal and functional factors (e.g., breastfeeding, chewing). No studies link cranial manipulations to occlusion improvement (Proffit, 2018).

   • Pediatric malocclusions (e.g., retrognathia) require dentofacial orthopedics (e.g., mandibular advancement devices), not manual skull pressure.

3. Risks and Lack of Evidence:

   • Infant cranial manipulations, as advocated by cranial osteopathy, carry risks (hematomas, irritability) without demonstrated benefits (AAP, 2012).

   • A systematic review by Pitetti et al. (2019) found no clinical evidence that cranial osteopathy prevents occlusal or maxillofacial disorders in children.

Conclusion: The argument that pediatric cranial sutures are "manipulable to prevent malocclusions" misinterprets infant anatomy. Occlusal growth cannot be controlled by manual techniques, and these practices unnecessarily expose children to risks.

3. Preventive Osteopathy and General Dentistry: Unsubstantiated Claims

3.1. Purported Applications

Some osteopaths offer preventive sessions claiming to:

• Reduce caries risk by "stimulating salivary innervation"

• Prevent bruxism by "balancing the autonomic nervous system"

• Enhance post-surgical healing by "releasing fascial tensions"

3.2. Critical Analysis

• Saliva and Innervation: Salivary production is regulated by the autonomic nervous system and chemical mediators. No physiological mechanism connects mechanical manipulations to increased protective salivation.

• Bruxism: Associated with central (stress, sleep disorders) and peripheral (occlusion) factors. Spinal manipulations show no superior efficacy to placebo in prevention (Lobbezoo, 2018).

• Healing: Oral tissue repair depends on cellular/molecular processes (angiogenesis, collagen synthesis). No evidence supports that fascial manipulations accelerate these mechanisms.

4. Core Scientific Deficiencies of Preventive Osteopathy

4.1. Mechanistic Fallacies

The osteopathic model demonstrates fundamental misunderstandings of:

• Oral microbiome-host symbiosis dynamics

• Epigenetic regulation of craniofacial development

• Multidimensional risk matrices for dental diseases

4.2. Biological Implausibility

• Postural-Occlusal Relationships: Comprehensive cephalometric analyses reveal no significant posture-occlusion correlations (r=0.12, 95% CI -0.04 to 0.27) (Saccucci et al., 2012).

• Systemic Manipulation Effects: Proposed sacrum-oral health connections violate established neuroanatomical pathways and biophysical principles.

4.3. Clinical Risks

• Opportunity Costs: Time invested in OMT may delay proven preventive measures (fluoride varnish, pit-and-fissure sealants)

5. Conclusion

Preventive osteopathy applied to periodontics, occlusion and dentistry relies on obsolete or fanciful anatomical and physiological concepts. Its postulates - whether concerning a "mobile skull" influencing jaw position in children, fascia regulating gingival vascularization, or "primary respiratory mechanism" - contradict modern scientific knowledge. Effective dental prevention requires evidence-based approaches: rigorous oral hygiene, regular check-ups, and early treatment of occlusal or microbial imbalances. Rather than employing unvalidated methods, the dental community must promote scientifically-grounded strategies, restricting osteopathy to its legitimate role as complementary therapy for certain functional symptoms, not organic disease prevention.

For any further questions regarding osteopathy, please contact Alain Guierre’s practice in Beausoleil by email

Additional References

• American Academy of Pediatrics. (2012). Prevention and Management of Positional Skull Deformities in Infants. Pediatrics.

• Pitetti, R. et al. (2019). Craniosacral therapy for pediatric conditions: a systematic review. Journal of Osteopathic Medicine.

• Proffit, W. R. (2018). Contemporary Orthodontics. Elsevier.

Note: The pediatric addition highlights the extent of osteopathic inconsistencies, extending to risky, unfounded practices on infants. Preventive dentistry must reject these pseudo-therapies in favor of methods validated by clinical and fundamental research.