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Sunday, March 13, 2011

WHY IS NEUROMUSCULAR DENTISTRY SO SUCCESSFUL IN TREATING TMJ (TMD) DISORDERS AND HEADACHES. THE PRESENCE OF MYOFASCIAL PAIN IS THE LINK

TREATMENT OF TMD, TMJ DISORDERS, TENSION-TYPE HEADACHE AND MIGRAINE HAVE WIDE AREAS OF OVERLAP. THIS OVERLAP IS IN SYMPTOMS AND CAUSES BUT MYOFASCIAL TRIGGER POINTS ARE A MAJOR SOURCE OF PAIN.

NEUROMUSCULAR DENTISTRY IS VERY SUCCESSFUL AT TREATING TMJ, TMD AND MYOFASCIAL PAIN DISORDERS OF THE HEAD AND NECK. PATIENTS WHO DO NOT WANT LONG TERM DRUG THERAPY SHOULD CONSIDER THE NEUROMUSCULAR DENTISTRY APPROACH TO IMPROVING THE HEALTH OF THE MASTICATORY SYSTEM, RELIEVING CHRONIC MUSCLE PAIN AND MYOFASCIAL TRIGGER POINTS AND PREVENTING CENTRAL SENSITIZATION.

THE LITERATURE STRONGLY SUPPORTS THE ROLE OF MUSCLES IN CHRONIC PAIN. A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS AN IDEAL FIRST STEP FOR LONG TERM TREATMENT OF TMJ (TMD) DISORDERS AND HEADACHES. NEUROMUSCULAR DENTISTS FREQUENTLY WORK IN CONJUNCTION WITH PHYSICAL THERAPISTS, CHIROPRACTERS, OSTEOPATHS AND MASSAGE THERAPISTS.

IMPROVING THE QULITY OF LIFE OF PATIENTS ARISING FROM MUSCULAR DISORDERS AND IDEALIZING HOMEOSTASIS ARE BASIC TO NEUROMUSCULAR DENTAL TREATMENT.

There are 576 scientific articles that come up on a PubMed search using key terms of Myofascial Pain and TMJ. 221 PubMed articles come up searching Myofascial pain and Headache, and 61 articles when searching Myofascial Pain and Migraine. There are another 80 articles that come up searching Myofascial Pain and Tension-type Headaches.

Myofascial Pain is a constant in these searches. Myofascial pain results from repetitive overuse syndromes and is commonly considered a major component of TMD.
Neuromuscular Dentistry is directed toward treating myofascial pain, muscle spasm and other muscular disorders of the masticatory system.

An article "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." published in Feb 2011 Clinical Journal of Pain (abstract below) found that " TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved."

Central facillitation is central to many theories on why some patients get chronic headaches and migraines. Another article, "Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache." in the Feb 2011 Journal of Headache Pain (abstract below) confirms that tension type headaches in children are associated with myofascial pain.

The article states that "TrPs (myofascial trigger points) were identified with palpation and considered active when local and referred pains reproduce headache pain attacks." and that "The total number of TrPs was significantly greater in children with CTTH (chronic tension type headache) as compared to healthy children"

More significantly it stated "Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack.

THIS MEANS THAT TRIGGER POINTS CAUSE TENSION TYPE HEADACHES IN CHILDREN, THE MORE TRIGGER POINTS THAT WERE PRESENT THE LONGER THE HEADACHES LASTED.

The study found a similar association with neck pain and trigger points " Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children."

Another 2011 article "The relationship of temporomandibular disorders with headaches: a retrospective analysis." (abstract below)found that "The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach."

THIS MEANS THAT HEADACHES, ESPECIALLY TENSION-TYPE HEADACHES ARE FREQUENTLY CAUSED ASSOCIATED WITH TMD OR TMJ DISORDERS.

ANOTHER STUDY FROM DECEMBER 2010 JOURNAL PAIN "Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain." SHOWED CORRELATIONS OF HEADACHE FREQUENCY TO TMD.

THEY CONCLUDED THAT "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."

THIS MEANS THAT THE CENTRAL SENSITIZATION FOUND IN HEADACHES, MIGRAINES AND FIBROMYALGIA ARE POSSIBLY DUE TO TMD.

THE ARTICLE "Pure tension-type headache versus tension-type headache in the migraineur." FROM Curr Pain Headache Rep. 2010 Dec;14(6):465-9. STATES THAT IT CAN BE DIFFICULT TO DIFFERENTIATE MIGRAINE, TENSION TYPE HEADACHES AND SYMPTOMS OF TMD ESPECIALLY IN THE CASE OF CHRONIC PAIN.








Clin J Pain. 2011 Feb 28. [Epub ahead of print]
Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study.

Gonçalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME.

*Department of Dental Materials and Prosthodontics, Araraquara Dental School, Sao Paulo State University †Department of Neurology, School of Medicine at Ribeirao Preto, University of Sao Paulo Ribeirao Preto, São Paulo, Brazil ‡Department of Neurology, Albert Einstein College of Medicine, Bronx, NY §Merck Research Laboratories, West Point, PA, USA.
Abstract

OBJECTIVES: Temporomandibular disorders (TMDs) are considered to be comorbid with headaches. Earlier population studies have suggested that TMD may also be a risk factor for migraine progression. If that is true, TMD should be associated with specific headache syndromes (eg, migraine and chronic migraine), but not with headaches overall. Accordingly, our aim was to explore the relationship between TMD subtypes and severity with primary headaches in a controlled clinical study.

METHODS: The sample consisted of 300 individuals. TMDs were assessed using the Research Diagnostic Criteria for TMD, and primary headache was classified according to International Classification for Headache Disorders-2. Univariate and multivariate models assessed headache diagnoses and frequency as a function of the parameters of TMD.

RESULTS: Relative to those without TMD, individuals with myofascial TMD were significantly more likely to have chronic daily headaches (CDHs) [relative risk (RR)=7.8; 95% confidence interval (CI), 3.1-19.6], migraine (RR=4.4; 95% CI, 1.7-11.7), and episodic tension-type headache (RR=4.4; 95% CI, 1.5-12.6). Grade of TMD pain was associated with increased odds of CDH (P<0.0001), migraine (P<0.0001), and episodic tension-type headache (P<0.05). TMD severity was also associated with headache frequency. In multivariate analyses, TMD was associated with migraine and CDH (P=0.001). Painful TMD (P=0.0034) and grade of TMD pain (P<0.001) were associated with headache frequency.

DISCUSSION: TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.

PMID: 21368664 [PubMed - as supplied by publisher]

J Headache Pain. 2011 Feb 27. [Epub ahead of print]
Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

Fernández-de-Las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA.

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain, cesar.fernandez@urjc.es.
Abstract

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

PMID: 21359873 [PubMed - as supplied by publisher]

Agri. 2011 Jan;23(1):13-7.
The relationship of temporomandibular disorders with headaches: a retrospective analysis.

Cakır Özkan N, Ozkan F.

Department of Oral and Maxillofacial Surgery, Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey.
Abstract

Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches. Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ. Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03). Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.

PMID: 21341147 [PubMed - in process]

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]

Curr Pain Headache Rep. 2010 Dec;14(6):465-9.
Pure tension-type headache versus tension-type headache in the migraineur.

Blumenfeld A, Schim J, Brower J.

The Headache Center of Southern California, 320 Santa Fe Drive, Encinitas, CA 92024, USA. blumenfeld@neurocenter.com
Abstract

Primary headache disorders include tension-type headache and migraine. These headache types can be differentiated based on strict clinical definitions that depend on the patient's signs and symptoms. However, some of the clinical features can overlap, and in addition, the same comorbid conditions can occur in both headache types. Distinction between these headache types on occasion can be difficult due to comorbid conditions such as temporomandibular joint disorders and myofascial pain with forward head posturing, which may be present in both headache disorders, and thus result in similar features in both conditions. Furthermore, chronification, particularly of migraine, leads to a decrease in the associated symptoms of migraine, such as nausea, photophobia, and phonophobia, so that these headaches more closely resemble tension-type headache. Finally, in some patients, both tension-type headache and migraine may occur at different times.

PMID: 20878271 [PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 12:20 PM

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