If you are a sports connoisseur and watch the news often, the numerous injuries resulting in a concussion are overwhelming and may catch your attention. More than 3 million concussions occur annually with approximately 1.7 million concussions among kids where nearly 20% are sports related, more often in girls than boys.1 Based on the prevalence statistics, concussive care is finding its way into many medical, dental, and ancillary practices such as chiropractic and physical therapy. Many clinicians may not have recognized the connection to breathing, especially in the dental chair.2 The common denominator among these specialties and the injury is the breathing brain. How does the practitioner address this type of injury in their practice, and how is it identified? Major concerns in recent years are the longitudinal effect of concussion on health, such as vestibular changes, the development of chronic traumatic encephalopathy (CTE), and sleep apnea.3
A concussion impacts the “breathing brain” by a potential disruption in coordination between the brain and lungs because the brain cannot function as it did prior to the injury. The result is breathing disturbances with symptoms of fatigue, dizziness, and shortness of breath. Furthermore, breathing problems may be misidentified as sleep disordered breathing problems (SDBP), headaches, daytime fatigue, or exercise intolerance. The respiratory issues from post-concussion syndrome (PCS) may linger for months or years after the initial injury before diagnosis. A thorough history in the dentist’s office with a patient suspected as having SDBP should include concussion.
When there is any form of blunt trauma to the head, the bones of the skull become jammed. These bones fit together like a puzzle. The sphenoid and occipital bone articulate with each other to form the sphenobasilar joint. The temporal bone articulates with the occipital bone to form the jugular foramen. This foramen is where the glossopharyngeal nerve (IX), the vagus nerve (X), spinal accessory nerve (XI), and jugular vein exit from the brainstem (Figure 1). Because trauma shifts these bones, it affects nervous and vascular transmission. The vagus nerve is a part of the autonomic nervous system (ANS). This nerve is the major sensory pathway from the lungs to the brain. It controls pulmonary function and it regulates respiration, including normal breathing and respiratory defense mechanisms, and also provides sensory feedback from the lungs to the brain. This is why breathing has to be measured and addressed in treating Post Concussion Syndrome.
