Dr Barney Jankelson was a Seattle prosthodontist who was the first dentist to look at correcting the underlying muscle physiology when treating patients with chronic pain problems. Like ll great men he entered unchartered territory and the initial response of the dental community was to attack his theories even though they were founded on basic physiological priciples. The real reason for the initial anger toward Dr Jankelson was that he began to measure physiological variables and his measurements (measured facts) trumped the opinions of the "Experts" in the field. If his theories were correct than the careers of these "experts" were no longer very important.
A favorite statement of Dr Jankelson was "IF IT IS MEASURED IT IS A FACT, OTHERWISE IT IS AN OPINION". As a scientist he always preferred measured facts to the "opinions of self proclaimed experts"
This led many to attack not just Dr Jankelsons theories and advances in practice but also created a backlash at the tools used to relax the musculature and measure the results. If the tools could be discredited then the "facts" would no longer be a problem. Ths thinkinking delayed advancements in dentistry for many years. The fact that these tools were used in every other field of medicine eventually led to their wie acceptance in Dentistry.
The Las Vegas Institute(LVI) under the steady hand of Dr William Dickerson took a determined lead in the wiedspread acceptance of Neuromuscular Dentistry.
Dr Dickerson recruited Dr Robert Jankelson, Dr Norman Thomas and Dr Jim Garry as instructors in Neuromuscular Dental Education at LVI. The three top Neuromuscular Dentists and researchers in the United States. Dr Norman Thomas PhD is the worlds leading expert in the physiology and anatomy that underlies all Neuromuscular Dental Concepts and is in charge of Neuromuscular Dentistry at LVI.
Dr Jim Garry was the leading expert on the developmental aspects of neuromuscular health and/or dysfunction starting in new born infants. His work is still cutting ege years after his eath.
entists and patients with chronic pain owe a great debt to these pioneers of Neuromuscular Dentistry
Monday, June 28, 2010
MRI for Migraine: Does dye matter? Neuromuscular Dentistry addresses the problem directly.
Cathy Jo:
Can an MRI with intravenous dye show different results than an MRI without dye. I have suffered from migraine headaches since the age of 5 (I am currently 42) and currently on disability because of the severity of my migraines. I did sustain an injury at the age of 5 and may have injuried my neck according to my mother. I do strongly believe this is the origin of my migraines, but an MRI without dye showed normal results. Would an MRI with dye show anything different?
Dr Shapira: Dear Cathy Jo,
n my experience an additional MRI with dye will rarely, if ever be productive. If it makes you feel better you can have one but I would suggest looking for an answer to your problem. I am enclosing contact information for a Neuromuscular Dentist,. I would appreciate your feedback..
If you were my patient I would suggest you try a neuromuscular diagnostic orthotic as a first step in diagnosis and treatment. If it is a neck injury that began your problem you may also require some cervical therapy, NUCCA Chiropractic and/or A/O Atlas -Orthogonal is frequently very effective when combined with a neuromuscular orthotic. It is important that you feel comfortable with your doctor and you should expect a consultation that takes at least 60-90 minutes. Your history is extremely important.
If you eliminate or substantially decrease the frequency an severity of migraines you can continue treatment. You might also want to try having a spenopalatine ganglion block as they often give incredible results. There is an excellent book "MIRACLES ON PARK AVENUE" that discusses SPG blocks in treating pain.
It is quite common for cervical problems an trigeminal problems and/or jaw problems to be related. The majority of patients have multiple muscle trigger points. Many times patients have severe and/or disabling headaches that are not acually migraines but just severe headaches. You did not give much detail in your letter. Details are extremely important in unraveling chronic pain problems.
Can an MRI with intravenous dye show different results than an MRI without dye. I have suffered from migraine headaches since the age of 5 (I am currently 42) and currently on disability because of the severity of my migraines. I did sustain an injury at the age of 5 and may have injuried my neck according to my mother. I do strongly believe this is the origin of my migraines, but an MRI without dye showed normal results. Would an MRI with dye show anything different?
Dr Shapira: Dear Cathy Jo,
n my experience an additional MRI with dye will rarely, if ever be productive. If it makes you feel better you can have one but I would suggest looking for an answer to your problem. I am enclosing contact information for a Neuromuscular Dentist,. I would appreciate your feedback..
If you were my patient I would suggest you try a neuromuscular diagnostic orthotic as a first step in diagnosis and treatment. If it is a neck injury that began your problem you may also require some cervical therapy, NUCCA Chiropractic and/or A/O Atlas -Orthogonal is frequently very effective when combined with a neuromuscular orthotic. It is important that you feel comfortable with your doctor and you should expect a consultation that takes at least 60-90 minutes. Your history is extremely important.
If you eliminate or substantially decrease the frequency an severity of migraines you can continue treatment. You might also want to try having a spenopalatine ganglion block as they often give incredible results. There is an excellent book "MIRACLES ON PARK AVENUE" that discusses SPG blocks in treating pain.
It is quite common for cervical problems an trigeminal problems and/or jaw problems to be related. The majority of patients have multiple muscle trigger points. Many times patients have severe and/or disabling headaches that are not acually migraines but just severe headaches. You did not give much detail in your letter. Details are extremely important in unraveling chronic pain problems.
CLUSTER HEADACHES TREATMENT WITH ELECTRICAL STIMULATION OF SPHENOPALATINE GANGLION BLOCK.
Cluster Headaches are a type of primary headache that frequently occur at night and are characterize by autonomic phenomena and bouts of severe unilateral head pain. Spenopalatine Ganglion blocks are frequently used by neuromuscular dentists as an adjunct procedure in treating a multitue of painful conditions. A popular book "Miracles on Park Avenue: Technique for Treating Arthritis and Other Chronic Pain by Albert B. Gerber (Hardcover - Nov 1986)" discussed how SPG blocks were used to treat a multitude of diverse pain conditions with minmal risk. Many Neuromuscular Dentists utilize this valuable technique. I teach the technique of SPG blocks at my courses in treating sleep apnea (http://www.ihatecpap.com).
PATIENTS WITH MIGRAINES, CLUSTER HEADACHES AND OTHER PAINFUL CONDITIONS CAN BE TAUGHT A SIMPLE TECHNIQUE FOR SELF ADMINISTERED SPG BLOCKS (WITH LIDOCAINE)
THAT CAN COMPLETELY OR PARTIALLY ABORT ATTACKS AND REDUCE OR ELIMINATE SYMPTOMS AFTER AN ATTACK BEGINS.
An article in April Headache (SEE PUBMED abstract below) discusses the use of acute electrical stimulation in test subjects to relieve acute cluster headache symptoms.
Neuromuscular dentistry is unique in that the autonomic fibers of the Trigeminal Nerve that pass thru the Sphenopalatine Ganglion (also called the pterygopalatine ganglion) are stimulated with the use of ultra-low frequency TENS and is frequently effectiving in treating many types of headaches and migraines including cluster headaches. The Sphenoplatine Ganglion contains sensory fibers of the Maxillary division of the Trigeminal Nerve.
ACCORDING TO WIKIPEDIA:
The Sphenopalatine Ganglion "receives a sensory, a motor, and a sympathetic root.
Sensory root.
Its sensory root is derived from two sphenopalatine branches of the maxillary nerve; their fibers, for the most part, pass directly into the palatine nerves; a few, however, enter the ganglion, constituting its sensory root."
IT IS BELIEVED THAT NEUROMUSCULAR DENTISTRY HAS A MAJOR EFFECT ON THIS STRUCTURE THRU ITS SENSORY ROOT THAT NEUROMUSCULAR DENTISTRY STIMULATES WITH ULTRA LOW FREQUENCY ANTI-DROMIC STIMULATION . IT IS WELL KNOWN THAT MANY TYPES OF TREATMENT RESISTANT HEADACHES ARE IMPROVED OR ELIMINATED AFTER USE OF A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC.
WIKIPEDIA ALSO STATES:
"Parasympathetic root
Its parasympathetic root is derived from the nervus intermedius (a part of the facial nerve) through the greater petrosal nerve.
In the pterygopalatine ganglion, the preganglionic parasympathetic fibers from the greater petrosal branch of the facial nerve synapse with neurons whose postganglionic axons, vasodilator and secretory fibers, are distributed with the deep branches of the TRIGEMINAL NERVE to the mucous membrane of the nose, soft palate, tonsils, uvula, roof of the mouth, upper lip and gums, and to the upper part of the pharynx. It also sends postganglionic parasympathetic fibers to the lacrimal gland via the zygomatic nerve, a branch of the maxillary nerve (from the trigeminal nerve) which then connects with the lacrimal nerve (a branch of the ophthalmic nerve, also part of the trigeminal nerve) to arrive at the lacrimal gland.
The nasal glands are innervated with secretomotor from the nasopalatine and greater palatine nerve. Similarly, the palatine glands are innervated by the nasopalatine, greater palatine nerve and lesser palatine nerves. The pharyngeal nerve innervates pharyngeal glands. These are all branches of maxillary nerve."
THIS EXPLAINS WHY NEUROMUSCULAR DENTISTRY FREQUENTLY RELIEVES AUTONOMIC ASPECTS OF HEADACHES. THERE IS A DECREASE IN NOCICEPTIVE (PAIN) INPUT TO THIS SENSORY CENTER THEREBY REDUCING THE AUTONOMIC SYMPTOMS ASSOCIATED WITH CLUSTER HEADACHES AND OTHER VASCULAR HEADACHES.
ANOTHER ARTICLE Curr Pain Headache Rep. 2010 Apr;14(2):160-3.
Role of sphenopalatine ganglion neuroablation in the management of cluster headache discusse electrical ablation of the sphenopalatine ganglion. I strong urge patients avoid this procedure except as a last resort. Previous attempts at Mayo met with disaster.
WIKIPEDIA ON THE SYMPATHETIC ROOT:
"The ganglion also consists of sympathetic efferent (postganglionic) fibers from the superior cervical ganglion. These fibers, from the superior cervical ganglion, travel through the carotid plexus, and then through the deep petrosal nerve. The deep petrosal nerve joins with the greater petrosal nerve to form the nerve of the pterygoid canal, which enters the ganglion. "
THE CONNECTIONS TO THE CERVICAL GANGLION AND CAROTID PLEXUS EXPLAIN THE CERVICAL CONNECTION AND EFFECTS ON BLOOD FLOW. THE TRIGEMNAL NERVE ALSO CONTROLS THE BLOOD FLOW TO THE BRAIN BY CONTROL OF BLOOD FLOWTHRU THE MEMINGES OF THE BRAIN.
Another study J Neurophysiol. 2010 Jan;103(1):172-82. Epub 2009 Nov 4.
Muscarinic acetylcholine receptor modulation of mu (mu) opioid receptors in adult rat sphenopalatine ganglion neurons. showed that "These results suggest that in rat SPG neurons activation of M(2) mAChR likely modulates opioid transmission in the brain vasculature to adequately maintain cerebral blood flow." THE MODULATION OF OPIOD RECEPTORS AND CONTROL OF VASCULAR FLOW TO THE BRAIN IS CENTRAL TO MANAGEMENT OF CLUSTER HEADACHES, MIGRAINES ANDOTHER TYPES OF VASCULAR HEADACHES.
NEUROMUSCULAR DENTISTRY IS EXTREMELY EFFECTIVE IN TREATING A WIDE VARIETY OF HEADACHES INCLUDING CLUSTER HEADACHES, SUNCT, CLASSICAL MIGRAINE, ATYPICAL MIGRANE AND OTHER VASCULAR HEADACHES AS WELL AS TENSION-TYPE HEADACHES, CHRONIC DAILY HEADACHES, SINUS HEADACHES AND A WIDE VARIETY OF FACIAL AND CRANIAL PAIN AND/OR DYSFUNCTION.
THE USE OF OXYGEN ON CLUSTER HEADACHE IS EFFECTIVE DUE TO INHIBITION OFTRIGEMINOCERVIAL COMPLEX ACCORDING TO AN ARTICLE IN Headache. 2009 Sep;49(8):1131-43. (SEE PUBMED ABSTRACT BELOW)
Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents. THE ARTICLE CLEARLY STATES THAT CLUSTER HEADACHES ARE A TRIGEMINAL AUTONOMIC CONDITION "To understand the mechanism of action of oxygen treatment in cluster headache. BACKGROUND: Trigeminal autonomic cephalalgias, including cluster headache, are characterized by unilateral head pain in association with ipsilateral cranial autonomic features. They are believed to involve activation of the trigeminovascular system and the parasympathetic outflow to the cranial vasculature from the superior salivatory nucleus (SuS) projections through the sphenopalatine ganglion, via the greater petrosal nerve of the VIIth (facial) cranial nerve. Cluster headache is remarkably responsive to treatment with oxygen, and yet our understanding of its mode of action is unknown"
IT SHOULD BE NOTED THAT THE MODE OF ACTION IS NOT WELL UNDERSTOOD. NEUROMUSCULAR DENTISTRY IS WELL UNDERSTOOD BUT IT IS NOT COMPLETELY UNDERSTOOD WHY SO MANY PATIENTS EXPERIENCE DRAMATIC RELIEF THAT SURPASSES STANDARD MEDICAL TECHNIQUES. NEUROMUSCULAR DENTISTRY IS ONE OF THE SAFEST METHODS OF TREATING ALL TYPES OF CHRONIC PAIN. THE TRIGEMINAL NERVE IS FREQUENTLY REFERRED TO AS THE DENTIST'S NERVE. AN EXCELLENT REFERENCE ON NEUROMUSCULAR DENTISTRY CAN BE FOUND IN SLEEP AND HEALTH JOURNAL http://www.sleepandhealth.com/neuromuscular-dentistry
Headache. 2010 Apr 22. [Epub ahead of print]
Electrical Stimulation of Sphenopalatine Ganglion for Acute Treatment of Cluster Headaches.
Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, Machado A, Narouze S.
From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
Abstract
(Headache 2010;**:**-**) Introduction.- Cluster headaches (CH) are primary headaches marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Despite aggressive management with medications, oxygen therapy, nerve blocks, as well as various lesioning and neurostimulation therapies, a number of patients are incapacitated and suffering. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of CH and has been a target for blocks, lesioning, and other surgical approaches. For this reason, it was selected as a target for an acute neurostimulation study. Methods.- Six patients with refractory chronic CH were treated with short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH. Headaches were spontaneously present at the time of stimulation or were triggered with agents known to trigger clusters headache in each patient. A standard percutaneous infrazygomatic approach was used to place a needle at the ipsilateral SPG in the pterygopalatine fossa under fluoroscopic guidance. Electrical stimulation was performed using a temporary stimulating electrode. Stimulation was performed at various settings during maximal headache intensity. Results.- Five patients had CH during the initial evaluation. Three returned 3 months later for a second evaluation. There were 18 acute and distinct CH attacks with clinically maximal visual analog scale (VAS) intensity of 8 (out of 10) and above. SPG stimulation resulted in complete resolution of the headache in 11 attacks, partial resolution (>50% VAS reduction) in 3, and minimal to no relief in 4 attacks. Associated autonomic features of CH were resolved in each responder. Pain relief was noted within several minutes of stimulation. Conclusion.- Sphenopalatine ganglion stimulation can be effective in relieving acute severe CH pain and associated autonomic features. Chronic long-term outcome studies are needed to determine the utility of SPG stimulation for management and prevention of CH.
PMID: 20438584 [PubMed - as supplied by publisher]
Curr Pain Headache Rep. 2010 Apr;14(2):160-3.
Role of sphenopalatine ganglion neuroablation in the management of cluster headache.
Narouze SN.
Pain Management Department, Anesthesiology Institute, Cleveland Clinic, OH 44195, USA. narouzs@ccf.org
Abstract
Cluster headache is a primary neurovascular headache. It is a strictly unilateral head pain that is associated with cranial autonomic symptoms and usually follows circadian and circannual patterns. Chronic cluster headache, which accounts for about 10% to 15% of patients with cluster headache, lacks the circadian pattern and is often resistant to pharmacological management. The sphenopalatine ganglion (SPG), located in the pterygopalatine fossa, is involved in the pathophysiology of cluster headache and has been a target for blocks and other surgical approaches. Percutaneous radiofrequency ablation of the SPG was shown to have encouraging results in those patients with intractable cluster headaches.
PMID: 20425206 [PubMed - in process]
J Neurophysiol. 2010 Jan;103(1):172-82. Epub 2009 Nov 4.
Muscarinic acetylcholine receptor modulation of mu (mu) opioid receptors in adult rat sphenopalatine ganglion neurons.
Margas W, Mahmoud S, Ruiz-Velasco V.
Department of Anesthesiology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
Abstract
The sphenopalatine ganglion (SPG) neurons represent the parasympathetic branch of the autonomic nervous system involved in controlling cerebral blood flow. In the present study, we examined the coupling mechanism between mu (mu) opioid receptors (MOR) and muscarinic acetylcholine receptors (mAChR) with Ca(2+) channels in acutely dissociated adult rat SPG neurons. Successful MOR activation was recorded in approximately 40-45% of SPG neurons employing the whole cell variant of the patch-clamp technique. In addition, immunofluorescence assays indicated that MOR are not expressed in all SPG neurons while M(2) mAChR staining was evident in all neurons. The concentration-response relationships generated with morphine and [d-Ala2-N-Me-Phe4-Glycol5]-enkephalin (DAMGO) showed IC(50) values of 15.2 and 56.1 nM and maximal Ca(2+) current inhibition of 26.0 and 38.7%, respectively. Activation of MOR or M(2) mAChR with morphine or oxotremorine-methiodide (Oxo-M), respectively, resulted in voltage-dependent inhibition of Ca(2+) currents via coupling with Galpha(i/o) protein subunits. The acute prolonged exposure (10 min) of neurons to morphine or Oxo-M led to the homologous desensitization of MOR and M(2) mAChR, respectively. The prolonged stimulation of M(2) mAChR with Oxo-M resulted in heterologous desensitization of morphine-mediated Ca(2+) current inhibition, and was sensitive to the M(2) mAChR blocker methoctramine. On the other hand, when the neurons were exposed to morphine or DAMGO for 10 min, heterologous desensitization of M(2) mAChR was not observed. These results suggest that in rat SPG neurons activation of M(2) mAChR likely modulates opioid transmission in the brain vasculature to adequately maintain cerebral blood flow.
PMID: 19889856 [PubMed - indexed for MEDLINE]PMCID: PMC2807216 [Available on 2011/1/1]
Headache. 2009 Sep;49(8):1131-43.
Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents.
Akerman S, Holland PR, Lasalandra MP, Goadsby PJ.
Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA 94143-0114, USA.
Abstract
OBJECTIVE: To understand the mechanism of action of oxygen treatment in cluster headache. BACKGROUND: Trigeminal autonomic cephalalgias, including cluster headache, are characterized by unilateral head pain in association with ipsilateral cranial autonomic features. They are believed to involve activation of the trigeminovascular system and the parasympathetic outflow to the cranial vasculature from the superior salivatory nucleus (SuS) projections through the sphenopalatine ganglion, via the greater petrosal nerve of the VIIth (facial) cranial nerve. Cluster headache is remarkably responsive to treatment with oxygen, and yet our understanding of its mode of action is unknown. METHODS: Combining models of trigeminovascular nociception and a novel approach that activates the trigeminal-autonomic reflex, using SuS/facial nerve stimulation, we explored the effect of oxygen on trigeminal nerve activation as well as on autonomic responses through blood flow observations of the lacrimal duct/sac. RESULTS: Meningeal vasodilation and neuronal firing in the trigeminocervical complex (TCC), in response to dural electrical stimulation, was unaffected by treatment with 100% oxygen. Stimulation of the SuS via the facial nerve caused only marginal changes in dural blood vessel diameter, but did result in evoked firing in the TCC. Two populations of neurons were characterized, those responsive to 100% oxygen treatment, with a maximal inhibition of 33%, 20 minutes after the start of oxygen treatment (t(15) = 4.4, P < .0001). A second population of neurons were not inhibited by oxygen and tended to have shorter latency. Oxygen also inhibited evoked blood flow changes in the lacrimal sac/duct caused by SuS stimulation. CONCLUSIONS: The data provide the first systematic, experimental evidence for a mechanism of action of oxygen in cluster headache. The data show oxygen has no direct effect on trigeminal afferents, acting specifically on the parasympathetic/facial nerve projections to the cranial vasculature to inhibit both evoked trigeminovascular activation and activation of the autonomic pathway during cluster headache attacks. Moreover, the studies begin to characterize a novel laboratory model for the most painful primary headache syndrome known--cluster headache.
PMID: 19719541 [PubMed - indexed for MEDLINE
PATIENTS WITH MIGRAINES, CLUSTER HEADACHES AND OTHER PAINFUL CONDITIONS CAN BE TAUGHT A SIMPLE TECHNIQUE FOR SELF ADMINISTERED SPG BLOCKS (WITH LIDOCAINE)
THAT CAN COMPLETELY OR PARTIALLY ABORT ATTACKS AND REDUCE OR ELIMINATE SYMPTOMS AFTER AN ATTACK BEGINS.
An article in April Headache (SEE PUBMED abstract below) discusses the use of acute electrical stimulation in test subjects to relieve acute cluster headache symptoms.
Neuromuscular dentistry is unique in that the autonomic fibers of the Trigeminal Nerve that pass thru the Sphenopalatine Ganglion (also called the pterygopalatine ganglion) are stimulated with the use of ultra-low frequency TENS and is frequently effectiving in treating many types of headaches and migraines including cluster headaches. The Sphenoplatine Ganglion contains sensory fibers of the Maxillary division of the Trigeminal Nerve.
ACCORDING TO WIKIPEDIA:
The Sphenopalatine Ganglion "receives a sensory, a motor, and a sympathetic root.
Sensory root.
Its sensory root is derived from two sphenopalatine branches of the maxillary nerve; their fibers, for the most part, pass directly into the palatine nerves; a few, however, enter the ganglion, constituting its sensory root."
IT IS BELIEVED THAT NEUROMUSCULAR DENTISTRY HAS A MAJOR EFFECT ON THIS STRUCTURE THRU ITS SENSORY ROOT THAT NEUROMUSCULAR DENTISTRY STIMULATES WITH ULTRA LOW FREQUENCY ANTI-DROMIC STIMULATION . IT IS WELL KNOWN THAT MANY TYPES OF TREATMENT RESISTANT HEADACHES ARE IMPROVED OR ELIMINATED AFTER USE OF A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC.
WIKIPEDIA ALSO STATES:
"Parasympathetic root
Its parasympathetic root is derived from the nervus intermedius (a part of the facial nerve) through the greater petrosal nerve.
In the pterygopalatine ganglion, the preganglionic parasympathetic fibers from the greater petrosal branch of the facial nerve synapse with neurons whose postganglionic axons, vasodilator and secretory fibers, are distributed with the deep branches of the TRIGEMINAL NERVE to the mucous membrane of the nose, soft palate, tonsils, uvula, roof of the mouth, upper lip and gums, and to the upper part of the pharynx. It also sends postganglionic parasympathetic fibers to the lacrimal gland via the zygomatic nerve, a branch of the maxillary nerve (from the trigeminal nerve) which then connects with the lacrimal nerve (a branch of the ophthalmic nerve, also part of the trigeminal nerve) to arrive at the lacrimal gland.
The nasal glands are innervated with secretomotor from the nasopalatine and greater palatine nerve. Similarly, the palatine glands are innervated by the nasopalatine, greater palatine nerve and lesser palatine nerves. The pharyngeal nerve innervates pharyngeal glands. These are all branches of maxillary nerve."
THIS EXPLAINS WHY NEUROMUSCULAR DENTISTRY FREQUENTLY RELIEVES AUTONOMIC ASPECTS OF HEADACHES. THERE IS A DECREASE IN NOCICEPTIVE (PAIN) INPUT TO THIS SENSORY CENTER THEREBY REDUCING THE AUTONOMIC SYMPTOMS ASSOCIATED WITH CLUSTER HEADACHES AND OTHER VASCULAR HEADACHES.
ANOTHER ARTICLE Curr Pain Headache Rep. 2010 Apr;14(2):160-3.
Role of sphenopalatine ganglion neuroablation in the management of cluster headache discusse electrical ablation of the sphenopalatine ganglion. I strong urge patients avoid this procedure except as a last resort. Previous attempts at Mayo met with disaster.
WIKIPEDIA ON THE SYMPATHETIC ROOT:
"The ganglion also consists of sympathetic efferent (postganglionic) fibers from the superior cervical ganglion. These fibers, from the superior cervical ganglion, travel through the carotid plexus, and then through the deep petrosal nerve. The deep petrosal nerve joins with the greater petrosal nerve to form the nerve of the pterygoid canal, which enters the ganglion. "
THE CONNECTIONS TO THE CERVICAL GANGLION AND CAROTID PLEXUS EXPLAIN THE CERVICAL CONNECTION AND EFFECTS ON BLOOD FLOW. THE TRIGEMNAL NERVE ALSO CONTROLS THE BLOOD FLOW TO THE BRAIN BY CONTROL OF BLOOD FLOWTHRU THE MEMINGES OF THE BRAIN.
Another study J Neurophysiol. 2010 Jan;103(1):172-82. Epub 2009 Nov 4.
Muscarinic acetylcholine receptor modulation of mu (mu) opioid receptors in adult rat sphenopalatine ganglion neurons. showed that "These results suggest that in rat SPG neurons activation of M(2) mAChR likely modulates opioid transmission in the brain vasculature to adequately maintain cerebral blood flow." THE MODULATION OF OPIOD RECEPTORS AND CONTROL OF VASCULAR FLOW TO THE BRAIN IS CENTRAL TO MANAGEMENT OF CLUSTER HEADACHES, MIGRAINES ANDOTHER TYPES OF VASCULAR HEADACHES.
NEUROMUSCULAR DENTISTRY IS EXTREMELY EFFECTIVE IN TREATING A WIDE VARIETY OF HEADACHES INCLUDING CLUSTER HEADACHES, SUNCT, CLASSICAL MIGRAINE, ATYPICAL MIGRANE AND OTHER VASCULAR HEADACHES AS WELL AS TENSION-TYPE HEADACHES, CHRONIC DAILY HEADACHES, SINUS HEADACHES AND A WIDE VARIETY OF FACIAL AND CRANIAL PAIN AND/OR DYSFUNCTION.
THE USE OF OXYGEN ON CLUSTER HEADACHE IS EFFECTIVE DUE TO INHIBITION OFTRIGEMINOCERVIAL COMPLEX ACCORDING TO AN ARTICLE IN Headache. 2009 Sep;49(8):1131-43. (SEE PUBMED ABSTRACT BELOW)
Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents. THE ARTICLE CLEARLY STATES THAT CLUSTER HEADACHES ARE A TRIGEMINAL AUTONOMIC CONDITION "To understand the mechanism of action of oxygen treatment in cluster headache. BACKGROUND: Trigeminal autonomic cephalalgias, including cluster headache, are characterized by unilateral head pain in association with ipsilateral cranial autonomic features. They are believed to involve activation of the trigeminovascular system and the parasympathetic outflow to the cranial vasculature from the superior salivatory nucleus (SuS) projections through the sphenopalatine ganglion, via the greater petrosal nerve of the VIIth (facial) cranial nerve. Cluster headache is remarkably responsive to treatment with oxygen, and yet our understanding of its mode of action is unknown"
IT SHOULD BE NOTED THAT THE MODE OF ACTION IS NOT WELL UNDERSTOOD. NEUROMUSCULAR DENTISTRY IS WELL UNDERSTOOD BUT IT IS NOT COMPLETELY UNDERSTOOD WHY SO MANY PATIENTS EXPERIENCE DRAMATIC RELIEF THAT SURPASSES STANDARD MEDICAL TECHNIQUES. NEUROMUSCULAR DENTISTRY IS ONE OF THE SAFEST METHODS OF TREATING ALL TYPES OF CHRONIC PAIN. THE TRIGEMINAL NERVE IS FREQUENTLY REFERRED TO AS THE DENTIST'S NERVE. AN EXCELLENT REFERENCE ON NEUROMUSCULAR DENTISTRY CAN BE FOUND IN SLEEP AND HEALTH JOURNAL http://www.sleepandhealth.com/neuromuscular-dentistry
Headache. 2010 Apr 22. [Epub ahead of print]
Electrical Stimulation of Sphenopalatine Ganglion for Acute Treatment of Cluster Headaches.
Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, Machado A, Narouze S.
From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
Abstract
(Headache 2010;**:**-**) Introduction.- Cluster headaches (CH) are primary headaches marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Despite aggressive management with medications, oxygen therapy, nerve blocks, as well as various lesioning and neurostimulation therapies, a number of patients are incapacitated and suffering. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of CH and has been a target for blocks, lesioning, and other surgical approaches. For this reason, it was selected as a target for an acute neurostimulation study. Methods.- Six patients with refractory chronic CH were treated with short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH. Headaches were spontaneously present at the time of stimulation or were triggered with agents known to trigger clusters headache in each patient. A standard percutaneous infrazygomatic approach was used to place a needle at the ipsilateral SPG in the pterygopalatine fossa under fluoroscopic guidance. Electrical stimulation was performed using a temporary stimulating electrode. Stimulation was performed at various settings during maximal headache intensity. Results.- Five patients had CH during the initial evaluation. Three returned 3 months later for a second evaluation. There were 18 acute and distinct CH attacks with clinically maximal visual analog scale (VAS) intensity of 8 (out of 10) and above. SPG stimulation resulted in complete resolution of the headache in 11 attacks, partial resolution (>50% VAS reduction) in 3, and minimal to no relief in 4 attacks. Associated autonomic features of CH were resolved in each responder. Pain relief was noted within several minutes of stimulation. Conclusion.- Sphenopalatine ganglion stimulation can be effective in relieving acute severe CH pain and associated autonomic features. Chronic long-term outcome studies are needed to determine the utility of SPG stimulation for management and prevention of CH.
PMID: 20438584 [PubMed - as supplied by publisher]
Curr Pain Headache Rep. 2010 Apr;14(2):160-3.
Role of sphenopalatine ganglion neuroablation in the management of cluster headache.
Narouze SN.
Pain Management Department, Anesthesiology Institute, Cleveland Clinic, OH 44195, USA. narouzs@ccf.org
Abstract
Cluster headache is a primary neurovascular headache. It is a strictly unilateral head pain that is associated with cranial autonomic symptoms and usually follows circadian and circannual patterns. Chronic cluster headache, which accounts for about 10% to 15% of patients with cluster headache, lacks the circadian pattern and is often resistant to pharmacological management. The sphenopalatine ganglion (SPG), located in the pterygopalatine fossa, is involved in the pathophysiology of cluster headache and has been a target for blocks and other surgical approaches. Percutaneous radiofrequency ablation of the SPG was shown to have encouraging results in those patients with intractable cluster headaches.
PMID: 20425206 [PubMed - in process]
J Neurophysiol. 2010 Jan;103(1):172-82. Epub 2009 Nov 4.
Muscarinic acetylcholine receptor modulation of mu (mu) opioid receptors in adult rat sphenopalatine ganglion neurons.
Margas W, Mahmoud S, Ruiz-Velasco V.
Department of Anesthesiology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
Abstract
The sphenopalatine ganglion (SPG) neurons represent the parasympathetic branch of the autonomic nervous system involved in controlling cerebral blood flow. In the present study, we examined the coupling mechanism between mu (mu) opioid receptors (MOR) and muscarinic acetylcholine receptors (mAChR) with Ca(2+) channels in acutely dissociated adult rat SPG neurons. Successful MOR activation was recorded in approximately 40-45% of SPG neurons employing the whole cell variant of the patch-clamp technique. In addition, immunofluorescence assays indicated that MOR are not expressed in all SPG neurons while M(2) mAChR staining was evident in all neurons. The concentration-response relationships generated with morphine and [d-Ala2-N-Me-Phe4-Glycol5]-enkephalin (DAMGO) showed IC(50) values of 15.2 and 56.1 nM and maximal Ca(2+) current inhibition of 26.0 and 38.7%, respectively. Activation of MOR or M(2) mAChR with morphine or oxotremorine-methiodide (Oxo-M), respectively, resulted in voltage-dependent inhibition of Ca(2+) currents via coupling with Galpha(i/o) protein subunits. The acute prolonged exposure (10 min) of neurons to morphine or Oxo-M led to the homologous desensitization of MOR and M(2) mAChR, respectively. The prolonged stimulation of M(2) mAChR with Oxo-M resulted in heterologous desensitization of morphine-mediated Ca(2+) current inhibition, and was sensitive to the M(2) mAChR blocker methoctramine. On the other hand, when the neurons were exposed to morphine or DAMGO for 10 min, heterologous desensitization of M(2) mAChR was not observed. These results suggest that in rat SPG neurons activation of M(2) mAChR likely modulates opioid transmission in the brain vasculature to adequately maintain cerebral blood flow.
PMID: 19889856 [PubMed - indexed for MEDLINE]PMCID: PMC2807216 [Available on 2011/1/1]
Headache. 2009 Sep;49(8):1131-43.
Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents.
Akerman S, Holland PR, Lasalandra MP, Goadsby PJ.
Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA 94143-0114, USA.
Abstract
OBJECTIVE: To understand the mechanism of action of oxygen treatment in cluster headache. BACKGROUND: Trigeminal autonomic cephalalgias, including cluster headache, are characterized by unilateral head pain in association with ipsilateral cranial autonomic features. They are believed to involve activation of the trigeminovascular system and the parasympathetic outflow to the cranial vasculature from the superior salivatory nucleus (SuS) projections through the sphenopalatine ganglion, via the greater petrosal nerve of the VIIth (facial) cranial nerve. Cluster headache is remarkably responsive to treatment with oxygen, and yet our understanding of its mode of action is unknown. METHODS: Combining models of trigeminovascular nociception and a novel approach that activates the trigeminal-autonomic reflex, using SuS/facial nerve stimulation, we explored the effect of oxygen on trigeminal nerve activation as well as on autonomic responses through blood flow observations of the lacrimal duct/sac. RESULTS: Meningeal vasodilation and neuronal firing in the trigeminocervical complex (TCC), in response to dural electrical stimulation, was unaffected by treatment with 100% oxygen. Stimulation of the SuS via the facial nerve caused only marginal changes in dural blood vessel diameter, but did result in evoked firing in the TCC. Two populations of neurons were characterized, those responsive to 100% oxygen treatment, with a maximal inhibition of 33%, 20 minutes after the start of oxygen treatment (t(15) = 4.4, P < .0001). A second population of neurons were not inhibited by oxygen and tended to have shorter latency. Oxygen also inhibited evoked blood flow changes in the lacrimal sac/duct caused by SuS stimulation. CONCLUSIONS: The data provide the first systematic, experimental evidence for a mechanism of action of oxygen in cluster headache. The data show oxygen has no direct effect on trigeminal afferents, acting specifically on the parasympathetic/facial nerve projections to the cranial vasculature to inhibit both evoked trigeminovascular activation and activation of the autonomic pathway during cluster headache attacks. Moreover, the studies begin to characterize a novel laboratory model for the most painful primary headache syndrome known--cluster headache.
PMID: 19719541 [PubMed - indexed for MEDLINE
Sunday, June 27, 2010
NEUROMUSCULAR DENTISTRY: FIND A NEUROMUSCULAR DENTIST
NEUROMUSCULAR DENTISTRY is an exciting field not only about teeth, jaws and jaw joints but intimately involved with neurology, orthopedics, rehabilitative medicine, physiatry otolaryngology and osteopathic medicine. Patients who can benefit from Neuromuscular Dentistry cover almost every field of medicine.
Headaches are especially well suited to treatment by Neuromuscular Dental proceedures. A wide varienty of headaches may respond well to the first step of Neuromuscular Dental treatment, the Neuromuscular Diagnostic Orthotic. Patients with Classical Migraine, Atypical Migraine, Opthalmic Migraines, and Chronic Daily Migraine all frequently respond well to Neuromuscular Dental Treatment due to the connections to the Trigeminal Nervous System. Almost 100% of all types of Migraines are in full or in part mediated by the Trigeminal Nervous System and are therefore amenable to treatment with a Neuromuscular Dental Orthotic. A Neuromuscular Dental Orthotic is designed to decrease pathologic accomadation of the trigeminal neuromuscular system to decrease nociceptive input to the central nervous system. This nociceptive input is actually the bodies attempt to correct physical malalignment of the masticatory system. This results not only in central nervous system overload of the trigeminal system but also to repetitive strain injuries to the piostural muscles of the head and neck.
Muscle Spasm Headaches, Tension-Type Headaches, Chronic Daily Headaches, Cervically referred headaches (cervicalgia), Muscle Tension Headaches and headaches secondary to Myofascial Pain and Dysfunction Synrome are all examples of repetitive muscle strain disorders that result in headaches that are always upsetting and often disabling but fortunately these headaches almost always respond to Neuromuscular Dentistry. The Neuromuscular Dental treatment always begins by using an Ultra-Low Frequency TENS (transcutaneous electrical neurostimulation) to relax the muscles by utilizing anti -dromic impulses and by pumping waste products out of the muscles and allowing nutrients in to allow the natural (holistic) relaxation of the muscles. Once a TENS treatment has created a healthier state in the muscles and nervous tissues a diagnostic testing work-up utilizing EMG (electromyography) and MKG or CMS (madibular kinesiograph or computerized mandibular scan) is utilized to identify the ideal mandibular (lower jaw) position for healthy functioning of the cervical and jaw musculature and healthy postural position. This correction is achieve with a Diagnostic Neuromuscular Orthotic.
AND THEN THE MAGIC BEGINS!
The changes are not magical but often they seem that way to patients who have suffered from years of chronic pain and dysfunction. "Suffer No More: Dealing with the Great Imposter"
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor is an excellent article in Sleep and Health Journal that explains a few of the consequences of TMJ disorders and compromisd Neuromuscular functioning. There is anthother article http://www.sleepandhealth.com/neuromuscular-dentistry in Sleep and Health Journal that explains the scientific basis of Neuromuscular Dentistry.
The Diagnostic Orthotic of Neuromuscular Dentistry corrects the underlying pathology that has created muscle pathology and neuromuscular nociception. When the underlying pathology is eliminated the body "naturally heals" itself. The return to healthy homeostasis is a basic premise of Neuromuscular Dentistry as originally described by Dr Barney Jankelson. Dr "J" as he was affectionally known was a prosthodontist who drastically change the field of entistry by using healthy physiology as a basis for treatment instead of the outdated mechanistic theory of centric relation. Centric Relation actually has over 26 different definitions as old theory was adapted to new scientific facts and measurements. The definition of Centric Relation has little to do with healthy physiology and a lot to do with transferring information to an articulator for labratory procedures.
Orthopedic corrections of forward head position thru Neuromuscular Dentistry is n incredibly complex physiologic process that ocurs quickly after placing a neuromuscular diagnostic orthotic. The Quadrant Theorem of Guzay explains much of the complex changes that occur. The size of the airway also has a lot to do with correction of forward neck posture. Patients with compromised airways assume a forward neck posture with rotation of the atlas/ occipital and axis to maintain an open airway. It is this complex relationship that led the NHLBI (NTIONAL HEART LUNG AND BLOOD INSTITUTE) to release the report "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS".
Chronic muscle pain, Fibromyalgia, Myofascial Pain and Dysfunction and numerous other chronic muscle problems relate to sleep disorders as outlined in that report.
ENT symptoms including Ear Aches, Otalgia, Eustacian Tube Dysfunction, stuffy ears, clicking and popping noises in the ears, dizziness and equilibrium problems are frequently secondary to these muscle problems. These problems are also closely related to abnormal jaw function and neuromuscular dental disorders.
Sleep disorders and Neuromuscular Dentistry are intimately related and are a major cause of morning headaches.
Headaches are especially well suited to treatment by Neuromuscular Dental proceedures. A wide varienty of headaches may respond well to the first step of Neuromuscular Dental treatment, the Neuromuscular Diagnostic Orthotic. Patients with Classical Migraine, Atypical Migraine, Opthalmic Migraines, and Chronic Daily Migraine all frequently respond well to Neuromuscular Dental Treatment due to the connections to the Trigeminal Nervous System. Almost 100% of all types of Migraines are in full or in part mediated by the Trigeminal Nervous System and are therefore amenable to treatment with a Neuromuscular Dental Orthotic. A Neuromuscular Dental Orthotic is designed to decrease pathologic accomadation of the trigeminal neuromuscular system to decrease nociceptive input to the central nervous system. This nociceptive input is actually the bodies attempt to correct physical malalignment of the masticatory system. This results not only in central nervous system overload of the trigeminal system but also to repetitive strain injuries to the piostural muscles of the head and neck.
Muscle Spasm Headaches, Tension-Type Headaches, Chronic Daily Headaches, Cervically referred headaches (cervicalgia), Muscle Tension Headaches and headaches secondary to Myofascial Pain and Dysfunction Synrome are all examples of repetitive muscle strain disorders that result in headaches that are always upsetting and often disabling but fortunately these headaches almost always respond to Neuromuscular Dentistry. The Neuromuscular Dental treatment always begins by using an Ultra-Low Frequency TENS (transcutaneous electrical neurostimulation) to relax the muscles by utilizing anti -dromic impulses and by pumping waste products out of the muscles and allowing nutrients in to allow the natural (holistic) relaxation of the muscles. Once a TENS treatment has created a healthier state in the muscles and nervous tissues a diagnostic testing work-up utilizing EMG (electromyography) and MKG or CMS (madibular kinesiograph or computerized mandibular scan) is utilized to identify the ideal mandibular (lower jaw) position for healthy functioning of the cervical and jaw musculature and healthy postural position. This correction is achieve with a Diagnostic Neuromuscular Orthotic.
AND THEN THE MAGIC BEGINS!
The changes are not magical but often they seem that way to patients who have suffered from years of chronic pain and dysfunction. "Suffer No More: Dealing with the Great Imposter"
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor is an excellent article in Sleep and Health Journal that explains a few of the consequences of TMJ disorders and compromisd Neuromuscular functioning. There is anthother article http://www.sleepandhealth.com/neuromuscular-dentistry in Sleep and Health Journal that explains the scientific basis of Neuromuscular Dentistry.
The Diagnostic Orthotic of Neuromuscular Dentistry corrects the underlying pathology that has created muscle pathology and neuromuscular nociception. When the underlying pathology is eliminated the body "naturally heals" itself. The return to healthy homeostasis is a basic premise of Neuromuscular Dentistry as originally described by Dr Barney Jankelson. Dr "J" as he was affectionally known was a prosthodontist who drastically change the field of entistry by using healthy physiology as a basis for treatment instead of the outdated mechanistic theory of centric relation. Centric Relation actually has over 26 different definitions as old theory was adapted to new scientific facts and measurements. The definition of Centric Relation has little to do with healthy physiology and a lot to do with transferring information to an articulator for labratory procedures.
Orthopedic corrections of forward head position thru Neuromuscular Dentistry is n incredibly complex physiologic process that ocurs quickly after placing a neuromuscular diagnostic orthotic. The Quadrant Theorem of Guzay explains much of the complex changes that occur. The size of the airway also has a lot to do with correction of forward neck posture. Patients with compromised airways assume a forward neck posture with rotation of the atlas/ occipital and axis to maintain an open airway. It is this complex relationship that led the NHLBI (NTIONAL HEART LUNG AND BLOOD INSTITUTE) to release the report "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS".
Chronic muscle pain, Fibromyalgia, Myofascial Pain and Dysfunction and numerous other chronic muscle problems relate to sleep disorders as outlined in that report.
ENT symptoms including Ear Aches, Otalgia, Eustacian Tube Dysfunction, stuffy ears, clicking and popping noises in the ears, dizziness and equilibrium problems are frequently secondary to these muscle problems. These problems are also closely related to abnormal jaw function and neuromuscular dental disorders.
Sleep disorders and Neuromuscular Dentistry are intimately related and are a major cause of morning headaches.
Saturday, June 12, 2010
Neuromuscular Dentistry, Neuromuscular orthotics, Neuromuscular Reconstruction all work by removing impediments to healing.
To understand Neuromuscular Dentistry you need to recognize the difference between ideal health,absence of overt disease and the presence of TMD symptoms including Migraines, Tension Type Headaches, Chronic Daily Headaches, Facial Pain, Sinus Pain and/or sinus headaches, temporal headaches, morning heaaches and hundreds of other symptoms of TMD (temporomandibular disorders).
We all recognize when we do not fel well but often we are subject to sub-clinical disease where there are neuromuscular adaptations that allow us to cover-up most symptoms but are still far from ideal health.
Is health the absence of Illness or is it optimum health a state where our physiological and anotomical processes function at their best.
The real beauty of Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) is that it produces idealized physiology of the trigeminal nervous sytem and idealization of the posture of the patient. Posturology is the science of ideal posture, Neuromuscular Dentistry combines idealized posture, physiology and neural function.
What is a diagnostic Neuromuscular Orthotic? A diagnostic orthotic allows the application of Neuromuscular Dentistry to idealize a three dimensional relation of the cranium to the mandible. Idealizing this relation starts a process of healing and postural corrections. The diagnostic orthotic is adjuste to match healing throughout the body. This is not magic though many patients report pain relief that seems magical.
In reality as we remove impediments to healing, the body heals itself. This is what holistic medicine and/or anti-aging medicine is about. Creation of a internal environment that idealies internal physiological processes. A Neuromuscular Reconstruction is a long term solution to long term stabilizing of the most important joints and systems in the body.
The trigeminal nerve is responsible for maintaining nutrition and respiration both necessary for life. The trigeminal nerve also is key to communication and central to romance and interpersonal relations. The trigeminal nervous system is key to almost all measures of health due to its autonomic functions and control of blood flow to the brain.
Wikipedia defines Neuromuscular Dentistry based on symptoms rather than underlying science. The current Wikpedia definitions are reproduced below. In future blogs I will point out shortcomings to these definitions.
"Neuromuscular dentistry is a dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry claims that "misalignment problem(s)" can be corrected by understanding the relationships of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion.
Symptoms of temporomandibular joint disorder (TMD) are claimed to include:
Headaches / migraines
Facial pain
Back, neck and shoulder pain
Tinnitus (ringing in the ears)
Vertigo (dizziness)
Trigeminal neuralgia (tic douloureux), a neuropathic pain disorder unrelated to TMD
Bell's Palsy, a nerve disorder unrelated to TMD
Sensitive and sore teeth
Jaw pain
Limited jaw movement or locking jaw
Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
Worn or cracked teeth
Clicking or popping in the jaw joints
Jaw joint pain
Clenching/bruxing
Tender sensitive teeth
Trigeminal sensitization of the brain and related Fibromyalgia
A limited opening or inability to open the mouth comfortably
Deviation of the jaw to one side
The jaw locking open or closed
Postural problems (forward head posture) Forward head posture is actually forward neck posture with rotation of the occiput an the atlas.
Torticollis
Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
Pain in the muscles surrounding the temporomandibular joints
Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
Pain behind the eyes
Swelling on the side of the face and/or mouth
A bite that feels uncomfortable, "off," or as if it is continually changing
Older Bells palsy
The basic premise of Neuromuscular Dentistry is to find a rest position that when the patient closes their mouth to swallow the muscle will return to a healthy rest position. There should be no muscle accomadation necessary to go from rest to Myocentric position. The Trigeminal Nerve is paramount in attaining this position. Swallowing is a neuromuscular resetting mechanism. A more complete explanation of the science behind Neuromuscular Dentistry is found in Sleep and Health Journal, and was originally published by the American Equilibration society. http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG) and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording. [citation needed]
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3-6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Because of the additional training needed and the complex computer systems and hardware required, neuromuscular dentistry is more expensive than conventional dentistry. The costs can range from $3,500 to $25,000 for usually four to six months, and up to one year or more of treatment for complex cases. (This does not include any additional orthodontics or restorative treatment)."
We all recognize when we do not fel well but often we are subject to sub-clinical disease where there are neuromuscular adaptations that allow us to cover-up most symptoms but are still far from ideal health.
Is health the absence of Illness or is it optimum health a state where our physiological and anotomical processes function at their best.
The real beauty of Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) is that it produces idealized physiology of the trigeminal nervous sytem and idealization of the posture of the patient. Posturology is the science of ideal posture, Neuromuscular Dentistry combines idealized posture, physiology and neural function.
What is a diagnostic Neuromuscular Orthotic? A diagnostic orthotic allows the application of Neuromuscular Dentistry to idealize a three dimensional relation of the cranium to the mandible. Idealizing this relation starts a process of healing and postural corrections. The diagnostic orthotic is adjuste to match healing throughout the body. This is not magic though many patients report pain relief that seems magical.
In reality as we remove impediments to healing, the body heals itself. This is what holistic medicine and/or anti-aging medicine is about. Creation of a internal environment that idealies internal physiological processes. A Neuromuscular Reconstruction is a long term solution to long term stabilizing of the most important joints and systems in the body.
The trigeminal nerve is responsible for maintaining nutrition and respiration both necessary for life. The trigeminal nerve also is key to communication and central to romance and interpersonal relations. The trigeminal nervous system is key to almost all measures of health due to its autonomic functions and control of blood flow to the brain.
Wikipedia defines Neuromuscular Dentistry based on symptoms rather than underlying science. The current Wikpedia definitions are reproduced below. In future blogs I will point out shortcomings to these definitions.
"Neuromuscular dentistry is a dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal systems. It is a treatment modality of dentistry that focuses on correcting "misalignment" of the jaw at the temporomandibular joint (TMJ). Neuromuscular dentistry acknowledges the multi-facted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region. Neuromuscular dentistry claims that "misalignment problem(s)" can be corrected by understanding the relationships of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves. In short, proponents of neuromuscular dentistry claim that it adds objective data and understanding to previous mechanical models of occlusion.
Symptoms of temporomandibular joint disorder (TMD) are claimed to include:
Headaches / migraines
Facial pain
Back, neck and shoulder pain
Tinnitus (ringing in the ears)
Vertigo (dizziness)
Trigeminal neuralgia (tic douloureux), a neuropathic pain disorder unrelated to TMD
Bell's Palsy, a nerve disorder unrelated to TMD
Sensitive and sore teeth
Jaw pain
Limited jaw movement or locking jaw
Numbness in the fingers and arms (related to the cervical musculature and nerves, not to TMD)
Worn or cracked teeth
Clicking or popping in the jaw joints
Jaw joint pain
Clenching/bruxing
Tender sensitive teeth
Trigeminal sensitization of the brain and related Fibromyalgia
A limited opening or inability to open the mouth comfortably
Deviation of the jaw to one side
The jaw locking open or closed
Postural problems (forward head posture) Forward head posture is actually forward neck posture with rotation of the occiput an the atlas.
Torticollis
Pain in the joint(s) or face when opening or closing the mouth, yawning, or chewing
Pain in the muscles surrounding the temporomandibular joints
Pain in the occipital (back), temporal (side), frontal (front), or infra-orbital (below the eyes) portions of the head
Pain behind the eyes
Swelling on the side of the face and/or mouth
A bite that feels uncomfortable, "off," or as if it is continually changing
Older Bells palsy
The basic premise of Neuromuscular Dentistry is to find a rest position that when the patient closes their mouth to swallow the muscle will return to a healthy rest position. There should be no muscle accomadation necessary to go from rest to Myocentric position. The Trigeminal Nerve is paramount in attaining this position. Swallowing is a neuromuscular resetting mechanism. A more complete explanation of the science behind Neuromuscular Dentistry is found in Sleep and Health Journal, and was originally published by the American Equilibration society. http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular dentistry uses computerized instrumentation to measure the patient's jaw movements via Computerized Mandibular Scanning (CMS) or Jaw Motion Analysis (JMA), muscle activity via electromyography (EMG) and temporomandibular joint sounds via Electro-Sonography (ESG) or Joint Vibration Analysis (JVA) to assist in identifying joint derangements. Surface EMG's are used to verify pre-, mid- and post-treatment conditions before and after ultra-low frequency Transcutaneous Electrical Nerve Stimulator (TENS). By combining both computerized mandibular scanning (CMS) or jaw motion analysis (JMA) with ultra-low frequency TENS, the dentist is able to locate a "physiological rest" position as a starting reference position to find a relationship between the upper and lower jaw along an isotonic path of closure up from the physiologic rest position in order to establish a bite position. Electromyography can be used to confirm rested/homeostatic muscle activity of the jaw prior to taking a bite recording. [citation needed]
Once a physiologic rest position is found, the doctor can determine the optimal positioning of the lower jaw to the upper jaw. An orthotic is commonly worn for 3-6 months (24 hours per day) to realign the jaw, at which point orthodontic treatment, use of the orthotic as a "orthopedical realigning appliance", overlay partial, or orthodontic treatment and/or rehabilitation of the teeth is recommended to correct teeth and jaw position.
Because of the additional training needed and the complex computer systems and hardware required, neuromuscular dentistry is more expensive than conventional dentistry. The costs can range from $3,500 to $25,000 for usually four to six months, and up to one year or more of treatment for complex cases. (This does not include any additional orthodontics or restorative treatment)."
Chicago Neuromuscular Dentistry: Correction of Jaw position helps correct entire body posture.
Patients with posture problems and chronic pain may benefit tremendously from a diagnostic neuromuscular orthotic. There are two main causes of forward head posture more accurately referred to as forward neck posture with cranial rotation at C1 and C2 or the Atlas and Axis. The first reason is that the jaw acts as a counterbalance to the head through a complicated series of connections. In general if the jaw closes too far, ie decreased vertical dimension or is pushed to far back, posterior displacement . This causes stretching of the supra and infrahyoid. When this occurs for extended period of time it will cause the cranium to tip forward and down. To correct visual line of site the head then rotates at the joint of the first vertebrae (Atlas ) to the head or occiput.
The second cause is to open the pharyngeal airway. Patients attempting to correct their head position will always fail if they do not address the airway.
Airway and jaw position are tied together so closely that most patients with TMJ disorders (TMD or Temporomandibular Disorders) actually have both conditions. The National Heart Lung and Blood Institute (NHLBI) has a report "CQRDIOVSCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS"
IT IS WELL ESTABLISHED THAT MOST PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (SNORING, HYPOPNEA, UARS, RERA) HAVE SMALL AIRWAYS WHEN THEY ARE AWAKE AS WELL AS ASLEEP. WHEN AWAKE THEY PROTECT THEIR AIRWAY BY NEUROMUSCULAR COMPENSATION. FOWARD HEAD POSITION AND ABERRANT JAW POSITIONS ARE A DIRECT RESULT OF PROTECTING THE AIRWAY.
CORRECTION OF ABERRANT HEAD POSITION SHOULD ALWAYS ADDRESS THE AIRWAY.
SYMPTOMS RELATED TO AIRWAY AND FORWARD HEAD POSITION MAY INCLUDE:
HEADACHES
MIGRAINES
NECK PAIN
BACK PAIN
HIGH BLOOD PRESSURE
CORONARY ARTERY DISEASE
SHORT TERM MEMORY LOSS
SLEEP APNEA
FACIAL PAIN
ARM PAIN AND WEAKNESS
ARM NUMBNESS AND TINGLING OR SENSATION OF FALLING ASLEEP
POSTURAL DISTORTION
SLEEP APNEA
SNORING
AND ADDITIONAL AUTONOMIC AND PHYSICAL SYMPTOMS TO NUMEROUS TO COVER IN THIS BLOG
The second cause is to open the pharyngeal airway. Patients attempting to correct their head position will always fail if they do not address the airway.
Airway and jaw position are tied together so closely that most patients with TMJ disorders (TMD or Temporomandibular Disorders) actually have both conditions. The National Heart Lung and Blood Institute (NHLBI) has a report "CQRDIOVSCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS"
IT IS WELL ESTABLISHED THAT MOST PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (SNORING, HYPOPNEA, UARS, RERA) HAVE SMALL AIRWAYS WHEN THEY ARE AWAKE AS WELL AS ASLEEP. WHEN AWAKE THEY PROTECT THEIR AIRWAY BY NEUROMUSCULAR COMPENSATION. FOWARD HEAD POSITION AND ABERRANT JAW POSITIONS ARE A DIRECT RESULT OF PROTECTING THE AIRWAY.
CORRECTION OF ABERRANT HEAD POSITION SHOULD ALWAYS ADDRESS THE AIRWAY.
SYMPTOMS RELATED TO AIRWAY AND FORWARD HEAD POSITION MAY INCLUDE:
HEADACHES
MIGRAINES
NECK PAIN
BACK PAIN
HIGH BLOOD PRESSURE
CORONARY ARTERY DISEASE
SHORT TERM MEMORY LOSS
SLEEP APNEA
FACIAL PAIN
ARM PAIN AND WEAKNESS
ARM NUMBNESS AND TINGLING OR SENSATION OF FALLING ASLEEP
POSTURAL DISTORTION
SLEEP APNEA
SNORING
AND ADDITIONAL AUTONOMIC AND PHYSICAL SYMPTOMS TO NUMEROUS TO COVER IN THIS BLOG
Wednesday, June 2, 2010
Headache and Migraine: Elimination and Prevention Through Neuromuscular Dentistry - Improve The Quality Of Your Life and Live Pain Free!
Reprint of 24/7 press release below:
"Quality of life is destroyed when you live with chronic pain. Migraines, chronic daily headaches and other chronic head and neck pain can frequently be eliminated through the science of Neuromuscular Dentistry and Trigeminal Nervous system relief."
URNEE, IL, June 02, 2010 /24-7PressRelease/ -- A recent patient who suffered a constant headache for over 50 years is now pain free without dependence on medication. Patient M was married to a physician and had access to the finest care available but still lived in continuous pain for over 50 years. Patient M met Dr Ira L Shapira by accident. Her husband had sleep apnea and loud snoring and found Dr Sapira through the website http://www.IHateCPAP.com.
M was at her husband's consultation and Dr Shapira noticed she held her temple during the appointment and asked if she had a headache. She did, and he used a simple technique to turn off a trigger point and to relieve her pain. This was a first for M who had never experienced this in 50 years of living with chronic headache pain. Neuromuscular Dentistry was discussed briefly at that visit and at the second visit her husband received his oral appliance to eliminate his sleep apnea and snoring and M began her Neuromuscular Dentistry treatment.
M recieved a Diagnostic Neuromuscular Orthotic that day and except for one day has been headache free since that time. M does report that when she is sick she may get a headache but it is different than the headaches she lived with for most of her life.
What is Neuromuscular Dentistry and what is a Diagnostic Neuromuscular Orthotic and how does it work?
An article that Dr Shapira was asked to write for the American Equilibration Society is one of the best explanations available online and has been reprinted in Sleep and Health Journal @ http://www.sleepandhealth.com/neuromuscular-dentistry.
A second article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal discusses typical patient stories.
In the most simple terms the way Neuromuscular Dentistry works is change input and output from our brains and central nervous system to muscles, joints, and nervous system end organs in the Trigeminal Nervous System. Our brains are similar to computers. GARBAGE IN- GARBAGE OUT explains in computer lingo how bad input leads to bad output. The brain is basically a biological computer and GARBAGE IN- GARBAGE OUT holds true when it comes to our brains.
Input to the brain comes from two sources, input from the spinal column which accounts for 20% of the total input to the brain and input from 12 pairs of cranial nerves that accounts for 80% of brain input. The cranial nerves are responsible for sight, smell, taste, vision, hearing, proprioception and control of the autonomic nervous system.
The trigeminal nerve accounts for approximately 70% of the input to the brain from the 12 cranial nerves or more than half of total brain input. The Trigeminal Nerve is also known as the Dentist's Nerve. It goes to the teeth, jaw joints, jaw muscles, the periodontal ligaments of the teeth, the muscle that tenses the eardrum, the muscle that opens and closes the eustacian tubes, that innervates the lining of the sinuses and nasal mucosa. It also controls the blood flow to the anterior 2/3 of the meninges of the brain. When we smell menthol that is another trigeminal nerve function which may be why Vicks Vapor Rub works for many pains.
The trigeminal nerve also has a enormous autonomic component and is a chief cause of central sensitization. Central Sensitization is a primary aspect of most headaches and migraines, facial pains, fibromyalgia and almost all other chronic pain syndromes.
GARBAGE IN - GARBAGE OUT takes on new meaning when we are talking about the majority of input to the brain. Neuromuscular Dentistry turns bad data our brain receives into good data. Central Sensitization can turn good input into bad output. Examples are Hyperesthesia where there is an over-reaction to pain stimuli and Allodynia where non-painful input is received as Nociceptive of Pain impulses. Fibromyalgia is considered a disease caused by or accompanied by Central Sensitization. The Trigeminal Nerve is also vital for controlling respiration and airway patency. The National Heart Lung and Blood Institute issued a report "Cardiovascular and Sleep Related Consequences Of Temporomandibular Disorders" which is available at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf.
Dr Shapira created http://www.ihateheadaches.org to help patients understand headaches, migraines and how Neuromuscular Dentistry is an essential and vital treatment resource.
Why do patients suffer for years if there is a treatment that can so drastically improve their lives?
Do problems addressed Neuromuscular Dentistry actually affect health and medical costs?
Cranio, The Journal for CranioMandibular Practice published two articles that answer that question. The studies by Shimshak et al showed that patients with TMJ disorders had a 300% increase in medical utilization in all fields of medicine except obstetrics. In other words, aside from not getting pregnant these patients utilize three times the average in medical expenses. Treatment of Temporomandibular disorders and the neuromuscular pathology that cause them can drastically improve patients lives and possibly drastically decrease medical expenses.
The NHLBI report discusses how respiratory disorders related to TMJ disorders can effect many body systems. Dental Sleep Medicine is an extremely effective approach to treating sleep apnea. It is more effective overall than surgery. CPAP is still considered the Gold Standard of treatment for Sleep Apnea but has horrendous issues with patients compliance.
Poor compliance means it works well if used but most patients do not use it. CPAP that is not used is worthless and dangerous because the patient remains untreated. A recent study showed that 60% of patients did not use their CPAP. Other patients refuse to even have a sleep test because they do not want to use CPAP. One study cited at the Trucking and Sleep Apnea conference presented by the American Sleep Apnea Association showed only 5% of truckers using their CPAP. This is a frightening fact considering than patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents. Patients overwhelmingly prefer oral appliances to CPAP when they offered a choice but most patients are never given a choice. That would be understandable if CPAP compliance wasn't an issue. Studies of patients who do use their CPAP show that they average only 4-5 hours a night of use not 7-7 1/2 that is ideal.
Patients with untreated sleep apnea have up to a six-fold increase of risk of heart attacks and strokes which usually occur in the early morning hours. Most CPAP users have already stopped utilizing their CPAP during the early morning hours when the risk is greatest.
Dr Shapira created the website I HATE CPAP! to help the majority of patients who could not tolerate treatment with CPAP. Thousands and thousands of patients visit this website every single month which leads them to appropriate and scientifically supported treatment.
Treatment and prevention sleep apnea with oral appliances is now well accepted but is still fighting for its proper place in medicine. In a few years oral appliances will probably account for a vast majority of treatment of mild to moderate sleep apnea.
Morning headaches have two primary causes, TMJ disorders and Sleep Apnea. The NHLBI says Sleep Apnea is a TMJ disorder. There is an FDA approved appliance for preventing migraines the the NTI-TSS appliance.
The Aqualizer appliance, invented by Dr Martin Lerman is an a simple inexpensive appliance that can produce incredible success but does not offer permanent correction. IAn Aqualizer was used to keep M free of pain between her first and second appointment until her diagnostic neuromuscular orthotic was delivered.
Neuromuscular Dental treatment starts with a Diagnostic Orthotic. When treatment effectiveness is assured patients can proceed with long term phase 2 treatment of a permanent removable orthotic, orthodontic correction or a Neuromuscular Reconstruction. Patient M chose reconstruction which not only eliminated her headaches but also gave her a beautiful new smile. Reconstruction can be accomplished in just a few appointments for patients who do not wish to go through extended treatment with orthodontics or wear a long term orthotic.
The Aqualizer and NTI-TSS are excellent tools but they do not provide definitive treatment.
Dr Shapira studied Neuromuscular Dentistry with Barney Jankelson who founded the science and with his son Robert Jankelson. His 30 years of neuromuscular dentistry and pioneer work in Dental Sleep Medicine makes him uniquely suited to treating patients with chronic head and neck pain.
The Las Vegas Institute is the primary educator in Neuromuscular Dentistry and has appointed Dr Norman Thomas to head educational and research studies into Neuromuscular Dentistry. Dr Thomas is a world leading expert in the field of Neuromuscular Dentistry and how it relates to Physiology and Anatomy of masticatory and postural systems.
Dr Barry Cooper also does a superb job at introducing dentists to the field of Neuromuscular Dentistry. Dr Shapira strongly recommends dentists begin their training with Dr Cooper because he teaches small groups of 1-6 doctors which is the ideal learning environment. Dr Shapira limits his sleep apnea and Dental Sleep Medicine classes to six doctors as well. This allows for one on one interaction and follow-up during the most difficult period of the learning curve.
The international college of craniomandibular orthopedics or iccmo is the leading organization representing neuromuscular dentistry. Dr shapira stronly suggests you find a neuromuscular dentist who is a member of iccmo. Iccmo was founded by dr barney jankelson, the father of neuromuscular dentistry.
Patients in Northern Illinois and southern Wiscosin looking for a Neuromuscular Dentist are a comfortable drive to Dr Shapira's general dentistry office, Delany Dental Care Ltd in Gurnee and to the offices of Chicagoland Dental Sleep Medicine Associates. Dr Shapira currently sees patients in Skokie and Schaumburg and recently announced a new office will open soon in Highland Park, Illinois.
Dr Shapira's team can make arrangements for patients from outside of the Chicago Metropolitan area
to have an intensive course of treatment. Dr Shapira will consider accepting long distance patients on a case by case basis. Patients wishing to see Dr Shapira can contact his office toll-free at 1-800-TM-Joint or 1-8-NO-PAP-MASK or 847-623-5530
Patients can contact Dr Shapira through the following websites:
http://www.ihatecpap.com
http://ww.ihateheadaches.org
http://delanydentalcare.com
http://www.chicagoland.ihatecpap.com/
Dr Shapira will help patients locate a Sleep Apnea Dentist or Neuromuscular Dentist anywhere in the country. Dr Shapira strongly advises patients to seek out treatment of Sleep Apnea only from dentists trained in treating TMJ disorders preferably by Neuromuscular Dentists.
The American Academy of Sleep Medicine (AASM) advised that patients receive oral appliances from dentists trained in Dental Sleep Medicine and treatment of Temporomandibular Disorders (TMD). The American Academy of Dental Sleep Medicine (AADSM) endorsed the position of the AASM.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President of I Hate Headaches LLC, President Dato-TECH, and has a General Dental Practice, Delany Dental Care Ltd with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin
"Quality of life is destroyed when you live with chronic pain. Migraines, chronic daily headaches and other chronic head and neck pain can frequently be eliminated through the science of Neuromuscular Dentistry and Trigeminal Nervous system relief."
URNEE, IL, June 02, 2010 /24-7PressRelease/ -- A recent patient who suffered a constant headache for over 50 years is now pain free without dependence on medication. Patient M was married to a physician and had access to the finest care available but still lived in continuous pain for over 50 years. Patient M met Dr Ira L Shapira by accident. Her husband had sleep apnea and loud snoring and found Dr Sapira through the website http://www.IHateCPAP.com.
M was at her husband's consultation and Dr Shapira noticed she held her temple during the appointment and asked if she had a headache. She did, and he used a simple technique to turn off a trigger point and to relieve her pain. This was a first for M who had never experienced this in 50 years of living with chronic headache pain. Neuromuscular Dentistry was discussed briefly at that visit and at the second visit her husband received his oral appliance to eliminate his sleep apnea and snoring and M began her Neuromuscular Dentistry treatment.
M recieved a Diagnostic Neuromuscular Orthotic that day and except for one day has been headache free since that time. M does report that when she is sick she may get a headache but it is different than the headaches she lived with for most of her life.
What is Neuromuscular Dentistry and what is a Diagnostic Neuromuscular Orthotic and how does it work?
An article that Dr Shapira was asked to write for the American Equilibration Society is one of the best explanations available online and has been reprinted in Sleep and Health Journal @ http://www.sleepandhealth.com/neuromuscular-dentistry.
A second article "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal discusses typical patient stories.
In the most simple terms the way Neuromuscular Dentistry works is change input and output from our brains and central nervous system to muscles, joints, and nervous system end organs in the Trigeminal Nervous System. Our brains are similar to computers. GARBAGE IN- GARBAGE OUT explains in computer lingo how bad input leads to bad output. The brain is basically a biological computer and GARBAGE IN- GARBAGE OUT holds true when it comes to our brains.
Input to the brain comes from two sources, input from the spinal column which accounts for 20% of the total input to the brain and input from 12 pairs of cranial nerves that accounts for 80% of brain input. The cranial nerves are responsible for sight, smell, taste, vision, hearing, proprioception and control of the autonomic nervous system.
The trigeminal nerve accounts for approximately 70% of the input to the brain from the 12 cranial nerves or more than half of total brain input. The Trigeminal Nerve is also known as the Dentist's Nerve. It goes to the teeth, jaw joints, jaw muscles, the periodontal ligaments of the teeth, the muscle that tenses the eardrum, the muscle that opens and closes the eustacian tubes, that innervates the lining of the sinuses and nasal mucosa. It also controls the blood flow to the anterior 2/3 of the meninges of the brain. When we smell menthol that is another trigeminal nerve function which may be why Vicks Vapor Rub works for many pains.
The trigeminal nerve also has a enormous autonomic component and is a chief cause of central sensitization. Central Sensitization is a primary aspect of most headaches and migraines, facial pains, fibromyalgia and almost all other chronic pain syndromes.
GARBAGE IN - GARBAGE OUT takes on new meaning when we are talking about the majority of input to the brain. Neuromuscular Dentistry turns bad data our brain receives into good data. Central Sensitization can turn good input into bad output. Examples are Hyperesthesia where there is an over-reaction to pain stimuli and Allodynia where non-painful input is received as Nociceptive of Pain impulses. Fibromyalgia is considered a disease caused by or accompanied by Central Sensitization. The Trigeminal Nerve is also vital for controlling respiration and airway patency. The National Heart Lung and Blood Institute issued a report "Cardiovascular and Sleep Related Consequences Of Temporomandibular Disorders" which is available at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf.
Dr Shapira created http://www.ihateheadaches.org to help patients understand headaches, migraines and how Neuromuscular Dentistry is an essential and vital treatment resource.
Why do patients suffer for years if there is a treatment that can so drastically improve their lives?
Do problems addressed Neuromuscular Dentistry actually affect health and medical costs?
Cranio, The Journal for CranioMandibular Practice published two articles that answer that question. The studies by Shimshak et al showed that patients with TMJ disorders had a 300% increase in medical utilization in all fields of medicine except obstetrics. In other words, aside from not getting pregnant these patients utilize three times the average in medical expenses. Treatment of Temporomandibular disorders and the neuromuscular pathology that cause them can drastically improve patients lives and possibly drastically decrease medical expenses.
The NHLBI report discusses how respiratory disorders related to TMJ disorders can effect many body systems. Dental Sleep Medicine is an extremely effective approach to treating sleep apnea. It is more effective overall than surgery. CPAP is still considered the Gold Standard of treatment for Sleep Apnea but has horrendous issues with patients compliance.
Poor compliance means it works well if used but most patients do not use it. CPAP that is not used is worthless and dangerous because the patient remains untreated. A recent study showed that 60% of patients did not use their CPAP. Other patients refuse to even have a sleep test because they do not want to use CPAP. One study cited at the Trucking and Sleep Apnea conference presented by the American Sleep Apnea Association showed only 5% of truckers using their CPAP. This is a frightening fact considering than patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents. Patients overwhelmingly prefer oral appliances to CPAP when they offered a choice but most patients are never given a choice. That would be understandable if CPAP compliance wasn't an issue. Studies of patients who do use their CPAP show that they average only 4-5 hours a night of use not 7-7 1/2 that is ideal.
Patients with untreated sleep apnea have up to a six-fold increase of risk of heart attacks and strokes which usually occur in the early morning hours. Most CPAP users have already stopped utilizing their CPAP during the early morning hours when the risk is greatest.
Dr Shapira created the website I HATE CPAP! to help the majority of patients who could not tolerate treatment with CPAP. Thousands and thousands of patients visit this website every single month which leads them to appropriate and scientifically supported treatment.
Treatment and prevention sleep apnea with oral appliances is now well accepted but is still fighting for its proper place in medicine. In a few years oral appliances will probably account for a vast majority of treatment of mild to moderate sleep apnea.
Morning headaches have two primary causes, TMJ disorders and Sleep Apnea. The NHLBI says Sleep Apnea is a TMJ disorder. There is an FDA approved appliance for preventing migraines the the NTI-TSS appliance.
The Aqualizer appliance, invented by Dr Martin Lerman is an a simple inexpensive appliance that can produce incredible success but does not offer permanent correction. IAn Aqualizer was used to keep M free of pain between her first and second appointment until her diagnostic neuromuscular orthotic was delivered.
Neuromuscular Dental treatment starts with a Diagnostic Orthotic. When treatment effectiveness is assured patients can proceed with long term phase 2 treatment of a permanent removable orthotic, orthodontic correction or a Neuromuscular Reconstruction. Patient M chose reconstruction which not only eliminated her headaches but also gave her a beautiful new smile. Reconstruction can be accomplished in just a few appointments for patients who do not wish to go through extended treatment with orthodontics or wear a long term orthotic.
The Aqualizer and NTI-TSS are excellent tools but they do not provide definitive treatment.
Dr Shapira studied Neuromuscular Dentistry with Barney Jankelson who founded the science and with his son Robert Jankelson. His 30 years of neuromuscular dentistry and pioneer work in Dental Sleep Medicine makes him uniquely suited to treating patients with chronic head and neck pain.
The Las Vegas Institute is the primary educator in Neuromuscular Dentistry and has appointed Dr Norman Thomas to head educational and research studies into Neuromuscular Dentistry. Dr Thomas is a world leading expert in the field of Neuromuscular Dentistry and how it relates to Physiology and Anatomy of masticatory and postural systems.
Dr Barry Cooper also does a superb job at introducing dentists to the field of Neuromuscular Dentistry. Dr Shapira strongly recommends dentists begin their training with Dr Cooper because he teaches small groups of 1-6 doctors which is the ideal learning environment. Dr Shapira limits his sleep apnea and Dental Sleep Medicine classes to six doctors as well. This allows for one on one interaction and follow-up during the most difficult period of the learning curve.
The international college of craniomandibular orthopedics or iccmo is the leading organization representing neuromuscular dentistry. Dr shapira stronly suggests you find a neuromuscular dentist who is a member of iccmo. Iccmo was founded by dr barney jankelson, the father of neuromuscular dentistry.
Patients in Northern Illinois and southern Wiscosin looking for a Neuromuscular Dentist are a comfortable drive to Dr Shapira's general dentistry office, Delany Dental Care Ltd in Gurnee and to the offices of Chicagoland Dental Sleep Medicine Associates. Dr Shapira currently sees patients in Skokie and Schaumburg and recently announced a new office will open soon in Highland Park, Illinois.
Dr Shapira's team can make arrangements for patients from outside of the Chicago Metropolitan area
to have an intensive course of treatment. Dr Shapira will consider accepting long distance patients on a case by case basis. Patients wishing to see Dr Shapira can contact his office toll-free at 1-800-TM-Joint or 1-8-NO-PAP-MASK or 847-623-5530
Patients can contact Dr Shapira through the following websites:
http://www.ihatecpap.com
http://ww.ihateheadaches.org
http://delanydentalcare.com
http://www.chicagoland.ihatecpap.com/
Dr Shapira will help patients locate a Sleep Apnea Dentist or Neuromuscular Dentist anywhere in the country. Dr Shapira strongly advises patients to seek out treatment of Sleep Apnea only from dentists trained in treating TMJ disorders preferably by Neuromuscular Dentists.
The American Academy of Sleep Medicine (AASM) advised that patients receive oral appliances from dentists trained in Dental Sleep Medicine and treatment of Temporomandibular Disorders (TMD). The American Academy of Dental Sleep Medicine (AADSM) endorsed the position of the AASM.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President of I Hate Headaches LLC, President Dato-TECH, and has a General Dental Practice, Delany Dental Care Ltd with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, a Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin
Subscribe to:
Posts (Atom)