The use of chiropractic care during dental procedures allows veterinarians to evaluate the stomatognathic system, reset the entire nervous system, and pick up on clinical changes we would otherwise miss.
The purpose of this article is to shed light on the importance of chiropractic care in general, and more specifically following dental procedures. Though the focus is on dogs and cats, all species that may suffer from spinal subluxations can benefit.
In dogs, collar and leash use, rough play, dog park activity, basic training and restraint often cause compensated vertebral issues that, if left unresolved, can lead to chronic orthopedic issues down the road. Cats are also subject to the same issues, due more to jumping up and down from high places and from rougher acrobatic-like play. Cats, even more than dogs, are better at masking such issues, but just a single orthopedic manipulation (as felines are more often out in the lumbar spine) can significantly improve mobility.
Dental care in itself is one of the most important aspects of a pet’s overall health. By incorporating orthopedic manipulative care, we are able to make it even more valuable to the whole animal. During each and every anesthetic dental procedure, whether extractions are needed or not, the use of chiropractic care can only enhance the outcome upon discharge, whether the animal’s issues are related to dental problems or are pre-existing. We are able to provide profound results that most of our clients have never seen before, thus encouraging compliance with future dental health maintenance, and improving caregiver loyalty to the veterinarian.
Below, we will review the goals of evaluating structural conformation and performing orthopedic manipulation at the time of dental procedures.
The Stomatognathic System and Upper Cervical Manipulation
Dental procedures allow us as veterinarians to evaluate the stomatognathic system and reset the entire nervous system. The stomatognathic system is comprised of teeth, jaws and associated soft tissue. Its effect on the nervous system in general, and conformational integrity has long been overlooked.1
Anesthetic dental procedures involve manipulation of the head and neck for proper dental cleaning and polishing, radiograph positioning and extractions. Completing these procedures can result in additional subluxation on top of pre-existing ones. This is because the plates of the skull are connected, and sutures allow the skull to move in a very subtle way. The pressure placed on those sutures by the necessary bracing during an extraction process can lead to less than ideal repositioning of the plates.
Once a dental procedure is complete, taking the time to palpate the skull to feel for any asymmetry, and gently holding and repositioning sutures in the subtlest of ways, will greatly help each patient.
Resetting the sphenoid and palatine bones
This can be done by palpation within the roof and along the inside of the mouth and temporal mandibular joint. Place one index finger on each TM joint to check for symmetry within the jaw, and then apply a steady gentle pressure to realign the area. As you start to check these with each dental procedure, you will become more comfortable and skilled at realigning. When you perform this technique during a normal dental cleaning without any extractions (with anesthesia), you can start to identify and correct pre-existing problems. During this time, it is prudent to complete the exam by checking both ear canals with the otoscope, and removing any pre-existing wax, foxtails or other foreign bodies that may have been overlooked.
Prior to full sedation, perform a pre-op physical exam that includes an orthopedic vertebral evaluation:
- Evaluate each pet from the front from afar (at least 2’ or 3’) and get accustomed to subtle changes that can have a profound effect on the area of the brain stem. Allow the animal to hold his or her head in its natural position and evaluate the lower eyelids for subtle changes. By drawing an imaginary thin line across the lower aspect of the lids, you will often see that one of the eyes is ever so slightly off and lies a bit lower than the other. Some cases are dramatically offset, as seen below — both dogs show a low right and left eye respectively:
Some cases are dramatically clear while others are not so easy to pick up. Above are examples of two dogs off on alternate sides. The Bulldog (Figure 1) has a lower right eye, which most often is the result of the left atlas being displaced dorsally. The Yorkshire Terrier (Figure 2) is lower in the left eye, resulting in the right atlas being displaced dorsally.
In the simple displacement of the atlanto-occipital joint (AO), the atlas is displaced dorsally at the left and right sides respectively. Viewed and palpated from behind the animal, the displacement is seen structurally and palpated as below (Figures 3 and 4):
Confirmation of a simple displacement is done by standing behind the animal and placing the right index finger at the wing of the right atlas, and the left index finger at the wing of the left atlas. Careful practice of palpation will reveal one wing higher than the other when the animal is still. By dorsal palpation with each index finger, you can feel a tightening in the obliqus capitis cranialis and the major and minor rectus capitis dorsalis muscle groups. Human neurology shows that ¾ of a degree of a protractor (the thickness of just three fingernails) can have a huge effect on the muscle centers of relaxation being inhibited, and therefore abnormal vital muscular contracture. From above the spinal cord, the Red nucleus, the vestibular apparatus, and the lateral and medial reticulo spinal tracts control the two muscle centers that in turn control the Para spinal muscles from the poll to the pelvis, in the process of relaxation or contraction.2 These muscles relax or contract when the atlas is misaligned. Once corrected, additional subluxations can be cleared in the vertebral spine. A simple AO misalignment as in the Bulldog above, where the eye is low at the right and the atlas is high at the left, has the following pathology going on as seen in Figure 11. It is corrected by bracing caudal right side of atlas and gently flicking the left atlas down and around, starting from the most cranial or anterior aspect going ventral caudally (Figure 6).
Again, the initial evaluation must be done prior to sedation so that an occiput misalignment can be identified, if present. Such misalignments involving the occiput in addition to the atlas are called secondary or complex misalignments.
The highest neurological interference comes from an occiput misalignment. If this is the case, such corrections should always be done once the animal has recovered from the dental procedure and is awake. The reason is that once the occiput is corrected (which is done from the front of the animal), his or her natural head position must be evaluated prior to proceeding with the AO correction. This is critical because such secondary or complex misalignments are a challenge even for the most experienced. Such complex misalignments will show the following during initial exam:
The dog at left (Figure 7) with a complex misalignment will reveal a dorsal displacement on the same side at which the eye is low. You would expect to see a low left eye if the atlas is simply displaced dorsally at the right (Figure 8). But in fact, the occiput is jammed in at the right atlas (Figure 9) so the right eye ends up being low on the right. This finding should be double and triple checked by close and careful repalpation of the major and minor rectus capitis dorsalis muscle groups, and reevaluation of the dog in a natural head position with no assistance from the holder. In other words, the neck should be free. Treats can be used from afar to hold the animal’s attention and keep the head forward. In such cases, the occiput should be aligned (in the case of dog above) by coming in front of the animal and placing the left index finger in front of the wing of the atlas on the left side, and directing gentle pressure caudo-medially on the ridge of the occiput. This motion is like rolling a ball; just a gentle push results in movement. (Figure 10) Once this is successfully completed, you can continue with the correction of the AO misalignment.
I recommend that dogs be muzzled during such corrections, but not during the evaluation portion. After each attempt at any upper cervical correction, dogs should be allowed to move freely in the room, shake their heads, and be given a break. Often, they can complete the rest of the correction with this natural head shaking. After this repositioning, you can reevaluate to see if any more manipulations are needed to fully correct the misalignment. Upon successful correction, an immediate release of the major and minor rectus capitis dorsalis muscles will take place, and no one side will feel tense to the touch. These secondary or complex misalignments occur because not only is the atlas displaced dorsally on the one right side (in the case of this dog above), but the occiput is also misaligned at the right side, with occiput also jammed in at the right, causing the eye to be low at the right.
These can be easily corrected by use of the activator, or by hand. When using an activator, the goal is to apply a small concentrated force to the dorsal spinal process from a 90° angle with cervical vertebra (Figure 11), 45° for thoracic (Figure 12) and 90° for lumbar (Figure 13).
It is common to do three passes, with the initial pass showing us which vertebral bodies are reactive and out of alignment; and the following passes showing what has or has not been cleared. Vertebral bodies that don’t clear after the third pass are most likely due to the chronicity of the subluxation. Such subluxations are usually cleared through subsequent treatment. It is often necessary to recheck these patients again in one week, and then follow up with another correction two weeks later, then three weeks after the second.
The pelvis is addressed by correcting the cranial point of the ileum (Figure 14) and addressing the most caudal point on the ischium (Figure 15) at both the right and left sides of each.
Once the subluxations are corrected, it is helpful to treat the lateral sides where visceral nerves and blood supplies exit the vertebral bodies. This is easily accomplished by placing the middle finger on the spine and moving the activator on either side, alternating sides as you move down the vertebral bodies (Figure 16). or using your index and middle finger over each transverse process down the thoracic and lumbar spine. Manual treatment involves using the index and middle fingers over each transverse process down the thoracic and lumber spine.
The final process to solidify the adjustment is releasing the fascia. The fascia, known as the “dura” within the cranium, is called “fascia” when it comes out of the vertebral column. This thin but durable layer covers all the organ and muscular surfaces of the body and forms a huge communication network within. It also is the primary reason why adjustments don’t hold — because of positional memory along with emotional energy that requires release. With the animal standing, I use the Vetrostim™ device for evaluation and release purposes — going down the dorsal neck, the base of each side, and down the dorsal spine and long epaxial muscles.
Freeing up the fascia allows muscles to release the memory held from chronic subluxation (which they have long been compensating for) (Figure 17).
The use of this unit is not limited to canines and equines, but the noise can be startling for most feline patients. Releases in cats should be kept brief. The detox from the muscular release should be used with caution on any animal with a severe heart murmur. Dogs are often placed in right and left lateral recumbence, resulting in further release along the epaxials, biceps femoris, tensor fascia lata, cleidocephalicus, brachiocephlicus (clavical intersection), obliques and the latissimus dorsi.
In closing of the full adjustment, the tail, when available, can be gently pressed on both sides with a slight traction applied (Figure 18) and held until the pet releases through a deep breath, sigh, yawn or licking motion. This is an indication that the limbic system is clearing and processing the full adjustment. Finally, to check the pelvis and any legs that might be short and not corrected from the AO correction, leg length can be evaluated (much easier in the small to medium dog). Extend both hind legs at the same time, when possible, and determine which side is shorter by looking at the pads and how they line up (Figure 19). Upon identifying the short side, place the thumb along the side of the anus (making contact with the area of the sacral tuberous ligament), and direct the tip of the thumb laterally (Figure 20).
Apply gentle and steady pressure laterally and dorsally until the thumb is slowly released and comes off the patient as the ligament relaxes. This isn’t always a comfortable process so have a handler present in case the animal reacts. Once released, allow the patient to walk a few strides and then recheck to ensure the correction is sufficient.
This completes the full range of an orthopedic manipulative exam, which is easily done following a dental procedure.
Dental procedures allow us as veterinarians to evaluate the stomatognathic system and reset the entire nervous system. Remember…for everything missed for not knowing, a hundred things are missed for not looking.3 During such a procedure, however, we can address a close evaluation of the AO misalignments for brain stem clearing. Clearing the brain stem is crucial and will have one of the most profound effects on the animal as it plays a huge role with its impingement on the vagus nerve, which affects the parasympathetic nervous system and arteriole dilation. To heal properly, the vagus nerve must be functioning for proper innervation to the lungs, the heart, and other organs (the exception being the adrenal gland.)
1hcbi.hlm.nih.gov. “The Relationship Between the Stomatognathic System and Body Posture”, NCBI-NIH
2Schwartz, Candell, et al. Principles of Neuroscience
4Crediting the late Dr. Cuthberth Padmore, Large animal professor, Tuskegee University School of Vet Med.
I would like to recognize Dr. Sherry Gaber, DC, who has taught and mentored me in learning upper cervical techniques.