The BBC news reproted that experts say there is "limited evidence" for using botox to treat migraine.
Botox has been licensed in the UK and US as a preventative treatment for chronic cases.
The BBC reprted that "But a review of evidence by the Drug and Therapeutics Bulletin said it could not "see a place" for giving botox to migraine sufferers."
Thursday, February 10, 2011
Saturday, February 5, 2011
New Article ties Joint hypermobility syndrome to migraines. This has long been known to be a factor in TMJ disorders and associated headaches.
Studies have shown that hypermobility syndrome is associated with chronic headache disorders. This new study shows that 75% of study group with the syndrome had migraines compared to only 43% of controls.
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Patients with Chronic Daily Headaches, Migraines, Tension-type headaches, myofascial pain and associated headaches, atypical migaine, classic migraine almost always are headaches related to the masticatory system, the trigeminal nerve and TMJ disorders(TMD). These problems are often best addressed by the use of a diagnostic neuromuscular orthotic that has been shown in various studies to give some improvement in close to 100% of patients. Almost all studies of orthotics (of all types) show better then 50 % of patients experiencing considrable improvement and in my experience neuromuscular orthotics are far superior to the typical orthotic. Patients with migraines and/or muscular headaches would be well advised to consider temporomandibular disorders as part of a differential diagnosis.
Unfortunately for most patients with migraines neurologists will usually begin with drug trials in spite of side effects and statistically lower response rates. Patients usually turn to neuromuscular dentistry after years of suffering. often the suffering was needless. Most physicians are not well informed about the field of neuromuscular dentistry.
Recent articles from the International Acadery of Dental Research have done an enormous disservice to patients by promoting the psychological and biosocial aspects of chronic pain strongly supporting the notion that drug therapy should precede occlusal therapy. This is a biased view that is particularly destructive to patients labeling their pain as a psychosocial disorder to be treated by drugs ignoring the underlying neuromuscular systems and trigemino-vascular connections that are best treated by neuromuscular orthotics.
I have listed a few of the 211 PubMed.gov abstracts below that are revealed by searching PubMed with these search terms; joint hypermobility , tmj
The study showed that "The adjusted odds ratio for the prevalence of migraine was 3.19 in JHS patients" and that " The rate ratios for migraine frequency and headache-related disability were 1.67 for JHS patients"
The authors stated "Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females."
Hypermobility symptom is a major risk factor for TMJ (TMD) disorders
Cephalalgia. 2011 Feb 2. [Epub ahead of print]
Joint hypermobility syndrome: A common clinical disorder associated with migraine in women.
Bendik EM, Tinkle BT, Al-Shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT.
University of Cincinnati College of Medicine, USA.
Abstract
Preliminary studies suggested that headache disorders are more common in patients with joint hypermobility syndrome (JHS). The objectives of this study were to determine if the prevalence, frequency, and disability of migraine differ between female patients with JHS and a control population. Twenty-eight patients with JHS and 232 controls participated in the case-cohort study. Participants underwent a structured verbal interview and were assigned a diagnosis of migraine based on criteria of the International Classification of Headache Disorders, 2nd Edition. The primary outcome measures were the prevalence, frequency, and headache-related disability of migraine. Logistic regression was used for the prevalence analysis and Poisson regression for the frequency and disability analyses. Results indicated that the prevalence of migraine was 75% in JHS patients and 43% in controls. The adjusted odds ratio for the prevalence of migraine was 3.19 (95% CI 1.24, 8.21] in JHS patients. The rate ratios for migraine frequency and headache-related disability were 1.67 (95% CI 1.01, 2.76) and 2.99 (95% CI 1.66, 5.38), respectively, for JHS patients. Our study suggests that JHS is a clinical disorder strongly associated with an increased prevalence, frequency, and disability of migraine in females.
PMID: 21278238 [PubMed - as supplied by publisher]
Acta Odontol Scand. 2010 Sep;68(5):289-99.
Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.
Marklund S, Wänman A.
Department of Odontology, Umeå University, Sweden. susanna.marklund@odont.umu.se
Abstract
OBJECTIVE: To analyze whether gender, self-reported bruxism, and variations in dental occlusion predicted incidence and persistence of temporomandibular disorder (TMD) during a 2-year period.
MATERIAL AND METHODS: The study population comprised 280 dental students at Umeå University in Sweden. The study design was that of a case-control study within a 2-year prospective cohort. The investigation comprised a questionnaire and a clinical examination at enrolment and at 12 and 24 months. Cases (incidence) and controls (no incidence) were identified among those without signs and symptoms of TMD at the start of the study. Cases with 2-year persistence of signs and symptoms of TMD were those with such signs and symptoms at all three examinations. Clinical registrations of baseline variables were used as independent variables. Odds ratio estimates and 95% confidence intervals of the relative risks of being a case or control in relation to baseline registrations were calculated using logistic regression analyses.
RESULTS: The analyses revealed that self-reported bruxism and crossbite, respectively increased the risk of the 2-year cumulative incidence and duration of temporomandibular joint (TMJ) signs or symptoms. Female gender was related to an increased risk of developing and maintaining myofascial pain. Signs of mandibular instability increased the risk of maintained TMD signs and symptoms during the observation period.
CONCLUSION: This 2-year prospective observational study indicated that self-reported bruxism and variations in dental occlusion were linked to the incidence and persistence of TMJ signs and symptoms to a higher extent than to myofascial pain.
PMID: 20528485 [PubMed - indexed for MEDLINE]
J Orofac Pain. 2009 Fall;23(4):303-11.
Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the recognition of an anterior disc displacement with reduction.
Naeije M, Kalaykova S, Visscher CM, Lobbezoo F.
Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. m.naeije@acta.nl
Comment in:
J Orofac Pain. 2009 Fall;23(4):312-5; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):320-2; author reply 323-4.
J Orofac Pain. 2009 Fall;23(4):316-9; author reply 323-4.
Abstract
The aim of this Focus Article is to review critically the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the recognition of an anterior disc displacement with reduction (ADDR) in the temporomandibular joint (TMJ). This evaluation is based upon the experience gained through the careful analysis of mandibular movement recordings of hundreds of patients and controls with or without an ADDR. Clinically, it is a challenge to discriminate between the two most prevalent internal derangements of the TMJ: ADDR and symptomatic hypermobility. It is due to the very nature of these derangements that they both show clicking on opening and closing (reciprocal clicking), making reciprocal clicking not a distinguishing feature between these disorders. However, there is a difference in timing of their opening and closing clicks. Unfortunately, it is not feasible to use this difference in timing clinically to distinguish between the two internal derangements, because it is the amount of mouth opening at the time of the clicking which is clinically noted, not the condylar translation. Two other criteria proposed by the RDC/TMD for the recognition of an ADDR are the 5-mm difference in mouth opening at the time of the opening and closing clicks, and the detection of joint sounds on protrusion or laterotrusion in case of non?reciprocal clicking. These, however, run the risk of false-positive or negative results and therefore have no great diagnostic value. Instead, it is recommended that the elimination of clicking on protrusive opening and closing be examined in order to distinguish ADDRs from symptomatic hypermobility.
PMID: 19888478 [PubMed - indexed for MEDLINE]
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):e54-7.
Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.
Sáez-Yuguero Mdel R, Linares-Tovar E, Calvo-Guirado JL, Bermejo-Fenoll A, Rodríguez-Lozano FJ.
Faculty of Medicine, University of Murcia, Murcia, Spain. mrosario@um.es
Abstract
OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD).
STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement.
RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02).
CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.
PMID: 19464645 [PubMed - indexed for MEDLINE]
Eur J Oral Sci. 2008 Dec;116(6):525-30.
Association between generalized joint hypermobility and signs and diagnoses of temporomandibular disorders.
Hirsch C, John MT, Stang A.
Department of Pediatric Dentistry, School of Dentistry, University of Leipzig, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de
Comment in:
J Evid Based Dent Pract. 2010 Jun;10(2):91-2.
Abstract
The aim of this study was to analyze whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular disorders (TMD). We examined 895 subjects (20-60 yr of age) in a population-based cross-sectional sample in Germany for GJH according to the Beighton classification and for TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). After controlling for the effects of age, gender, and general joint diseases using multiple logistic regression analyses, hypermobile subjects (with four or more hypermobile joints on the 0-9 scale) had a higher risk for reproducible reciprocal clicking as an indicator for disk displacement with reduction (Odds Ratio (OR) = 1.68) compared with those subjects without hypermobile joints. Concurrently, subjects with four or more hypermobile joints had a lower risk for limited mouth opening (< 35 mm; OR = 0.26). The associations between GJH and reproducible reciprocal clicking or limited mouth opening were statistically significant in a trend test. No association was observed between hypermobility and myalgia/arthralgia (RDC/TMD Group I/IIIa). In conclusion, GJH was found to be associated with non-painful subtypes of TMD.
PMID: 19049522 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Dentomaxillofac Radiol. 2010 Dec;39(8):494-500.
Evaluation of the lateral pterygoid muscle using magnetic resonance imaging.
D'Ippolito SM, Borri Wolosker AM, D'Ippolito G, Herbert de Souza B, Fenyo-Pereira M.
Rua Prof Filadelfo Azevedo, 617, apt. 61, 04508-011, São Paulo, SP, Brazil. silvia.dippolito@uol.com.br
Abstract
OBJECTIVES: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD).
METHODS: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed.
RESULTS: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed.
CONCLUSIONS: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders.
PMID: 21062943 [PubMed - indexed for MEDLINE
Severe Headaches in Temples and Throbbing pain in teeth and joints after dental work.
Ruby: Headache in right temple. Throbbing in teeth and tm joint. Neck pain. Had a splint put in 10 days ago. Went for Pt, massage, chiro and today pain management dr who I didn't like much and jumped to wanting to do a nerve block. Just trying to find the right person to treat me. Chronic grinder, had crowns put on all uppers and didn't make night guard fast enough. Tmj dentist only does splints and says jaw position is 80% better. Help! Haven't been able to work in almost 2 weeks.
Dr Shapira Reponse: Dear Ruby,
I am sorry to learn of your ordeal.
Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a neuromuscular dentist. Blocks can be very effective but they are rarely a first line of treatment. MASSAGE THERAPY, CHIROPRACTIC OR OSTEOPATHIC ADJUSTMENTS CAN BE HELPFUL BUT THEY DO NOT ADDRESS THE UNDERLYING CAUSES OF THE PROBLEM ABD ARE MERELY PALLIATIVE IN NATURE. Frequently, you may also have long-standing underlying postural problems that these therapies will correct.
To say your jaw position is 80% better when you are in the pain you describe is ludicrous. Quality of life is always a primary concern and it does not appear that you are doing well from the little information you have given me. I normally hold off on permanent dental work until the pain is under control but I do not know if the pain was there prior to your dental work.
The use of spray and stretch with vapocoolant and trigger point injections can speed results but the utilization of the Low Frequency TENS to reduce spasm and pain is very important.
The headache in the temple area and throbbing pain in the teeth following dental work indicates that this probably is myofascial pain or TMD that should respond well to Neuromuscular Dental Treatment. A Diagnostic neuromuscular orthotic will be made to allow your muscles to function in a physiologic zone. An orthotic is designed to correct orthopedic and physiologic funtion rather than just protect the teeth like a "splint:.
Good Luck with your treatment.
I am forwarding your information to Dr **** ******. I hope that he will be able to help you improve your quality of life quickly.. I am available in Chicago if you do not find answers but Dr **** is an excellent practitioner. If for any reason it does not work out I can help you find another doctor but I know Dr **** and he can consult with me if there are any questions.
I am willing to see long distance patients but to be effective I try to schedule you so that we can initiate treatment and control your pain and correct orthopedics as quickly as possible. This requires a significant amount of time being scheduled in advance.
Dr Ira L Shapira
Dr Shapira Reponse: Dear Ruby,
I am sorry to learn of your ordeal.
Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a neuromuscular dentist. Blocks can be very effective but they are rarely a first line of treatment. MASSAGE THERAPY, CHIROPRACTIC OR OSTEOPATHIC ADJUSTMENTS CAN BE HELPFUL BUT THEY DO NOT ADDRESS THE UNDERLYING CAUSES OF THE PROBLEM ABD ARE MERELY PALLIATIVE IN NATURE. Frequently, you may also have long-standing underlying postural problems that these therapies will correct.
To say your jaw position is 80% better when you are in the pain you describe is ludicrous. Quality of life is always a primary concern and it does not appear that you are doing well from the little information you have given me. I normally hold off on permanent dental work until the pain is under control but I do not know if the pain was there prior to your dental work.
The use of spray and stretch with vapocoolant and trigger point injections can speed results but the utilization of the Low Frequency TENS to reduce spasm and pain is very important.
The headache in the temple area and throbbing pain in the teeth following dental work indicates that this probably is myofascial pain or TMD that should respond well to Neuromuscular Dental Treatment. A Diagnostic neuromuscular orthotic will be made to allow your muscles to function in a physiologic zone. An orthotic is designed to correct orthopedic and physiologic funtion rather than just protect the teeth like a "splint:.
Good Luck with your treatment.
I am forwarding your information to Dr **** ******. I hope that he will be able to help you improve your quality of life quickly.. I am available in Chicago if you do not find answers but Dr **** is an excellent practitioner. If for any reason it does not work out I can help you find another doctor but I know Dr **** and he can consult with me if there are any questions.
I am willing to see long distance patients but to be effective I try to schedule you so that we can initiate treatment and control your pain and correct orthopedics as quickly as possible. This requires a significant amount of time being scheduled in advance.
Dr Ira L Shapira
Wednesday, February 2, 2011
Can Treatment of Fibromyalgia and/or Chronic Pain with Amitryptilne increase Sleep Apnea (AHI)
Amitryptilne is frequently prescribed for treating chronic pain including tension-type headaches, TMJ disorders and fibromyalgia. It is also used to treat mild insomnia and mild sleep apnea. The drug is classified as a tri-cyclic antidepressant but is frequently used off label in low dose therapy.
The authors concluded that Amytriptiline increasesAHI or apnea /hypopnea index.
This is an interesting finding because sleep disturbances are so closely tied to fibromyalgia and TMJ disorders. The NHLBI, National Heart Lung and Blood Institute published a report "Cardiovascular and Sleep Related Consequences of TMJ disorders. Fibromyalgia is frequently considered in part a disorder of disturbed sleep with UARS, upper airway resistance syndrome frequently associated with the disorder. Worsening of the sleep disordered breating may make the underlying condition worse over time .
This abstract was presented at the AASM meeting in Seattle in 2009.
"EFFECTS OF AMITRIPTYLINE ON AHI Perrott J, Renda F, Fitzgerald H, Botros W Sleep Clinic, Kitchener, ON, Canada
Introduction: Amitriptyline is a tricyclic antidepressant used in the pharmacologic management of depressive illness. Although not a la- beled indication, amitriptyline is widely used as an atypical treatment of insomnia and mild sleep apnea. This is significant due to the fact that the comorbidity between insomnia and sleep related breathing disorders is substantial. Amitriptyline is believed to help mild sleep apnea by im- proving pharyngeal tone. This study will determine the effect of amitrip- tyline on the AHI.
Methods: A sample of 29 patients diagnosed with insomnia that at- tended nPSG without amitriptyline as well as nPSG with amitriptyline were selected. The sample consisted of both males and females between the ages of 18-65. AHI was independently calculated for both diagnostic and therapeutic studies and statistical analysis performed.
Results: The average difference between the diagnostic and therapeutic AHI is an increase of 4.97. For n=29 a one-tailed test was used where Ho: amitriptyline has no effect on AHI and H1: amitriptyline increases AHI. The μ = np = (29)(0.7) = 20.3, σ = 2.46, z = 5-μ/σ = -6.199, α = 0.9998. Therefore 99.9 % of all sample size 29 would lead to rejection of Ho.
Conclusion: Based on the above results it would appear that taking amitriptyline increases the AHI. We acknowledge that the sample size is small and parameters such as increased sleep efficiency were not consid- ered. The practice of prescribing amitriptyline in insomnia patients with mild AHI needs further examination."
The authors concluded that Amytriptiline increasesAHI or apnea /hypopnea index.
This is an interesting finding because sleep disturbances are so closely tied to fibromyalgia and TMJ disorders. The NHLBI, National Heart Lung and Blood Institute published a report "Cardiovascular and Sleep Related Consequences of TMJ disorders. Fibromyalgia is frequently considered in part a disorder of disturbed sleep with UARS, upper airway resistance syndrome frequently associated with the disorder. Worsening of the sleep disordered breating may make the underlying condition worse over time .
This abstract was presented at the AASM meeting in Seattle in 2009.
"EFFECTS OF AMITRIPTYLINE ON AHI Perrott J, Renda F, Fitzgerald H, Botros W Sleep Clinic, Kitchener, ON, Canada
Introduction: Amitriptyline is a tricyclic antidepressant used in the pharmacologic management of depressive illness. Although not a la- beled indication, amitriptyline is widely used as an atypical treatment of insomnia and mild sleep apnea. This is significant due to the fact that the comorbidity between insomnia and sleep related breathing disorders is substantial. Amitriptyline is believed to help mild sleep apnea by im- proving pharyngeal tone. This study will determine the effect of amitrip- tyline on the AHI.
Methods: A sample of 29 patients diagnosed with insomnia that at- tended nPSG without amitriptyline as well as nPSG with amitriptyline were selected. The sample consisted of both males and females between the ages of 18-65. AHI was independently calculated for both diagnostic and therapeutic studies and statistical analysis performed.
Results: The average difference between the diagnostic and therapeutic AHI is an increase of 4.97. For n=29 a one-tailed test was used where Ho: amitriptyline has no effect on AHI and H1: amitriptyline increases AHI. The μ = np = (29)(0.7) = 20.3, σ = 2.46, z = 5-μ/σ = -6.199, α = 0.9998. Therefore 99.9 % of all sample size 29 would lead to rejection of Ho.
Conclusion: Based on the above results it would appear that taking amitriptyline increases the AHI. We acknowledge that the sample size is small and parameters such as increased sleep efficiency were not consid- ered. The practice of prescribing amitriptyline in insomnia patients with mild AHI needs further examination."
Tuesday, February 1, 2011
Why you want to find the most experienced Neuromuscular Dentist to Treat TMJ, TMD, Headaches and Migraines.
Neuromuscular Dentistry can give incredible relief of headaches, TMJ symptoms migraines and numerous other chronic pain disorders. It is important to chose your Neuromuscular Dentist wisely.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/
I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.
The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.
The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry
Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.
Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.
In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.
NEW ARTICLE IN JOURNAL PAIN LINKS TEMPLE HEADACHES TO TMJ DISORDERS
TENSION-TYPE Headaches in the temples are positively correlated to TMD dysfunction. This correlation extends to all of the various TMJ symptoms.
It has long been known that headaches are almost a universal symptom of TMJ disorders. Treatment of TMJ disorders usually leads to significant reduction in headache pain. Neuromuscular Dentistry should always be considered diagnostic work-up of chronic headache patients. The majority of patients experience elimination or very significant pain relief within a brief time period after being treated with a diagnostic neuromuscular orthotic. PPatients frequently consider the results "miraculous"
Learn more about Neuromuscular Dentistry:
Sleep and Health Journal
http://www.sleepandhealth.com/neuromuscular-dentistry
What is not as well known is that TMD is only one of a large family of craniomandibular disorders and problems related to the trigeminal nervous system. The Trigeminal Nerve and its central nervous system connections are involved in almost all headaches. The use of Neuromuscular Dentistry is extremely effective in treating TMJ disorders and associated headaches.
Neuromuscular Dentistry is also extremely effective in treating Chronic Daily Headaches, Tension-Type Headaches, Classic Migraine, Atypical Migraine , Migraine Staticus, Sinus and facial pain, occiptal headache and other chronic pains of the head and neck.
Physicians who do not have the same thorough understanding of the Trigeminal Nerve frequently underplay the importance of the Trigeminal Nerve in almost all headaches. This leads them to approach treatment of headaches with powerful drugs that often have dangerous side effects.
Neuromuscular Dentistry works by reducing noxious input to the central nervous system thru the Trigeminal Nerve.
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
It has long been known that headaches are almost a universal symptom of TMJ disorders. Treatment of TMJ disorders usually leads to significant reduction in headache pain. Neuromuscular Dentistry should always be considered diagnostic work-up of chronic headache patients. The majority of patients experience elimination or very significant pain relief within a brief time period after being treated with a diagnostic neuromuscular orthotic. PPatients frequently consider the results "miraculous"
Learn more about Neuromuscular Dentistry:
Sleep and Health Journal
http://www.sleepandhealth.com/neuromuscular-dentistry
What is not as well known is that TMD is only one of a large family of craniomandibular disorders and problems related to the trigeminal nervous system. The Trigeminal Nerve and its central nervous system connections are involved in almost all headaches. The use of Neuromuscular Dentistry is extremely effective in treating TMJ disorders and associated headaches.
Neuromuscular Dentistry is also extremely effective in treating Chronic Daily Headaches, Tension-Type Headaches, Classic Migraine, Atypical Migraine , Migraine Staticus, Sinus and facial pain, occiptal headache and other chronic pains of the head and neck.
Physicians who do not have the same thorough understanding of the Trigeminal Nerve frequently underplay the importance of the Trigeminal Nerve in almost all headaches. This leads them to approach treatment of headaches with powerful drugs that often have dangerous side effects.
Neuromuscular Dentistry works by reducing noxious input to the central nervous system thru the Trigeminal Nerve.
Pain. 2010 Dec 31. [Epub ahead of print]
Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.
Anderson GC, John MT, Ohrbach R, Nixdorf DR, Schiffman EL, Truelove ES, List T.
University of Minnesota School of Dentistry, Department of Developmental and Surgical Sciences, Minneapolis, MN, USA.
Abstract
The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Subjects with painful temporomandibular disorders (TMD) showed significant trends for increased signs and symptoms of TMD associated with increased frequency of concurrent temple headaches.
Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PMID: 21196079 [PubMed - as supplied by publisher]
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