Improving balance is crucial especially in older adults and in patients recovering from severe injuries. Neuromuscular Dentistry is being used to improve balance, strength and speed in professional athletes. The PPM Mouthguard or Makkar Pure Power Mouthguard is used by professional athletes like the New Orleans Saints to improve athletic preformance.
Neuromuscular Dentistry can also be used to improve balance and gait in patients with balance and equilibrium difficulties. The same technology that is used to relieve and prevent migraines and tension headaches can also be used to increase balance and strength.
Sunday, January 31, 2010
Saturday, January 30, 2010
TMD AND VERIGO AS EXPLAINED BY DR NORMAN THOMAS OF THE LAS VEGAS INSTITUTE
Neuromuscular Dentistry frequently eliminates not just headaches and Migranes but vertigo and dizzinss as well. There are many possible ways in which this occurs based on neurological changes in the trigeminal nervous system and the connections to other cranial nerves. The following is an anatomical explanation of how neuromuscular dentistry treats Vertigo. Other causes can include the Tensor tympani and Tensor palati causing increase in pressure in the inner ear creating endolymph movement in the semi-circular canals, Tensor typani and palati influenced by postural anomolies to contract and relax in an imbalanced way, th Head of the condyle seated posteriorly putting pressure on the inner ear, and the Misalignment of Atlas - Axis - Occiput and resulting compression on the balance centre in the brainstem
Patients with TMJ disorders frequently suffer from dizziness and verigo as well as migraines, tension-type headaches, facial pain and many other symptoms usually associate with the trigeminal nervous system and secondary postural canges in the atlas, axis and other cervical vertebrae. The term "The great Imposter" (See "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor)
is often applied to TMJ disorders because they masquerade as so many disorders. The following is an anatomical description by Dr Norman Thomas, the head of Neuromuscular Dental Research at LVI (Las Vegas Institute) research of how imbalance of the HIP plane can result in Vertigo thru actions on the Tensor Tympani and and Tensor Palatini muscles.
Per Dr Thomas "You asked for the explanation I put forward about HIP tinnitus and vertigo. The tensor tympani and tensor palati muscles intertwine as they associate at the side of the bony canal of the pharyngo tympanic tube. The entwined fibers pass downward from their attachment in the scaphoid fossa over the hamular notch into the soft palate. Thus the attachment of tensor typani and palati crosses the fulcrum at the hamular notch between IP and the occipital condyle. When the HIP is this not balanced with gravitational field there is tension on the the palate and the tensor tympani (attached at its distal end to the malleus) while the tensor palati closes the Eustachian tube opening at its palatal end Thus there is pressure in the middle ear which compresses the fenestra ovalis on the medial wall of the middle ear to change circua;lation in the semicircular canals with resulting vertigo and tinnitus."
THE HIP Plane as described in the Journal of Oral Rehabilitation is "The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60)" Other planes of clinical interest in the cranium and face include the he occlusal plane, Frankfort plane, Camper's plane. The hip plane is parallel to the gravitational field.
PubMed abstract
J Oral Rehabil. 2007 Feb;34(2):136-40.
Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults.
Fu PS, Hung CC, Hong JM, Wang JC.
Department of Prosthodontics, Graduate Institute of Dental Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P < 0.05). The results showed that the occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.
PMID: 17244236 [PubMed - indexed for MEDLINE]
Patients with TMJ disorders frequently suffer from dizziness and verigo as well as migraines, tension-type headaches, facial pain and many other symptoms usually associate with the trigeminal nervous system and secondary postural canges in the atlas, axis and other cervical vertebrae. The term "The great Imposter" (See "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor)
is often applied to TMJ disorders because they masquerade as so many disorders. The following is an anatomical description by Dr Norman Thomas, the head of Neuromuscular Dental Research at LVI (Las Vegas Institute) research of how imbalance of the HIP plane can result in Vertigo thru actions on the Tensor Tympani and and Tensor Palatini muscles.
Per Dr Thomas "You asked for the explanation I put forward about HIP tinnitus and vertigo. The tensor tympani and tensor palati muscles intertwine as they associate at the side of the bony canal of the pharyngo tympanic tube. The entwined fibers pass downward from their attachment in the scaphoid fossa over the hamular notch into the soft palate. Thus the attachment of tensor typani and palati crosses the fulcrum at the hamular notch between IP and the occipital condyle. When the HIP is this not balanced with gravitational field there is tension on the the palate and the tensor tympani (attached at its distal end to the malleus) while the tensor palati closes the Eustachian tube opening at its palatal end Thus there is pressure in the middle ear which compresses the fenestra ovalis on the medial wall of the middle ear to change circua;lation in the semicircular canals with resulting vertigo and tinnitus."
THE HIP Plane as described in the Journal of Oral Rehabilitation is "The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60)" Other planes of clinical interest in the cranium and face include the he occlusal plane, Frankfort plane, Camper's plane. The hip plane is parallel to the gravitational field.
PubMed abstract
J Oral Rehabil. 2007 Feb;34(2):136-40.
Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults.
Fu PS, Hung CC, Hong JM, Wang JC.
Department of Prosthodontics, Graduate Institute of Dental Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P < 0.05). The results showed that the occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.
PMID: 17244236 [PubMed - indexed for MEDLINE]
Friday, January 29, 2010
What to expect at your headache or TMJ disorder consult.
When you see a doctor for the first time for a TMJ disorder you should expect to have to give lengthy and detailed history. There are usually forms to fill out. What is important is that this history should be reviewed with the patient and how the history relates to the current problem should be explored. The initial consult is usually at least 45 minutes but can last for several hours.
In most cases the doctor can provide instant relief of some of the painful conditions by deactivating muscular trigger points. This is usually done by use of a technique called Spray and Stretch that utilizes a vapocoolant spray. These techniques were developed by President Kennedy's personal physician Dr Janet Travell. In most patients it is possible to connect their symptoms to their history in an understandable fashion.
If there is a acute close-lock of the TM Joint time is of the essence and immediate reduction is best if possible. Prescribing anti-inflamatories should never take the place of attempting to reduce an acute disc dislocation.
Permanent and/or irreversible treatment should rarely be the initial treatment. Adjusting the teeth or doing equilibration of the back teeth should be avoided when there s acute muscle spasm. The exception is if a recently placed restoration is in hyperocclusion and percipitated the problem. It should be carefully evaluated because acute spasm can change the bite.
A thorough examination of the muscles and joints is usually performed before initiating treatment. A Neuromuscular Dentist will usually take impressions and a bite utilizing TENS (transcutaneous electrical neuro stimulation) as well as EMG and computerized mandibular scans. This information helps the dentist understand all aspects of the problem before initiating treatment.
Many insurance companies deny coverage of TMJ disorders and Neuromuscular diagnostic work-ups. This is done to "save money" but in reality it has a heavy toll in the quality of patients lives and their future health and welfare. Insurance companies are not in the business of caring for patients. Insurance companies are in business to make money for their shareholders. The larger the premiums they collect and the less they pay in benefits the better the bottom line. A healthy bottom line is the primary concern of insurance companies. These companies are in business to creat profit and shareholder value. The executive of insurance companies make millions of dollars in bonuses for increasing profitability. Unfortunately for patients increasing profitability usally is done by denying patients medical benefits. The more effective an insurance company is in reducing payments for care the more profitable they become.
The insurance companies often use terms such as reasonable and customary to explain why patients are not given the coverage they were promised. I have been treating sleep apnea with oral appliances for close to 30 years. In the early years I was the only dentist in the state of Illinois doing this type of treatment. I would still receive letters telling me my fees were more than "usual and customary" even though I was the only doctor doing these treatments.
In most cases the doctor can provide instant relief of some of the painful conditions by deactivating muscular trigger points. This is usually done by use of a technique called Spray and Stretch that utilizes a vapocoolant spray. These techniques were developed by President Kennedy's personal physician Dr Janet Travell. In most patients it is possible to connect their symptoms to their history in an understandable fashion.
If there is a acute close-lock of the TM Joint time is of the essence and immediate reduction is best if possible. Prescribing anti-inflamatories should never take the place of attempting to reduce an acute disc dislocation.
Permanent and/or irreversible treatment should rarely be the initial treatment. Adjusting the teeth or doing equilibration of the back teeth should be avoided when there s acute muscle spasm. The exception is if a recently placed restoration is in hyperocclusion and percipitated the problem. It should be carefully evaluated because acute spasm can change the bite.
A thorough examination of the muscles and joints is usually performed before initiating treatment. A Neuromuscular Dentist will usually take impressions and a bite utilizing TENS (transcutaneous electrical neuro stimulation) as well as EMG and computerized mandibular scans. This information helps the dentist understand all aspects of the problem before initiating treatment.
Many insurance companies deny coverage of TMJ disorders and Neuromuscular diagnostic work-ups. This is done to "save money" but in reality it has a heavy toll in the quality of patients lives and their future health and welfare. Insurance companies are not in the business of caring for patients. Insurance companies are in business to make money for their shareholders. The larger the premiums they collect and the less they pay in benefits the better the bottom line. A healthy bottom line is the primary concern of insurance companies. These companies are in business to creat profit and shareholder value. The executive of insurance companies make millions of dollars in bonuses for increasing profitability. Unfortunately for patients increasing profitability usally is done by denying patients medical benefits. The more effective an insurance company is in reducing payments for care the more profitable they become.
The insurance companies often use terms such as reasonable and customary to explain why patients are not given the coverage they were promised. I have been treating sleep apnea with oral appliances for close to 30 years. In the early years I was the only dentist in the state of Illinois doing this type of treatment. I would still receive letters telling me my fees were more than "usual and customary" even though I was the only doctor doing these treatments.
Turning off a migraine headaches in seconds without drugs.
There is an very cool trick that can be used to provide instant relief for some migraines and tesion-type headaches. Because most headaches are trigeminal in orgin stimulation of the GAG reflex will often alleviate both headaches from muscle spasm and/or myofascial pain. The gag reflex is a protective reflex that prevents aspiration of vomit into the lungs by rapid wide opening of the mouth.
The GAG reflex causes the elevators of the mandible (mouth closing muscles) to instantly relax completely and the suprahyoid and infrahyoid muscles that are depressors of the mandible (mouth opening muscles) instantly contract. This causes a mouth opening like a snake as oposed to a normal hinge opening. If a patient has a tension-type headache,ETTH, chronic daily headache or muscle contraction headache from the jaw muscles they will frequently have complete or very significant headache relief. This same technique can also be used to reduce an acute close lock (joint locking that prevents opening) of the mandible.
Migraine headaches can also be turned off or sometimes prevented if this proceedure is done before a full migraine occurs. The mechanism is both reduction of muscle pain which is a significant portion of most migraines but also a change in the circulation to the anterior 2/3 rds of the meninges of the brain. The trigeminal nerve controls that blood flow and a forceful gag will often correct the vascular cause of the migraine thru trigeminal nerve changes. This can also be used by patients who do not have access to their headache medication.
It is very important to keep the teeth from touching after stimulating the gag reflex to prevent a return of the headache.
Many physicians and patients consider nauseau and vomiting associated with headaches to be diagnostic of migraines but this is not always the case. TMJ and muscle caused headaches frequently are associated with nauseau.
Patients who have migraines that are relieved after vomiting should consider the trigeminal nerve and its related muscles as a cause of their headaches. Neuromuscular Dentistry can frequently supply long-lasting relief for these patients. The gag reflex is a remedial maneuver that can relieve a severe headache but long-term improvement in the quality of life can be achieved for many patients by utilizing a diagnostic neuromuscular orthotic. If substantial relief is achieved the patient can the consider a long term correction based on the position of the jaw when wearing the orthotic.
The GAG reflex causes the elevators of the mandible (mouth closing muscles) to instantly relax completely and the suprahyoid and infrahyoid muscles that are depressors of the mandible (mouth opening muscles) instantly contract. This causes a mouth opening like a snake as oposed to a normal hinge opening. If a patient has a tension-type headache,ETTH, chronic daily headache or muscle contraction headache from the jaw muscles they will frequently have complete or very significant headache relief. This same technique can also be used to reduce an acute close lock (joint locking that prevents opening) of the mandible.
Migraine headaches can also be turned off or sometimes prevented if this proceedure is done before a full migraine occurs. The mechanism is both reduction of muscle pain which is a significant portion of most migraines but also a change in the circulation to the anterior 2/3 rds of the meninges of the brain. The trigeminal nerve controls that blood flow and a forceful gag will often correct the vascular cause of the migraine thru trigeminal nerve changes. This can also be used by patients who do not have access to their headache medication.
It is very important to keep the teeth from touching after stimulating the gag reflex to prevent a return of the headache.
Many physicians and patients consider nauseau and vomiting associated with headaches to be diagnostic of migraines but this is not always the case. TMJ and muscle caused headaches frequently are associated with nauseau.
Patients who have migraines that are relieved after vomiting should consider the trigeminal nerve and its related muscles as a cause of their headaches. Neuromuscular Dentistry can frequently supply long-lasting relief for these patients. The gag reflex is a remedial maneuver that can relieve a severe headache but long-term improvement in the quality of life can be achieved for many patients by utilizing a diagnostic neuromuscular orthotic. If substantial relief is achieved the patient can the consider a long term correction based on the position of the jaw when wearing the orthotic.
EXPLODING HEAD SYNDROME USUALLY DOES NOT HAVE SIGNIFICANT PAIN ASSOCIATED WITH IT.
Exploding head syndrome is an interesting syndrome of unknown pathogenisis. It is documented and accepted in the International Classification of Sleep Disorders (ICSD).
An article by Casucci G, d'Onofrio F, Torelli P. discusses " trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome." This article in Neurol Sci. 2004 Oct;25 Suppl 3:S77-83 and discusses Rare primary headaches: clinical insights.
The symptoms (according to ICSD) are:
"The patient complains of a sudden loud noise or sense of explosion in the head at either the wake-sleep transition or upon waking during the night."
" The experience is not associated with significant pain complaints"
"The patient rouses immediately after the event, usually with a sense of fright"
It is considered to be a seperate entity from Idiopathic Stabbing Headache (ice pick headache) which is benign and characterized by brief stabs of pain on the side of the head.
It is also different than Thunderclap Headache which is a severe sudden-onset pain that must be considered a warning sign of a subarachnoid hemorrhage but can also be benign.
There are also cluster headaches, sleep related migraines and nocturnal paroxysmal hemicrania. It is possible that Exploding Head Syndrome is a pain free version of one of these disorders.
Severe migraines can be related to sleep apnea as well. See I HATE CPAP!! (http://www.ihatecpap.com)
PubMed abstract below:
J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):907-10.
Clinical features of the exploding head syndrome.
Pearce JM.
Department of Neurology, Hull Royal Infirmary, UK.
Fifty patients suffering from the "exploding head syndrome" are described. This hitherto unreported syndrome is characterised by a sense of an explosive noise in the head usually in the twilight stage of sleep. The associated symptoms are varied, but the benign nature of the condition is emphasised and neither extensive investigation nor treatment are indicated.
PMID: 2769286 [PubMed - indexed for MEDLINE]
Neurol Sci. 2004 Oct;25 Suppl 3:S77-83.
Rare primary headaches: clinical insights.
Casucci G, d'Onofrio F, Torelli P.
U. O. di Medicina Generale, Casa di Cura San Francesco, Viale Europa 21, I-82037 Telese Terme (BN), Italy. gerardocasucci@tin.it
So-called "rare" headaches, whose prevalence rate is lower than 1% or is not known at all and have been reported in only a few dozen cases to date, constitute a very heterogeneous group. Those that are best characterised from the clinical point of view can be classified into forms with prominent autonomic features and forms with sparse or no autonomic features. Among the former are trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome. The major clinical discriminating factor for the differential diagnosis of TACs is the relationship between duration and frequency of attacks: the forms in which pain is shorter lived are those with the higher frequency of daily attacks. Other aspects to be considered are the time pattern of symptoms, intensity and timing of attacks, the patient's behaviour during the attacks, the presence of any triggering factors and of the refractory period after an induced attack, and response to therapy, especially with indomethacin. Often these are little known clinical entities, which are not easily detected in clinical practice. For some of them, e. g., thunderclap headache, it is always necessary to perform instrumental tests to exclude the presence of underlying organic diseases.
PMID: 15549575 [PubMed - indexed for MEDLINE]
An article by Casucci G, d'Onofrio F, Torelli P. discusses " trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome." This article in Neurol Sci. 2004 Oct;25 Suppl 3:S77-83 and discusses Rare primary headaches: clinical insights.
The symptoms (according to ICSD) are:
"The patient complains of a sudden loud noise or sense of explosion in the head at either the wake-sleep transition or upon waking during the night."
" The experience is not associated with significant pain complaints"
"The patient rouses immediately after the event, usually with a sense of fright"
It is considered to be a seperate entity from Idiopathic Stabbing Headache (ice pick headache) which is benign and characterized by brief stabs of pain on the side of the head.
It is also different than Thunderclap Headache which is a severe sudden-onset pain that must be considered a warning sign of a subarachnoid hemorrhage but can also be benign.
There are also cluster headaches, sleep related migraines and nocturnal paroxysmal hemicrania. It is possible that Exploding Head Syndrome is a pain free version of one of these disorders.
Severe migraines can be related to sleep apnea as well. See I HATE CPAP!! (http://www.ihatecpap.com)
PubMed abstract below:
J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):907-10.
Clinical features of the exploding head syndrome.
Pearce JM.
Department of Neurology, Hull Royal Infirmary, UK.
Fifty patients suffering from the "exploding head syndrome" are described. This hitherto unreported syndrome is characterised by a sense of an explosive noise in the head usually in the twilight stage of sleep. The associated symptoms are varied, but the benign nature of the condition is emphasised and neither extensive investigation nor treatment are indicated.
PMID: 2769286 [PubMed - indexed for MEDLINE]
Neurol Sci. 2004 Oct;25 Suppl 3:S77-83.
Rare primary headaches: clinical insights.
Casucci G, d'Onofrio F, Torelli P.
U. O. di Medicina Generale, Casa di Cura San Francesco, Viale Europa 21, I-82037 Telese Terme (BN), Italy. gerardocasucci@tin.it
So-called "rare" headaches, whose prevalence rate is lower than 1% or is not known at all and have been reported in only a few dozen cases to date, constitute a very heterogeneous group. Those that are best characterised from the clinical point of view can be classified into forms with prominent autonomic features and forms with sparse or no autonomic features. Among the former are trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome. The major clinical discriminating factor for the differential diagnosis of TACs is the relationship between duration and frequency of attacks: the forms in which pain is shorter lived are those with the higher frequency of daily attacks. Other aspects to be considered are the time pattern of symptoms, intensity and timing of attacks, the patient's behaviour during the attacks, the presence of any triggering factors and of the refractory period after an induced attack, and response to therapy, especially with indomethacin. Often these are little known clinical entities, which are not easily detected in clinical practice. For some of them, e. g., thunderclap headache, it is always necessary to perform instrumental tests to exclude the presence of underlying organic diseases.
PMID: 15549575 [PubMed - indexed for MEDLINE]
Monday, January 25, 2010
Cluster Headaches, hate headaches, treatment and prevention
Thomas comments : I've been having cluster headaches for about twenty years, skipping a year every once in a while. I'm currently taking gabapentin and amitrypaline, seems to be working as of this time (we will see) and I have oxygen (havent tried it yet
) headaches wake me from sleep, last about 30 to 45 min., pacing and or burying my head in the couch cushions while trying to calm my breathing. etc.
Dr Shapira Response: I would suggest that you have a sleep study done because sleep apnea can be a exacerbate or cause cluster headaches as can bruxism and/or jaw clenching thru the trigeminal nerve. The oxygen (100%0 can often supply almost immediate relief.
) headaches wake me from sleep, last about 30 to 45 min., pacing and or burying my head in the couch cushions while trying to calm my breathing. etc.
Dr Shapira Response: I would suggest that you have a sleep study done because sleep apnea can be a exacerbate or cause cluster headaches as can bruxism and/or jaw clenching thru the trigeminal nerve. The oxygen (100%0 can often supply almost immediate relief.
Sunday, January 24, 2010
TMJ Disorders Increases Headaches and Overall Body Pain in Female Patients
A new article in the Clinical Journal of Pains shows that patients who develop TMD have increases in Headaches & Migraines but also have significant increases in other bodily pains. In addition to increase in headaches patients who were diagnosed as developing TMD had increases in muscle and joint pain, back pain, chest pain, abdominal pain and menstrual pain.
The study was done on 266 female patients aged 18-34 years old who initially were free of TMD symptoms. Over 5% of the population developed new TMD symptoms. There is no question that the majority of headaches are caused by the trigeminal nerve (dental Nerve) what this study sees to imply is that the trigemino system may increase perception of pain throughout the body. This may be do to central sensitization. This is a rationale for utilizing neuromuscular dentistry to treat patients early to prevent a local problem from becoming widespread.
Dr Barry Cooper has shown an "overwhelming" positive effect on headaches and TMJ disorders with Neuromuscular Dentistry. A neuromuscular dentist has the training and equipment necessary to evaluate physiologic parameters and idealize occlusion to reduce or eliminate TMD symptoms and Headaches and prevent a local problem from becoming a whole body problem.
Clin J Pain. 2010 Feb;26(2):116-20.
Development of temporomandibular disorders is associated with greater bodily pain experience.
Lim PF, Smith S, Bhalang K, Slade GD, Maixner W.
Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599-7455, USA. peifeng_lim@dentistry.unc.edu
OBJECTIVES: The aim of this study is to examine the difference in the report of bodily pain experienced by patients who develop temporomandibular disorders (TMD) and by those who do not develop TMD over a 3-year observation period. METHODS: This is a 3-year prospective study of 266 females aged 18 to 34 years initially free of TMD pain. All patients completed the Symptom Report Questionnaire (SRQ) at baseline and yearly intervals, and at the time they developed TMD (if applicable). The SRQ is a self-report instrument evaluating the extent and location of pain experienced in the earlier 6 months. Statistical analysis was carried out using repeated measures ANOVA. RESULTS: Over the 3-year period, 16 patients developed TMD based on the Research Diagnostic Criteria for TMD. Participants who developed TMD reported more headaches (P=0.0089), muscle soreness or pain (P=0.005), joint soreness or pain (P=0.0012), back pain (P=0.0001), chest pain (P=0.0004), abdominal pain (P=0.0021), and menstrual pain (P=0.0036) than Participants who did not develop TMD at both the baseline and final visits. Participants who developed TMD also reported significantly more headache (P=0.0006), muscle soreness or pain (P=0.0059), and other pains (P=0.0188) when they were diagnosed with TMD compared with the baseline visit. DISCUSSION: The development of TMD was accompanied by increases in headaches, muscle soreness or pain, and other pains that were not observed in the Participants who did not develop TMD. Participants who developed TMD also report higher experience of joint, back, chest, and menstrual pain at baseline.
PMID: 20090437 [PubMed - in process]
The study was done on 266 female patients aged 18-34 years old who initially were free of TMD symptoms. Over 5% of the population developed new TMD symptoms. There is no question that the majority of headaches are caused by the trigeminal nerve (dental Nerve) what this study sees to imply is that the trigemino system may increase perception of pain throughout the body. This may be do to central sensitization. This is a rationale for utilizing neuromuscular dentistry to treat patients early to prevent a local problem from becoming widespread.
Dr Barry Cooper has shown an "overwhelming" positive effect on headaches and TMJ disorders with Neuromuscular Dentistry. A neuromuscular dentist has the training and equipment necessary to evaluate physiologic parameters and idealize occlusion to reduce or eliminate TMD symptoms and Headaches and prevent a local problem from becoming a whole body problem.
Clin J Pain. 2010 Feb;26(2):116-20.
Development of temporomandibular disorders is associated with greater bodily pain experience.
Lim PF, Smith S, Bhalang K, Slade GD, Maixner W.
Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599-7455, USA. peifeng_lim@dentistry.unc.edu
OBJECTIVES: The aim of this study is to examine the difference in the report of bodily pain experienced by patients who develop temporomandibular disorders (TMD) and by those who do not develop TMD over a 3-year observation period. METHODS: This is a 3-year prospective study of 266 females aged 18 to 34 years initially free of TMD pain. All patients completed the Symptom Report Questionnaire (SRQ) at baseline and yearly intervals, and at the time they developed TMD (if applicable). The SRQ is a self-report instrument evaluating the extent and location of pain experienced in the earlier 6 months. Statistical analysis was carried out using repeated measures ANOVA. RESULTS: Over the 3-year period, 16 patients developed TMD based on the Research Diagnostic Criteria for TMD. Participants who developed TMD reported more headaches (P=0.0089), muscle soreness or pain (P=0.005), joint soreness or pain (P=0.0012), back pain (P=0.0001), chest pain (P=0.0004), abdominal pain (P=0.0021), and menstrual pain (P=0.0036) than Participants who did not develop TMD at both the baseline and final visits. Participants who developed TMD also reported significantly more headache (P=0.0006), muscle soreness or pain (P=0.0059), and other pains (P=0.0188) when they were diagnosed with TMD compared with the baseline visit. DISCUSSION: The development of TMD was accompanied by increases in headaches, muscle soreness or pain, and other pains that were not observed in the Participants who did not develop TMD. Participants who developed TMD also report higher experience of joint, back, chest, and menstrual pain at baseline.
PMID: 20090437 [PubMed - in process]
Friday, January 22, 2010
PREVENTING HEADACHES IN OUR CHILDREN THRU EARLY INTERVENTION
I HAVE REPRINTED AN ENTRY FROM THE I HATE CPAP BLOG THAT EXPLAINS WHY MANY HEADACHE PROBLEMS PERSIST AND RUN IN FAMILIES. THEIR IS A DEVELOPMENT PATHWAY THAT LEADS TO PHYSICAL AND STRUCTURAL CHANGES THAT LEAD TO HEADACHES AND MIGRAINES. WHILE NEUROMUSCULAR DENTISTRY ALLOWS US TO TREAT PATIENTS AND ALLEVIATE THE MIGRAINES AND OTHER HEADACHES IT IN IMPORTANT THAT WE RECOGNIZE THAT THESE PROBLES ARE OFTEN PREVENTABLE IF WE ACT EARLY TO PROTECT OUR CHILDREN.
FROM I HATE CPAP BLOG
DEVELOPMENTAL CHANGES IN CHILDREN WITH SLEEP APNEA MUST BE ADDRESSED AFTER REMOVAL OF TONSILS AND ADENOIDS
A recent study in the International Journal of Pediatric Otorhinolaryngology looked at arch Maxillary (upper jaw) development in children with snoring and sleep apnea and evaluated changes after adenotonsillar surgery. The physical changes did not correct after surgery and these children were left with residual problems that could plague the for their entire life. The authors concluded " Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended."
It is essential that the pediatric and dental communities recognize that children do not grow and eliminate the problems of enlarged tonsils and adenoids but rather they experience distorted growth that must be corrected. Early diagnosis and treatment of airway is essential for proper dento-facial growth. The NHLBI considers sleep apnea to be a TMJ Disorder. Sleep Apnea, Snoring, Migraines, Tension Headaches, Chronic Daily Headaches and TMJ disorders all begin in a common developmental pathway.
Dental Sleep Meicine and Neuromuscular Dentistry are key in improving the quality of live of these patients as adults. Early intervention may greatly reduce the number of patients who develop these problems.
nt J Pediatr Otorhinolaryngol. 2009 Nov 23. [Epub ahead of print]
Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery.
Löfstrand-Tideström B, Hultcrantz E.
Department of Surgical Sciences, Division of Otorhinolaryngology, University of Uppsala, SE - 751 85 Uppsala, Sweden.
OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.
PMID: 19939470 [PubMed - as supplied by publisher]
FROM I HATE CPAP BLOG
DEVELOPMENTAL CHANGES IN CHILDREN WITH SLEEP APNEA MUST BE ADDRESSED AFTER REMOVAL OF TONSILS AND ADENOIDS
A recent study in the International Journal of Pediatric Otorhinolaryngology looked at arch Maxillary (upper jaw) development in children with snoring and sleep apnea and evaluated changes after adenotonsillar surgery. The physical changes did not correct after surgery and these children were left with residual problems that could plague the for their entire life. The authors concluded " Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended."
It is essential that the pediatric and dental communities recognize that children do not grow and eliminate the problems of enlarged tonsils and adenoids but rather they experience distorted growth that must be corrected. Early diagnosis and treatment of airway is essential for proper dento-facial growth. The NHLBI considers sleep apnea to be a TMJ Disorder. Sleep Apnea, Snoring, Migraines, Tension Headaches, Chronic Daily Headaches and TMJ disorders all begin in a common developmental pathway.
Dental Sleep Meicine and Neuromuscular Dentistry are key in improving the quality of live of these patients as adults. Early intervention may greatly reduce the number of patients who develop these problems.
nt J Pediatr Otorhinolaryngol. 2009 Nov 23. [Epub ahead of print]
Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery.
Löfstrand-Tideström B, Hultcrantz E.
Department of Surgical Sciences, Division of Otorhinolaryngology, University of Uppsala, SE - 751 85 Uppsala, Sweden.
OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.
PMID: 19939470 [PubMed - as supplied by publisher]
Tuesday, January 19, 2010
Ankylosing Spondylitis Associated With (TMJD) Craniomandibular Disorder
THIS IS AN INTERESTING ABSTRACT ON TREATMENT OF ANKYLOSING SPONDYLITIS AND TMD TREATMENT COMBINED
I have a patient who we treated many years ago with neuromuscular dentistry who had ankylosing Spondylitis as did his father. We started with a diagnostic work-up that included EMG and MKG and use of ULF TENS to relax trigeminally innervated muscles and created a dianostic orthotic. The patient finished his case orthodntically and has been stable for close to 20 years. The Ankylosing spondylitis resolved (Was this because of neuromuscular dental treatment or an incidental occurence?)
The patient firmly believes the neuromuscular dentistry "saved him" He later married and we treated his wife for severe headaches and vertigo again using neuromuscular dentistry. Her treatment included implants and overdentures but began with a diagnostic orthotic.
The neuromuscular diagnostic orthotic is an essential element in treating TMJ disorders, migraines and Tension Type headaches. After determination of the patients initial condition thru use of EMG (bipolar skin electrodes) MKG (mandibular kinesiograph) or computerized mandibular scan, ULF TENS a neuromuscular bite registration is taken to build the diagnostic orthotic. The orthotic is not 'perfect" at delivery but must be continually adjusted to account for changes in the patients posture and physiology. When the patient is stabilized it is necessary to reevaluate whether the desired results have been obtained ie; relief of headaches, ear pain , joint pain, sinus pain , clicking , locking , migraines or other symptoms. If the patient feels substantial improvement they can opt for a second phase of treatment for long term relief. This can be a cast removable orthotic, Crown and/or bridge reconstruction, implants, orthodontics or jaw surgery. If substantial improvement is not seen non-reversible treatment should be avoided. Sometimes irreversible treatment can be provided but expectations for relief should be minimal if orthotic treatment is not successful. I suggest "Patient Beware" , ask lots of questions and proceed with caution.
Contrast the Neuromuscular Dental approach to the CR or Centric Relation approach that often begins with equilibration (permanent changes to teeth and occlusion) as the first step or treatment. The position is often based on the concept of Bimanual Manipulation. This means that the dentist uses his hand muscles to determine the proper jaw position by manipulating the jaw. This has also been caused "Romancing the mandible" Barney Jankelson the Father of Neuromuscular Dentistry felt that romancing the mandible was a concept that would fall to the wayside when scientific instruments could be used to measure where and how the muscles and joints functioned with physiologic ideals. His famous quote "If it is measured it is a fact , otherwise it is an opinion " described why he felt the old concept of Centric Relation had outlived it usefullness. There have actually been at least 26 different definitions of CR as proponents tried to define an appropriate position for the joint.
Neuromuscular Dentistry is more concerned with creating a healthy condition where the muscles and neuromuscular bite auto-position the condyle of the TM Joint in the proper position.
Publication: World Journal of Orthodontics Winter 2009 Volume 10 , Issue 4
Ankylosing Spondylitis Associated With Craniomandibular Disorder—A Combined Orthodontic And Prosthodontic Therapeutic Approach
Petros T. Koidis, DDS, MS, PhD/Ioanna Basli, DDS/Nikos Topouzelis, DDS, PhD
Ankylosing spondylitis is a disease that causes inflammatory changes of the involved joints. Although the initial clinical signs are pain and discomfort, synovial changes progressively involve all the axial joints, including the temporomandibular joint (TMJ). Eventually, bony alterations develop (condylar erosions, flattening, sclerosis) that affect the position of the condyle, the superior joint space, and the range of movements. These symptoms correlate with the severity of the disease. Besides physiotherapy and surgery, no dental rehabilitation has been reported for these patients. This report of a female patient with ankylosing spondylitis and a TMJ disorder emphasizes dental rehabilitation. The aim of the splint, orthodontic, and prosthodontic treatment was to relieve the subjective symptoms through establishing a stable optimum occlusion. Anamnestic, laboratory, and clinical findings including pre- and postradiographic examination records are presented. World J Orthod 2009;10:371–377.
I have a patient who we treated many years ago with neuromuscular dentistry who had ankylosing Spondylitis as did his father. We started with a diagnostic work-up that included EMG and MKG and use of ULF TENS to relax trigeminally innervated muscles and created a dianostic orthotic. The patient finished his case orthodntically and has been stable for close to 20 years. The Ankylosing spondylitis resolved (Was this because of neuromuscular dental treatment or an incidental occurence?)
The patient firmly believes the neuromuscular dentistry "saved him" He later married and we treated his wife for severe headaches and vertigo again using neuromuscular dentistry. Her treatment included implants and overdentures but began with a diagnostic orthotic.
The neuromuscular diagnostic orthotic is an essential element in treating TMJ disorders, migraines and Tension Type headaches. After determination of the patients initial condition thru use of EMG (bipolar skin electrodes) MKG (mandibular kinesiograph) or computerized mandibular scan, ULF TENS a neuromuscular bite registration is taken to build the diagnostic orthotic. The orthotic is not 'perfect" at delivery but must be continually adjusted to account for changes in the patients posture and physiology. When the patient is stabilized it is necessary to reevaluate whether the desired results have been obtained ie; relief of headaches, ear pain , joint pain, sinus pain , clicking , locking , migraines or other symptoms. If the patient feels substantial improvement they can opt for a second phase of treatment for long term relief. This can be a cast removable orthotic, Crown and/or bridge reconstruction, implants, orthodontics or jaw surgery. If substantial improvement is not seen non-reversible treatment should be avoided. Sometimes irreversible treatment can be provided but expectations for relief should be minimal if orthotic treatment is not successful. I suggest "Patient Beware" , ask lots of questions and proceed with caution.
Contrast the Neuromuscular Dental approach to the CR or Centric Relation approach that often begins with equilibration (permanent changes to teeth and occlusion) as the first step or treatment. The position is often based on the concept of Bimanual Manipulation. This means that the dentist uses his hand muscles to determine the proper jaw position by manipulating the jaw. This has also been caused "Romancing the mandible" Barney Jankelson the Father of Neuromuscular Dentistry felt that romancing the mandible was a concept that would fall to the wayside when scientific instruments could be used to measure where and how the muscles and joints functioned with physiologic ideals. His famous quote "If it is measured it is a fact , otherwise it is an opinion " described why he felt the old concept of Centric Relation had outlived it usefullness. There have actually been at least 26 different definitions of CR as proponents tried to define an appropriate position for the joint.
Neuromuscular Dentistry is more concerned with creating a healthy condition where the muscles and neuromuscular bite auto-position the condyle of the TM Joint in the proper position.
Publication: World Journal of Orthodontics Winter 2009 Volume 10 , Issue 4
Ankylosing Spondylitis Associated With Craniomandibular Disorder—A Combined Orthodontic And Prosthodontic Therapeutic Approach
Petros T. Koidis, DDS, MS, PhD/Ioanna Basli, DDS/Nikos Topouzelis, DDS, PhD
Ankylosing spondylitis is a disease that causes inflammatory changes of the involved joints. Although the initial clinical signs are pain and discomfort, synovial changes progressively involve all the axial joints, including the temporomandibular joint (TMJ). Eventually, bony alterations develop (condylar erosions, flattening, sclerosis) that affect the position of the condyle, the superior joint space, and the range of movements. These symptoms correlate with the severity of the disease. Besides physiotherapy and surgery, no dental rehabilitation has been reported for these patients. This report of a female patient with ankylosing spondylitis and a TMJ disorder emphasizes dental rehabilitation. The aim of the splint, orthodontic, and prosthodontic treatment was to relieve the subjective symptoms through establishing a stable optimum occlusion. Anamnestic, laboratory, and clinical findings including pre- and postradiographic examination records are presented. World J Orthod 2009;10:371–377.
HEADACHE RELIEF AFTER 50 YEARS OF CONTINUOUS PAIN
I recently treated a patient who a a continuous headache for over 50 years. I originally saw hew husband and my Schaumburg Chicagoland Dental Sleep Medicine Associates office to treat his sleep apnea with an oral appliance. We successfully treated his sleep apnea and in the process eliminated his snoring which she commented greatly improved her life. We then discussed her headaches and did spray and stretch with ethyl chloride and relieved her 50 year headache and gave her an Aqualizer appliance as a temporary "crutch" Her headache stayed away until the Aqualizer broke.
I nest saw "M" at my Gurnee office and did a diagnostic appointment and a diagnostic orthotic. Her next visit she reported being totally headache free. LIFE CHANGING! Over the last few months we have reconstructed her mouth to the position determined by the diagnostic orthotic and she remains headache free despite extremely high family stress due to medical issues.
Her grandchildren would ask her everyday "Do you still not have a headache."
I nest saw "M" at my Gurnee office and did a diagnostic appointment and a diagnostic orthotic. Her next visit she reported being totally headache free. LIFE CHANGING! Over the last few months we have reconstructed her mouth to the position determined by the diagnostic orthotic and she remains headache free despite extremely high family stress due to medical issues.
Her grandchildren would ask her everyday "Do you still not have a headache."
Thursday, January 14, 2010
21 year old frequent headaches and migraine with no relief.
A recent email brings up many interesting questions. My comments follow this distressing case.
"I am writing this on behalf of our 21 year old son who has dealt with frequent headaches since kindergarten. The headaches have gotten more frequent and more severe as the years have gone by. Currently, he averages 4-5 headaches a week and approximately 2 migraines a month.
He takes Extra Strength Excedrin at the first sign of a headache. If there is no relief within 30 minutes, he will take a Relpax. We have tried food diaries, monitoring sleep patterns, massage therapy, chiropractors, and even sought 3 surgeons asking if his non-union clavicle could possible be the source of his headaches. He has tried Topomax, but no longer takes it daily.
He has had orthodontic work done and now wears a retainer nightly. Only recently have we thought to consider sleep apnea (he has always been a very restless sleeper; i.e. tossing and turning) and possibly TMJ. He is seeing a dentist tomorrow (1/14) and will ask about the TMJ.
Is it possible that this could be the cause of his headaches? I know my son would be thrilled if he could just have one headache a month! Even if it were a migraine, it would be better than what he is dealing with currently.
Thank you for your time, and I apologize if this is the second email you have received from me. I am sending this from work and because I have not heard from you, I am not sure you received my previous post."
Reply
This case brings up many interesting questions. When do the headaches occur? Does the patient wake in the morning with headaches or does pain wake him from sleep. Patients that only occur in the morning can sometimes be treated with a nightime only appliance but sleep apnea must be ruled out as a causes. The most common causes of morning headaches are sleep apnea and TMD (includes bruxism and clenching) TMD does not always have pain or clicking in the joint.
A second question is how much extra strength Excedrin (and caffeine) A patient can have a medication rebound headache as well. Orthodontics can make headaches, sleep apnea and TMJ problems better or worse or have no effect. If the ortho pulled the jaw back it is likely to make the problem worse. Also, was there bicuspids removed to treat the case? Removal of teeth, in my experience usually will make sleep apnea worse.
As discussed in previous posts Sleep Apnea is a TMJ disorder and I strongly Rx anyone with morning headaches, migraines or TMJ disorders read the NHLBI (National Heart Lng and Blood Institue) article "CARDIOVASCULAR AND SLEEP-RELATED
CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
The following is excerpted from the NHLBI paper:
"Mandibular Movements, Upper Airway Resistance, Breathing and Swallowing
There appears to an associated increase in coughing in subjects with sleep apnea. Occlusion of
the pharynx can force residual secretions into the glottis and trigger coughing reflexes,
swallowing reflexes, and other reflexes that could contribute to the disorganization of breathing
during sleep. In addition to the muscles of mastication, the tongue plays an important role in
the coordinated events of swallowing and breathing. The integration of breathing and
swallowing is tightly linked, and these events in turn are in some manner linked to blood
pressure regulation. Each of these pathways has been studied by scientists in individual
disciplines, but there is a need for interdisciplinary studies to determine the interactions of the
peripheral and central neural pathways controlling breathing, chewing, swallowing, and
cardiovascular events. The presence of pain in patients with TMD would be expected to
seriously impact upon these reflex and motor pathways. Little is known about the role of tongue
position and how this may be altered in subjects with altered jaw location and structure. Sleep
state has been shown to alter the central modulation of the coordination of breathing, airway
dynamics, swallowing, and associated cardiovascular events. Differences in central modulation
of these events in subjects with sleep apnea and TMD need to be evaluated using sleep as a
dynamic change in the state of the individual."
The paper also suggests 60-90% resolution which frequently occurs in treatment. I believe that Neuromuscular Dental treatment increases that success rate considerably.
Neuromuscular Dentistry has been shown to be "overwhelmingly successful according to Dr Barry Cooper's research reported in Cranio. The PubMED abstracts are include at the bottom of the post for convenience.
Other questions include what were the effects of physical medicine such as Chiropractic and massage and were the treatment combined. Was there no relief or only temporary relief. When either of those therapies only gives temporary relief you should suspect a problem with the neuromuscular bite position. TMD is a repetitive strain condition and breathing and swallowing as well as postural conditions can effect the bite just as the jaw position effects the entire bodies balance. The strongest influence on headaches is thru the trigeminal nerve.
An excellent way to both diagnose a cause and effect of jaw muscles to headache pain is the use of trigger point injections and diagnostic blocks. Frequently a severe headache can be relieved by judicious use of TP injections. Recurrent headaches are usually less frequent and severe if successful.
Cranio. 2009 Apr;27(2):101-8.
Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology of the State University of New York (SUNY) Stony Brook School of Dental Medicine, NY, USA. tmjbcooper@aol.com
A prominent etiological theory proposed for TMD related headache is that it results from a dysfunctional masticatory muscle system, wherein muscle hyperactivity is frequently caused by dental temporomandibular disharmony. The central goal of this article was to determine from a literature review of the subject whether there is significant evidence to support a relationship between headaches and TMD prevalence. A second purpose was to determine from such a review whether any relationship was one of cause and effect and whether treatment of the TMD condition can result in meaningful reduction or resolution of headaches. In the literature, there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type. Evidence for a cause and effect relationship was strong. It generally showed in numerous patients that TMD treatment of a large number of patients resulted in significant improvement in the physiological state of the masticatory system (muscles, joints and dental occlusion). Reduction or resolution of muscle tension-type headaches that were present was clinically significant. The authors concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition.
Cranio. 2008 Apr;26(2):104-17.
Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA. tmjbcooper@aol.com
Comment in:
Cranio. 2008 Jul;26(3):166; author reply 167.
The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
PMID: 18468270 [PubMed - indexed for MEDLINE]
"I am writing this on behalf of our 21 year old son who has dealt with frequent headaches since kindergarten. The headaches have gotten more frequent and more severe as the years have gone by. Currently, he averages 4-5 headaches a week and approximately 2 migraines a month.
He takes Extra Strength Excedrin at the first sign of a headache. If there is no relief within 30 minutes, he will take a Relpax. We have tried food diaries, monitoring sleep patterns, massage therapy, chiropractors, and even sought 3 surgeons asking if his non-union clavicle could possible be the source of his headaches. He has tried Topomax, but no longer takes it daily.
He has had orthodontic work done and now wears a retainer nightly. Only recently have we thought to consider sleep apnea (he has always been a very restless sleeper; i.e. tossing and turning) and possibly TMJ. He is seeing a dentist tomorrow (1/14) and will ask about the TMJ.
Is it possible that this could be the cause of his headaches? I know my son would be thrilled if he could just have one headache a month! Even if it were a migraine, it would be better than what he is dealing with currently.
Thank you for your time, and I apologize if this is the second email you have received from me. I am sending this from work and because I have not heard from you, I am not sure you received my previous post."
Reply
This case brings up many interesting questions. When do the headaches occur? Does the patient wake in the morning with headaches or does pain wake him from sleep. Patients that only occur in the morning can sometimes be treated with a nightime only appliance but sleep apnea must be ruled out as a causes. The most common causes of morning headaches are sleep apnea and TMD (includes bruxism and clenching) TMD does not always have pain or clicking in the joint.
A second question is how much extra strength Excedrin (and caffeine) A patient can have a medication rebound headache as well. Orthodontics can make headaches, sleep apnea and TMJ problems better or worse or have no effect. If the ortho pulled the jaw back it is likely to make the problem worse. Also, was there bicuspids removed to treat the case? Removal of teeth, in my experience usually will make sleep apnea worse.
As discussed in previous posts Sleep Apnea is a TMJ disorder and I strongly Rx anyone with morning headaches, migraines or TMJ disorders read the NHLBI (National Heart Lng and Blood Institue) article "CARDIOVASCULAR AND SLEEP-RELATED
CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
The following is excerpted from the NHLBI paper:
"Mandibular Movements, Upper Airway Resistance, Breathing and Swallowing
There appears to an associated increase in coughing in subjects with sleep apnea. Occlusion of
the pharynx can force residual secretions into the glottis and trigger coughing reflexes,
swallowing reflexes, and other reflexes that could contribute to the disorganization of breathing
during sleep. In addition to the muscles of mastication, the tongue plays an important role in
the coordinated events of swallowing and breathing. The integration of breathing and
swallowing is tightly linked, and these events in turn are in some manner linked to blood
pressure regulation. Each of these pathways has been studied by scientists in individual
disciplines, but there is a need for interdisciplinary studies to determine the interactions of the
peripheral and central neural pathways controlling breathing, chewing, swallowing, and
cardiovascular events. The presence of pain in patients with TMD would be expected to
seriously impact upon these reflex and motor pathways. Little is known about the role of tongue
position and how this may be altered in subjects with altered jaw location and structure. Sleep
state has been shown to alter the central modulation of the coordination of breathing, airway
dynamics, swallowing, and associated cardiovascular events. Differences in central modulation
of these events in subjects with sleep apnea and TMD need to be evaluated using sleep as a
dynamic change in the state of the individual."
The paper also suggests 60-90% resolution which frequently occurs in treatment. I believe that Neuromuscular Dental treatment increases that success rate considerably.
Neuromuscular Dentistry has been shown to be "overwhelmingly successful according to Dr Barry Cooper's research reported in Cranio. The PubMED abstracts are include at the bottom of the post for convenience.
Other questions include what were the effects of physical medicine such as Chiropractic and massage and were the treatment combined. Was there no relief or only temporary relief. When either of those therapies only gives temporary relief you should suspect a problem with the neuromuscular bite position. TMD is a repetitive strain condition and breathing and swallowing as well as postural conditions can effect the bite just as the jaw position effects the entire bodies balance. The strongest influence on headaches is thru the trigeminal nerve.
An excellent way to both diagnose a cause and effect of jaw muscles to headache pain is the use of trigger point injections and diagnostic blocks. Frequently a severe headache can be relieved by judicious use of TP injections. Recurrent headaches are usually less frequent and severe if successful.
Cranio. 2009 Apr;27(2):101-8.
Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology of the State University of New York (SUNY) Stony Brook School of Dental Medicine, NY, USA. tmjbcooper@aol.com
A prominent etiological theory proposed for TMD related headache is that it results from a dysfunctional masticatory muscle system, wherein muscle hyperactivity is frequently caused by dental temporomandibular disharmony. The central goal of this article was to determine from a literature review of the subject whether there is significant evidence to support a relationship between headaches and TMD prevalence. A second purpose was to determine from such a review whether any relationship was one of cause and effect and whether treatment of the TMD condition can result in meaningful reduction or resolution of headaches. In the literature, there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type. Evidence for a cause and effect relationship was strong. It generally showed in numerous patients that TMD treatment of a large number of patients resulted in significant improvement in the physiological state of the masticatory system (muscles, joints and dental occlusion). Reduction or resolution of muscle tension-type headaches that were present was clinically significant. The authors concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition.
Cranio. 2008 Apr;26(2):104-17.
Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA. tmjbcooper@aol.com
Comment in:
Cranio. 2008 Jul;26(3):166; author reply 167.
The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
PMID: 18468270 [PubMed - indexed for MEDLINE]
Saturday, January 9, 2010
Chronic Daily Headache in Children and Adolescents
Chronic Daily Headache which affects 2-4% of female adolescents and as high as 2% of males can have a devastating effect on children. They usually occur with a chronic baseline headache with episodes of severe migraine-like are severe in intensity. This condition can last for months and there is no known underlying pathology. A neuromuscular dentist (NEUROMUSCULAR DENTISTRY http://www.sleepandhealth.com/neuromuscular-dentistry) should evaluate these patients early in treatment after organic disease is ruled out. Children are experiencing numerous changes at this period of their life including changes in hormonal status, increase peer pressures in school as well as increasing demands from school. They are also frequently going thru transitional dentition.
The advantage to orthotic treatment is there is at least a 50-80% improvement in the majority of patients treated with an orthotic. Even this partial relief could be life changing. If there is a primary problem related to jaw function and/or trigeminal nerve function Neuromuscular Dentistry allows early correction and orthodontics for case completion. It must be recognized that this condition frequently begins during orthodontic treatment.
Children with Chronic Daily Headache (CDH) problems have associated symptoms including sleep disturbances, other pain problems, dizziness that frequently results in school absence. Temporomandibular disorders are also known to cause severe Tension-Type headaches as well as other symptoms including facial pain, neck pain dizziness, ear pain, stuffy ears , sinus pain and sleep disorders. The National Heart Lung and Blood Institute considers Sleep Apnea to be a TMJ disorder in their report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" The report defines The term TMD as "a collection of MEDICAL and dental conditions affecting the temporomandibular joint (TMJ) and/or muscles of mastication, as well as contiguous tissue components. Symptoms range from occasional discomfort to debilitating pain and severely compromised jaw function. The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking. This is not a dental problem but a medical problem that can cause wide spread problems including Migraines, Chronic Daily Headaches, Episodic Tension Type Headaches and Morning Headaches.
CDH is frequently associated with medication-overuse headache which is a bigger problem in children than adults as it can lead to a lifetime pattern of overuse. CDH is known to have "psychiatric comorbidity (anxiety and mood disorders) these may be a direct result of living with severe pain but may also be do to sleep apnea or other sleep disorders such as primary insomnia that is suspected as an etiology for central sensitization. The NHLBI report states " Pain linked to the TMJ and/or muscles of mastication constitutes the essential criterion for case assignment. It often qualifies as “aching”, “throbbing”, “tiring” and exhausting. About 60-90% of cases appear to experience satisfactory resolution of symptoms with a range of interventions. In contrast, the remaining group of patients does not respond well to these treatments and continues to exhibit persistent pain. Comorbid complaints, such as problems with sleep, blood pressure and breathing are not uncommon for this group of TMD patients but have not been well characterized. " The report of 60-90% relief is astounding compared to reports from neurological journals. Cases should be evaluated for TMD by a neuromuscular dentist for early treatment to lower the risk of developing central sensitization and a lifetime of chronic headaches and/or migraines. While there is a group reported to not respond to treatment it is a minority of patient.
This view is supported by Dr Barry Cooper in his paper " Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment." published in Cranio in April 2009. He reported "there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type". Dr Cooper reported " Evidence for a cause and effect relationship was strong." The paper concluded that "TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition." Early treatment to prevent progression is the ideal but relief of symptoms for 60-90 % of children as reported by the NHLBI would be sufficient to warrant evaluation of all pediaric and adolescent headaches.
Another paper in Cranio by Cooper BC, Kleinberg I. "Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients." reported Patients reported "overwhelming symptom relief" This study was based specifically on neuromuscular dental treatment and the results were overwhelming including "reduction of headaches and other pain symptoms." Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
Unfortunately both adult and pre-adult patients are often not referred for neuromuscular dental evaluation for numerous reasons. A surprising reason is that physicians are not comfortable referring to dentists. This is beginning to change as physicians see excellent results of treatment of sleep apnea with oral appliances (http://www.ihatecpap.com/oral_appliance.html) and the medical community recognizes the effects of periodontal disease on chronic inflamation, cytokines and the cardiovascular effects of these changes.
PubMed abstract below:
Rev Neurol (Paris). 2009 Jun-Jul;165(6-7):521-31. Epub 2008 Nov 28.
[Management of chronic daily headache in children and adolescents]
[Article in French]
Cuvellier JC.
Service de neuropédiatrie, clinique de pédiatrie, hôpital Roger-Salengro, centre hospitalier régional et universitaire de Lille, rue du Professeur-Laine, 59037 Lille cedex, France. jc-cuvellier@chru-lille.fr
Chronic daily headache (CDH) affects 2 to 4% of adolescent females and 0,8 to 2% of adolescent males. CDH is diagnosed when headaches occur more than 4 hours a day, for greater than or equal to 15 headache days per month, over a period of 3 consecutive months, without an underlying pathology. It is manifested by severe intermittent headaches, that are migraine-like, as well as a chronic baseline headache. Silberstein and Lipton divided patients into four diagnostic categories: transformed migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. The second edition of the International Classification of Headache Disorders did not comprise any CDH category as such, but provided criteria for all four types of CDH: chronic migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Children and adolescents with CDH frequently have sleep disturbance, pain at other sites, dizziness, medication-overuse headache and a psychiatric comorbidity (anxiety and mood disorders). CDH frequently results in school absence. CDH management plan is dictated by CDH subtype, the presence or absence of medication overuse, functional disability and presence of attacks of full-migraine superimposed. Reassuring, explaining, and educating the patient and family, starting prophylactic therapy and limiting aborting medications are the mainstay of treatment. It includes pharmacologic (acute and prophylactic therapy) and nonpharmacologic measures (biobehavioral management, biofeedback-assisted relaxation therapy, and psychologic or psychiatric intervention). Part of the teaching process must incorporate life-style changes, such as regulation of sleep and eating habits, regular exercise, avoidance of identified triggering factors and stress management. Emphasis must be placed on preventive measures rather than on analgesic or abortive strategies. Stressing the reintegration of the patient into school and family activities and assessing prognosis are other issues to address during the first visit. There are limited data evaluating the outcome of CDH in children and adolescents.
Cranio. 2009 Apr;27(2):101-8.
Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology of the State University of New York (SUNY) Stony Brook School of Dental Medicine, NY, USA. tmjbcooper@aol.com
A prominent etiological theory proposed for TMD related headache is that it results from a dysfunctional masticatory muscle system, wherein muscle hyperactivity is frequently caused by dental temporomandibular disharmony. The central goal of this article was to determine from a literature review of the subject whether there is significant evidence to support a relationship between headaches and TMD prevalence. A second purpose was to determine from such a review whether any relationship was one of cause and effect and whether treatment of the TMD condition can result in meaningful reduction or resolution of headaches. In the literature, there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type. Evidence for a cause and effect relationship was strong. It generally showed in numerous patients that TMD treatment of a large number of patients resulted in significant improvement in the physiological state of the masticatory system (muscles, joints and dental occlusion). Reduction or resolution of muscle tension-type headaches that were present was clinically significant. The authors concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition.
PMID: 19455921 [PubMed - indexed for MEDLINE]
Cranio. 2008 Apr;26(2):104-17.
Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA. tmjbcooper@aol.com
Comment in:
Cranio. 2008 Jul;26(3):166; author reply 167.
The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
PMID: 18468270 [PubMed - indexed for MEDLINE]
The advantage to orthotic treatment is there is at least a 50-80% improvement in the majority of patients treated with an orthotic. Even this partial relief could be life changing. If there is a primary problem related to jaw function and/or trigeminal nerve function Neuromuscular Dentistry allows early correction and orthodontics for case completion. It must be recognized that this condition frequently begins during orthodontic treatment.
Children with Chronic Daily Headache (CDH) problems have associated symptoms including sleep disturbances, other pain problems, dizziness that frequently results in school absence. Temporomandibular disorders are also known to cause severe Tension-Type headaches as well as other symptoms including facial pain, neck pain dizziness, ear pain, stuffy ears , sinus pain and sleep disorders. The National Heart Lung and Blood Institute considers Sleep Apnea to be a TMJ disorder in their report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" The report defines The term TMD as "a collection of MEDICAL and dental conditions affecting the temporomandibular joint (TMJ) and/or muscles of mastication, as well as contiguous tissue components. Symptoms range from occasional discomfort to debilitating pain and severely compromised jaw function. The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking. This is not a dental problem but a medical problem that can cause wide spread problems including Migraines, Chronic Daily Headaches, Episodic Tension Type Headaches and Morning Headaches.
CDH is frequently associated with medication-overuse headache which is a bigger problem in children than adults as it can lead to a lifetime pattern of overuse. CDH is known to have "psychiatric comorbidity (anxiety and mood disorders) these may be a direct result of living with severe pain but may also be do to sleep apnea or other sleep disorders such as primary insomnia that is suspected as an etiology for central sensitization. The NHLBI report states " Pain linked to the TMJ and/or muscles of mastication constitutes the essential criterion for case assignment. It often qualifies as “aching”, “throbbing”, “tiring” and exhausting. About 60-90% of cases appear to experience satisfactory resolution of symptoms with a range of interventions. In contrast, the remaining group of patients does not respond well to these treatments and continues to exhibit persistent pain. Comorbid complaints, such as problems with sleep, blood pressure and breathing are not uncommon for this group of TMD patients but have not been well characterized. " The report of 60-90% relief is astounding compared to reports from neurological journals. Cases should be evaluated for TMD by a neuromuscular dentist for early treatment to lower the risk of developing central sensitization and a lifetime of chronic headaches and/or migraines. While there is a group reported to not respond to treatment it is a minority of patient.
This view is supported by Dr Barry Cooper in his paper " Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment." published in Cranio in April 2009. He reported "there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type". Dr Cooper reported " Evidence for a cause and effect relationship was strong." The paper concluded that "TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition." Early treatment to prevent progression is the ideal but relief of symptoms for 60-90 % of children as reported by the NHLBI would be sufficient to warrant evaluation of all pediaric and adolescent headaches.
Another paper in Cranio by Cooper BC, Kleinberg I. "Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients." reported Patients reported "overwhelming symptom relief" This study was based specifically on neuromuscular dental treatment and the results were overwhelming including "reduction of headaches and other pain symptoms." Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
Unfortunately both adult and pre-adult patients are often not referred for neuromuscular dental evaluation for numerous reasons. A surprising reason is that physicians are not comfortable referring to dentists. This is beginning to change as physicians see excellent results of treatment of sleep apnea with oral appliances (http://www.ihatecpap.com/oral_appliance.html) and the medical community recognizes the effects of periodontal disease on chronic inflamation, cytokines and the cardiovascular effects of these changes.
PubMed abstract below:
Rev Neurol (Paris). 2009 Jun-Jul;165(6-7):521-31. Epub 2008 Nov 28.
[Management of chronic daily headache in children and adolescents]
[Article in French]
Cuvellier JC.
Service de neuropédiatrie, clinique de pédiatrie, hôpital Roger-Salengro, centre hospitalier régional et universitaire de Lille, rue du Professeur-Laine, 59037 Lille cedex, France. jc-cuvellier@chru-lille.fr
Chronic daily headache (CDH) affects 2 to 4% of adolescent females and 0,8 to 2% of adolescent males. CDH is diagnosed when headaches occur more than 4 hours a day, for greater than or equal to 15 headache days per month, over a period of 3 consecutive months, without an underlying pathology. It is manifested by severe intermittent headaches, that are migraine-like, as well as a chronic baseline headache. Silberstein and Lipton divided patients into four diagnostic categories: transformed migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. The second edition of the International Classification of Headache Disorders did not comprise any CDH category as such, but provided criteria for all four types of CDH: chronic migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Children and adolescents with CDH frequently have sleep disturbance, pain at other sites, dizziness, medication-overuse headache and a psychiatric comorbidity (anxiety and mood disorders). CDH frequently results in school absence. CDH management plan is dictated by CDH subtype, the presence or absence of medication overuse, functional disability and presence of attacks of full-migraine superimposed. Reassuring, explaining, and educating the patient and family, starting prophylactic therapy and limiting aborting medications are the mainstay of treatment. It includes pharmacologic (acute and prophylactic therapy) and nonpharmacologic measures (biobehavioral management, biofeedback-assisted relaxation therapy, and psychologic or psychiatric intervention). Part of the teaching process must incorporate life-style changes, such as regulation of sleep and eating habits, regular exercise, avoidance of identified triggering factors and stress management. Emphasis must be placed on preventive measures rather than on analgesic or abortive strategies. Stressing the reintegration of the patient into school and family activities and assessing prognosis are other issues to address during the first visit. There are limited data evaluating the outcome of CDH in children and adolescents.
Cranio. 2009 Apr;27(2):101-8.
Relationship of temporomandibular disorders to muscle tension-type headaches and a neuromuscular orthosis approach to treatment.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology of the State University of New York (SUNY) Stony Brook School of Dental Medicine, NY, USA. tmjbcooper@aol.com
A prominent etiological theory proposed for TMD related headache is that it results from a dysfunctional masticatory muscle system, wherein muscle hyperactivity is frequently caused by dental temporomandibular disharmony. The central goal of this article was to determine from a literature review of the subject whether there is significant evidence to support a relationship between headaches and TMD prevalence. A second purpose was to determine from such a review whether any relationship was one of cause and effect and whether treatment of the TMD condition can result in meaningful reduction or resolution of headaches. In the literature, there was a substantial amount of evidence for a positive relationship between TMD and the prevalence of headaches, and most importantly, that these were the muscle tension-type. Evidence for a cause and effect relationship was strong. It generally showed in numerous patients that TMD treatment of a large number of patients resulted in significant improvement in the physiological state of the masticatory system (muscles, joints and dental occlusion). Reduction or resolution of muscle tension-type headaches that were present was clinically significant. The authors concluded that TMD should be considered and explored as a possible causative factor when attempts are made to determine and resolve the cause of headaches in patients with this affliction. A benefit of resolving headaches at an early stage in their development is that it might result in the reduction of its potential for progression to a chronic and possibly migraine headache condition.
PMID: 19455921 [PubMed - indexed for MEDLINE]
Cranio. 2008 Apr;26(2):104-17.
Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.
Cooper BC, Kleinberg I.
Department of Oral Biology and Pathology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA. tmjbcooper@aol.com
Comment in:
Cranio. 2008 Jul;26(3):166; author reply 167.
The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
PMID: 18468270 [PubMed - indexed for MEDLINE]
Friday, January 8, 2010
Neuromuscular Dentistry Relieves Headaches
Neuromuscular Dentistry is a powerful resource for treating chronic headaches and TMJ disorders. It works by correcting abnormal balance in how the muscles of the head and neck function. It also has an enormous effect on the trigeminal nervous system. This is extremely important because the trigeminal nerve is responsible for the majority of migraines, Chronic daily headaches, Episodic Tension-Type Headaches as well as sinus headaches and facial pain.
There is often a classification of vascular headaches versus muscular headaches but this is actually not always appropriate. When there is a disturbance to the trigeminal nervous system it can lead to drastic vascular effects that leads to migraines and/or cluster headaches.
The importance of the Trigeminal Nerve is easily understood with a brief lesson in neuroanatomy. 20% of the input to the brain comes from the spinal cord. The other 80% of input to the brain comes from twelve sets of cranial nerves. These nerves include the occular nerve that is responsible for sight and the nerves responsible for eye movement, the olfactory nerve that is responsible for our sense of smell, the acoustic nerve that is responsible for hearing and balance and the Vagus nerve that controls our gut.
The fifth cranial nerve is the Trigeminal Nerve and it makes up almost 70% of the input frpm the 12 cranial nerves or more tham half the total input to the brain. The trigeminal nerve is the dentist's nerve and it can have enormous effects.
This single nerve goes to the jaw muscles, the jaw joints (TMJ), the teeth, the periodontal ligaments that connect the teeth to the jaw bone and to anterior 2/3 of the tongue. The trigeminal nerve also controls the blood flow to the anterior 2/3 of the brain, the tensor of the ear drum, the tensor of the soft palate that controls the eustacian tube, the lining of the sinuses and several connections to te autonomic nervous system. Again this is over half of the total input to the brain.
The control of blood flow to the brain by the trigeminal nerve explains why migraines and cluster headaches can be helped with neuromuscular dentistry.
The innervation to the sinus membranes explains why neuromuscular dentistry can help sinus headaches and chronic congestion often blamed on allergies.
The tensor of the ear drum explains why tinnitus is often relieved by neuromuscular dentistry.
The tensor palatine explains why swallowing disorders and eustacian tube dysfunction (including pressure in the ears, ear pain)
The symptoms related to the trigeminal nerve are outlined in two articles in Sleep and Health Journal:
SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
NEUROMUSCULAR DENTISTRY (originally published in the American Equilibration Society magazine)
http://www.sleepandhealth.com/neuromuscular-dentistry
Dr Shapira treats patients with Headaches, Sleep Apnea and TMJ disorders from across Illinois and Southern Wiscnsin including Gurnee, Libertyville,Vernon Hills, Lake Forest, Highland Park, Deerfield, Antioch, Barrington, Schaumburg, Chicago, Arlington Heights, Lake Bluff and Kenosha.
There is often a classification of vascular headaches versus muscular headaches but this is actually not always appropriate. When there is a disturbance to the trigeminal nervous system it can lead to drastic vascular effects that leads to migraines and/or cluster headaches.
The importance of the Trigeminal Nerve is easily understood with a brief lesson in neuroanatomy. 20% of the input to the brain comes from the spinal cord. The other 80% of input to the brain comes from twelve sets of cranial nerves. These nerves include the occular nerve that is responsible for sight and the nerves responsible for eye movement, the olfactory nerve that is responsible for our sense of smell, the acoustic nerve that is responsible for hearing and balance and the Vagus nerve that controls our gut.
The fifth cranial nerve is the Trigeminal Nerve and it makes up almost 70% of the input frpm the 12 cranial nerves or more tham half the total input to the brain. The trigeminal nerve is the dentist's nerve and it can have enormous effects.
This single nerve goes to the jaw muscles, the jaw joints (TMJ), the teeth, the periodontal ligaments that connect the teeth to the jaw bone and to anterior 2/3 of the tongue. The trigeminal nerve also controls the blood flow to the anterior 2/3 of the brain, the tensor of the ear drum, the tensor of the soft palate that controls the eustacian tube, the lining of the sinuses and several connections to te autonomic nervous system. Again this is over half of the total input to the brain.
The control of blood flow to the brain by the trigeminal nerve explains why migraines and cluster headaches can be helped with neuromuscular dentistry.
The innervation to the sinus membranes explains why neuromuscular dentistry can help sinus headaches and chronic congestion often blamed on allergies.
The tensor of the ear drum explains why tinnitus is often relieved by neuromuscular dentistry.
The tensor palatine explains why swallowing disorders and eustacian tube dysfunction (including pressure in the ears, ear pain)
The symptoms related to the trigeminal nerve are outlined in two articles in Sleep and Health Journal:
SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
NEUROMUSCULAR DENTISTRY (originally published in the American Equilibration Society magazine)
http://www.sleepandhealth.com/neuromuscular-dentistry
Dr Shapira treats patients with Headaches, Sleep Apnea and TMJ disorders from across Illinois and Southern Wiscnsin including Gurnee, Libertyville,Vernon Hills, Lake Forest, Highland Park, Deerfield, Antioch, Barrington, Schaumburg, Chicago, Arlington Heights, Lake Bluff and Kenosha.
TMD and Sleep Disorders and Idiopathic Pain Disorders
An article from Johns Hopkins School of Medicine evaluated TMD patients relative to sleep disorders and pain sensitivity. The study found two or more sleep disorders in 43% of patients. Insomnia and sleep bruxism were the two most commonly found sleep disorders. Both Primary Insomnias (PI) and Respiratory Disturbance Index (RDI) were associated with increased pain sensitivity.
The authors concluded Primary Insomnia and Sleep Apnea were at such high rates that any TMD patients complaining of sleep distubances should be rferred for polysomnography (sleep test). They also felt that Primary Insomnia was highly associate with hyperalgesia and may be linked to the onset of central sensitivity and be the underlying etiology in idiopathic pain disorders. The authors also stated "The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes."
The NHLBI has previously published a report "Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders" Which details the numerous problems related to TMD problems. The majority of problems are related to sleep apnea (http://www.ihatecpap.com/sleep_apnea_dangers.html) and to disturbances in the trigeminal nervous system and the trigeminal vascular effects.
It is becoming more apparent that TMJ joint pain and headaches related to TMD are only the tip of the iceberg. Correction of the neuromuscular function of the stomatognathic system could lead to widespread improvements in health and function in sites often not associated with TMD problems. An excellent article on neuromuscular dentistry can be found in Sleep and Health Journal at http://www.sleepandhealth.com/neuromuscular-dentistry.
PubMed abstract below:
Sleep. 2009 Jun 1;32(6):779-90.
Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.
Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, Klick B, Haythornthwaite JA.
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA. msmith62@jhmi.edu
STUDY OBJECTIVES: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. DESIGN: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. SETTING: Orofacial pain clinic and inpatient sleep research facility. PARTICIPANTS: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). CONCLUSIONS: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a nonorofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.
PMID: 19544755 [PubMed - indexed for MEDLINE]
The authors concluded Primary Insomnia and Sleep Apnea were at such high rates that any TMD patients complaining of sleep distubances should be rferred for polysomnography (sleep test). They also felt that Primary Insomnia was highly associate with hyperalgesia and may be linked to the onset of central sensitivity and be the underlying etiology in idiopathic pain disorders. The authors also stated "The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes."
The NHLBI has previously published a report "Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders" Which details the numerous problems related to TMD problems. The majority of problems are related to sleep apnea (http://www.ihatecpap.com/sleep_apnea_dangers.html) and to disturbances in the trigeminal nervous system and the trigeminal vascular effects.
It is becoming more apparent that TMJ joint pain and headaches related to TMD are only the tip of the iceberg. Correction of the neuromuscular function of the stomatognathic system could lead to widespread improvements in health and function in sites often not associated with TMD problems. An excellent article on neuromuscular dentistry can be found in Sleep and Health Journal at http://www.sleepandhealth.com/neuromuscular-dentistry.
PubMed abstract below:
Sleep. 2009 Jun 1;32(6):779-90.
Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.
Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, Klick B, Haythornthwaite JA.
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA. msmith62@jhmi.edu
STUDY OBJECTIVES: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. DESIGN: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. SETTING: Orofacial pain clinic and inpatient sleep research facility. PARTICIPANTS: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). CONCLUSIONS: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a nonorofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.
PMID: 19544755 [PubMed - indexed for MEDLINE]
Acupunture and TMD treatment
A recent paper in the Journal of Complementary Medicine in December 28, 2009 evaluate the acupuncture for treating TMD symptoms. They evaluated four previous randomized controlled studies that all showed statistically significant improvement in symptoms "in relation to short-term improvement of TMD signs and symptoms of a muscular origin". The authors concluded "research into the long-term effects of acupuncture in the treatment of TMD is needed" The PubMed abstract is listed below for your convenience.
J Altern Complement Med. 2009 Dec 28. [Epub ahead of print]
Effectiveness of Acupuncture in the Treatment of Temporomandibular Disorders of Muscular Origin: A Systematic Review of the Last Decade.
La Touche R, Angulo-Díaz-Parreño S, de-la-Hoz JL, Fernández-Carnero J, Ge HY, Linares MT, Mesa J, Sánchez-Gutiérrez J.
1 Program in Orofacial Pain and Craniomandibular Disorders, San Pablo CEU University , Madrid, Spain .
Abstract Objective: The purpose of this review is to evaluate the effectiveness of using acupuncture treatment for temporomandibular disorders (TMD) of muscular origin according to research published in the last decade. Methods: The information was gathered using the MEDLINE, EMBASE, CINAHL, and CISCOM databases. The inclusion criteria for selecting the studies were the following: (1) only randomized controlled trials (RCTs) were selected; (2) studies had to be carried out on patients with TMD of muscular origin; (3) studies had to use acupuncture treatment; and (4) studies had to be published in scientific journals between 1997 and 2008. Two (2) independent reviewers analyzed the methodological quality of the studies using the Delphi list. A total of four RCTs were chosen once the methodological quality was judged as being acceptable. All of the studies included in the review compared the acupuncture treatment with a placebo treatment. All of them described results that were statistically significant in relation to short-term improvement of TMD signs and symptoms of a muscular origin, except one of the analyzed studies that found no significant difference between acupuncture and sham acupuncture. Conclusions:In the authors' opinion, research into the long-term effects of acupuncture in the treatment of TMD is needed. We also recommend larger samples sizes for future studies, so the results will be more reliable.
PMID: 20038262 [PubMed - as supplied by publisher]
J Altern Complement Med. 2009 Dec 28. [Epub ahead of print]
Effectiveness of Acupuncture in the Treatment of Temporomandibular Disorders of Muscular Origin: A Systematic Review of the Last Decade.
La Touche R, Angulo-Díaz-Parreño S, de-la-Hoz JL, Fernández-Carnero J, Ge HY, Linares MT, Mesa J, Sánchez-Gutiérrez J.
1 Program in Orofacial Pain and Craniomandibular Disorders, San Pablo CEU University , Madrid, Spain .
Abstract Objective: The purpose of this review is to evaluate the effectiveness of using acupuncture treatment for temporomandibular disorders (TMD) of muscular origin according to research published in the last decade. Methods: The information was gathered using the MEDLINE, EMBASE, CINAHL, and CISCOM databases. The inclusion criteria for selecting the studies were the following: (1) only randomized controlled trials (RCTs) were selected; (2) studies had to be carried out on patients with TMD of muscular origin; (3) studies had to use acupuncture treatment; and (4) studies had to be published in scientific journals between 1997 and 2008. Two (2) independent reviewers analyzed the methodological quality of the studies using the Delphi list. A total of four RCTs were chosen once the methodological quality was judged as being acceptable. All of the studies included in the review compared the acupuncture treatment with a placebo treatment. All of them described results that were statistically significant in relation to short-term improvement of TMD signs and symptoms of a muscular origin, except one of the analyzed studies that found no significant difference between acupuncture and sham acupuncture. Conclusions:In the authors' opinion, research into the long-term effects of acupuncture in the treatment of TMD is needed. We also recommend larger samples sizes for future studies, so the results will be more reliable.
PMID: 20038262 [PubMed - as supplied by publisher]
Tuesday, January 5, 2010
Cluster Headaches
Blues Freak comments : I have cluster headaces for 8 plus yrs. I wore a TMJ piece nite and day for 2 yrs with no relief. Oxygen for almost a yr. even accuputcunter for over a yr. with a small amount for a short time. I don't work any longer I'm 56 on disabilty now. I need help
Dear Blues Freak,
When you say you are using oxygen I assume that is during an acute attack.. Oxygen (100%) can usually stop a cluster in its tracks. I understand that you wore a "TMJ mouthpiece" but all appliances are not the same. Some appliances are designed to effect primarily the jaw joint (TMJ) rather than address the neuromuscular problems that caused the joint problems. I call some appliances POPs which stands for Piece of Plastic. What is important is not the piece of plastic but how that piece of plastic how it functions. Some TMJ appliances ever do more than act a as a POP. TMD is Temporomandibular Dysfunction which includes muscles and joints. It is often necessary to evaluate the joints connecting the head to the first to vertebrae of the spine. The brain stem passes thru this area and these have an enormous effect on jaw relations as well as the entire nervous system. Atlas Orthogonal and NUCCA are two chiropractic groups that work with this area of the body.
I prefer the term orthotic or orthopedic appliance but what is important is what affect it is having on the body. In neuromuscular dentistry treatment starts with relaxing the muscles by pulsing the trigeminal nerves to create muscle relaxation but more importantly we then use the relaxed position to set the orthotic for minimal adaptation. This allowa the trigeninal nerve and the associated vascular effects to stabilize. http://www.sleepandhealth.com/neuromuscular-dentistry contains an explanation of how neuromuscular dentisty functions.
With cluster headaches it is possible initially to provoke a cluster headache so I would advise if oxygen relieves your pain to make sure the office is equipped with oxygen if needed.
Dear Blues Freak,
When you say you are using oxygen I assume that is during an acute attack.. Oxygen (100%) can usually stop a cluster in its tracks. I understand that you wore a "TMJ mouthpiece" but all appliances are not the same. Some appliances are designed to effect primarily the jaw joint (TMJ) rather than address the neuromuscular problems that caused the joint problems. I call some appliances POPs which stands for Piece of Plastic. What is important is not the piece of plastic but how that piece of plastic how it functions. Some TMJ appliances ever do more than act a as a POP. TMD is Temporomandibular Dysfunction which includes muscles and joints. It is often necessary to evaluate the joints connecting the head to the first to vertebrae of the spine. The brain stem passes thru this area and these have an enormous effect on jaw relations as well as the entire nervous system. Atlas Orthogonal and NUCCA are two chiropractic groups that work with this area of the body.
I prefer the term orthotic or orthopedic appliance but what is important is what affect it is having on the body. In neuromuscular dentistry treatment starts with relaxing the muscles by pulsing the trigeminal nerves to create muscle relaxation but more importantly we then use the relaxed position to set the orthotic for minimal adaptation. This allowa the trigeninal nerve and the associated vascular effects to stabilize. http://www.sleepandhealth.com/neuromuscular-dentistry contains an explanation of how neuromuscular dentisty functions.
With cluster headaches it is possible initially to provoke a cluster headache so I would advise if oxygen relieves your pain to make sure the office is equipped with oxygen if needed.
Friday, January 1, 2010
Another article discussing the increase in migraines in children and adolesents due to the trigeminovascular system.
The key phrase " conjunction with the peripheral trigeminovascular system," refers to the nerves and muscles and receptors of the jaw and face. This is exactly the type of problem that is often if not almost always best treated with a neuromuscular orthotic. In children and young adolescents it is ideal to evaluate and correct the underlying problems before central sensitization occurs. There is extensive dental literature on the effect of jaw development on breathing and swallowing.
J Headache Pain. 2009 Aug;10(4):227-33. Epub 2009 Jun 9.
Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification.
Charles JA, Peterlin BL, Rapoport AM, Linder SL, Kabbouche MA, Sheftell FD.
New Jersey Medical School, Bayonne, NJ, USA. jamesacharlesmd@aol.com
There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease.
PMID: 19506799 [PubMed - indexed for MEDLINE]
The key phrase " conjunction with the peripheral trigeminovascular system," refers to the nerves and muscles and receptors of the jaw and face. This is exactly the type of problem that is often if not almost always best treated with a neuromuscular orthotic. In children and young adolescents it is ideal to evaluate and correct the underlying problems before central sensitization occurs. There is extensive dental literature on the effect of jaw development on breathing and swallowing.
J Headache Pain. 2009 Aug;10(4):227-33. Epub 2009 Jun 9.
Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification.
Charles JA, Peterlin BL, Rapoport AM, Linder SL, Kabbouche MA, Sheftell FD.
New Jersey Medical School, Bayonne, NJ, USA. jamesacharlesmd@aol.com
There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease.
PMID: 19506799 [PubMed - indexed for MEDLINE]
Facial pain: Migraine or symptom of TMD
A recent abstract discussed a facial pain and failure of numerous treatments. It was then dcided the patient had atypical migraine. The abstract is reprinted with my comments following.
Acta Neurol Belg. 2009 Sep;109(3):235-7.
Migraine presenting as chronic facial pain.
Debruyne F, Herroelen L.
Headache Clinic, Department of Neurology, University Hospital UZ Gasthuisberg, Leuven, Belgium. freddebruyne@yahoo.com
We report the case of a 44-year-old woman with chronic facial pain. She was treated with several analgesics, prophylactic medications and infiltrations, but all treatment modalities were ineffective. Finally, the diagnosis of medication-overuse headache complicating migraine without aura was made and an appropriate treatment was initiated. Migraine is a very common primary headache and rarely presents as isolated facial pain. Stimulation of the dura with activation of the trigeminovascular system can result in pain in any of the three divisions of the trigeminal nerve. This is the anatomic basis of migraine pain presenting as referred pain to the second division of the trigeminal nerve. The atypical presentation of migraine pain can easily lead to inappropriate treatment regimens.
This patient had chronic facial pain and was treated with numerous drugs and then diagnosed as medication overuse headache and complicating migraine without aura. They used drug therapy but no mention is made of use of an orthotic. This myoptic type of treatment is common. Throw a drug at the problem , then another and another.
The conclusion that atypical pain can lead to inappropriate treatments regimens speaks for itself. When pain is from the maxillary branch of the trigeminal nerve it would seem appropriate to evaluate the masticatory system first.
Acta Neurol Belg. 2009 Sep;109(3):235-7.
Migraine presenting as chronic facial pain.
Debruyne F, Herroelen L.
Headache Clinic, Department of Neurology, University Hospital UZ Gasthuisberg, Leuven, Belgium. freddebruyne@yahoo.com
We report the case of a 44-year-old woman with chronic facial pain. She was treated with several analgesics, prophylactic medications and infiltrations, but all treatment modalities were ineffective. Finally, the diagnosis of medication-overuse headache complicating migraine without aura was made and an appropriate treatment was initiated. Migraine is a very common primary headache and rarely presents as isolated facial pain. Stimulation of the dura with activation of the trigeminovascular system can result in pain in any of the three divisions of the trigeminal nerve. This is the anatomic basis of migraine pain presenting as referred pain to the second division of the trigeminal nerve. The atypical presentation of migraine pain can easily lead to inappropriate treatment regimens.
This patient had chronic facial pain and was treated with numerous drugs and then diagnosed as medication overuse headache and complicating migraine without aura. They used drug therapy but no mention is made of use of an orthotic. This myoptic type of treatment is common. Throw a drug at the problem , then another and another.
The conclusion that atypical pain can lead to inappropriate treatments regimens speaks for itself. When pain is from the maxillary branch of the trigeminal nerve it would seem appropriate to evaluate the masticatory system first.
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