The Aqualizer Appliance, Neuromuscular Dentistry and Muscle Engrams

An important new article on Muscle Engrams was published in the October Cranio Journal (pubmed abstract follows).

This paper was written by my good friend and respected colleague Dr Martin Lerman who is also the inventor of the Aqualizer appliance. Dr Lerman has proven that the muscle engrams of neuromuscular dentistry as described by Dr Barney Jankelson exist. While Dr Jankelson utilized ULF TENS (ultra low frequency trancutaneous electrical neurostimulation) to eliminate the muscle activity of the Engram Dr Lerman utilizes an Aqualizer Appliance.

An interesting side note is that Dr Jankelson used to use Aqualizers with his patients on TENS prior to taking a bite. The Engram is the way the body masquerades bite discrepancies by correction thru conditioned muscle reflex. As Dr Lerman clearly shows eliminating the Engram is an essential step evaluating underlying neuromuscular bite discrepancies. The Aqualizer which utilizes Pascal's third law balances pressure bilaterally by fluid dynamics. Pitch Roll and Yaw are corrected.

Patients with TMJ disorders, headaches, facial pain, masticatory muscle pain or neck pain will all find that Engrams are an obstacle to healing. Elimination of the Engram and correction of the (engram free) bite will lead to healing and elimination of pain.

This is an important article and I will discuss it in more detail in the future.

Elimination of headaches, Migraines and facial pain by identifying and bypassing Engrams is the heart of Neuromuscular Dentistry. Read more about Neuromuscular Dentistry in Sleep and Health Journal online @

http://www.sleepandhealth.com/neuromuscular-dentistry

Cranio. 2011 Oct;29(4):297-303.

The muscle engram: the reflex that limits conventional occlusal treatment.

Lerman MD.

Source

Jumar Corporation, Prescott, Arizona, USA. lesboblyn@aol.com

Abstract

The engram (the masticatory "muscle memory") is shown to be a conditionable reflex whose muscle conditioning lasts less than two minutes, far shorter than previously thought. This reflex, reinforced and stored in the masticatory muscles at every swallow, adjusts masticatory muscle activity to guide the lower arch unerringly into its ICP. These muscle adjustments compensate for the continually changing intemal and external factors that affect the mandible's entry into the ICP. A simple quick experiment described in this article isolates the engram, enabling the reader to see its action clearly for the first time. It is urged that every reader perform this experiment. This experiment shows how the engram, by hiding the masticatory muscles' reaction (the hit-and-slide), limits the success of the therapist in achieving occlusion-muscle compatibility. This finding has major clinical implications. It means that, as regards the muscle aspect of treating occlusion, the dentist treating occlusion conventionally is working blind, a situation the neuromuscular school of occlusal thought seeks to correct. The controversy over occlusion continues.

Occipital Nerve Block Effective in treating and eliminating a variety of headaches.

Ihave been treating chronic headches , neuralgias and facial pain with occipital nerve blocks and greater occipital nerve blocks for many years. This study showed less effectiveness in treating facial pain and neuralgias.

A major problem with many studies is that they ty to minimize the number of variables. While this is good for clinical studies to determine effectiveness of single treatments it is detrimental in comprehensive patient care.

I frequently combine occipital nerve blocks with ULF TENS, Diagnostic Orthotics, Trigger Point injections and SPG blocks. There is enormous crossover in symptoms as well as neural connections that are excitatory or inhibitoy between these structures..

Blocks and combinations of blocks and trigger points utilized with a diagnostic neuromuscular orthotic and ULF TENS give almost universal improvement and frequently elimination of symptoms. These combinations are appropriate for treating chronic pain, especially tension-type headaches, migraines, cluster headaches and autonomic cephalgias.

I will usually teach patients how to block the SPG (sphenopalatine ganglion) at home to prevent headaches and migraines when the diagnostic orthotic doesn't eliminate the headaches completely.

J Headache Pain. 2012 Mar 3. [Epub ahead of print]

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain.

Jürgens TP, Müller P, Seedorf H, Regelsberger J, May A.

Source

Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Abstract

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal(75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.

PMID:

22383125

[PubMed - as supplied by publisher]

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Study Shows that Cluster Headaches Mediated By Trigeminal Nerve

This study confirms the role of the trigeminal nerve in cluster headaches. A diagnostic neuromuscular orthotic is a reasonable and positive step in confirming not only trigeminal involvement but may alleviate or eliminate cluster headaches. A negative result from a neuromuscular diagnostic orthotic can be followed by addition of a SPG block with safe lidocaine.

In my experience almost all patients have a positive response to SPG blocks (spenopalatine ganglion blocks) or neuromuscular orthotics. Combination of these treatments brings about almost universal sucess of varying levels.

Neurology. 2012 Mar 14. [Epub ahead of print]

Lateralized central facilitation of trigeminal nociception in cluster headache.

Holle D, Gaul C, Zillessen S, Naegel S, Krebs S, Diener HC, Kaube H, Katsarava Z, Obermann M.

Source

From the Department of Neurology (D.H., C.G., S.Z., S.N., S.K., H.-C.D., Z.K., M.O.), University of Duisburg-Essen, Essen; and Interdisciplinary Pain Center (H.K.), University of Freiburg, Freiburg, Germany.

Abstract

OBJECTIVE:

To investigate whether central facilitation of trigeminal pain processing is part of the pathophysiology of cluster headache (CH).

METHODS:

Sixty-six patients with CH (18 episodic CH inside bout, 28 episodic CH outside bout, 20 chronic CH) according to the International Classification of Headache Disorders-II classification, as well as 30 healthy controls, were investigated in a case-control study using simultaneous recordings of the nociceptive blink reflex (nBR) and pain-related evoked potentials (PREP) following nociceptive electrical stimulation on both sides of the forehead (V1).

RESULTS:

nBR latency ratio (headache side/nonheadache side) was decreased in all CH patients independent from CH subtype compared with healthy controls indicating central facilitation at brainstem level. Area under the curve ratio was increased in patients with episodic CH inside bout only. PREP showed decreased N2 latency ratio in patients with chronic CH indicating central facilitation at supraspinal (thalamic or cortical) level.

CONCLUSIONS:

Asymmetric facilitation of trigeminal nociceptive processing predominantly on brainstem level was detected in patients with CH. This alteration is most pronounced in the acute pain phase of the disease, but appears to persist in remission periods. Only chronic CH patients show additional changes of PREP prompting to supraspinal changes of pain processing related to the chronic state of disease in regard to neuronal plasticity, which exceeds changes observed in episodic CH.

PMID:

22422891

[PubMed - as supplied by publisher]

cluster headache and SPG (sphenopalatine Ganglion block) Block

I have been a strong advocate of utilizing sphenopalatine ganglion blocks to treat cluster headaches, acute and chronic daily migraines, sinus headaches and chronic daily headaches. The following Pub Med abstract is a case report on utilizing lidocaine (an extremely safe drug) to do SPG blocks for cluster headaches.

The Ptsosis (wikipedia...Ptosis (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid ) as well as the pain responded to the block. It is important to note that SPG blocks are more effective at preventing attacks than stopping them. I have many patients who use the blocks prophylactically to prevent headaches or migraines as well as avert them when there is the first onset of symptoms.

SPG blocks with lidocaine are probably the safest and most effective drug therapy for migraines, cluster headaches and other autonomic cranial facial pain syndromes, unfortunately very few physicians teach their patients this valuable technique .

Sphenopalatine Neuralgia or Sluders Neuralgia respond to topical blockage of the SPG ganglion. The second abstract discusses phenolization of the ganglion. I have always been more comfortable utilizing non-toxic lidocaine for SPG Blocks. In Sever cases I will do a block with Marcaine through the palate but I prefer to let the patient avoid attacks with a cotton applicator and lidocaine.

J Med Case Reports. 2012 Feb 15;6(1):64. [Epub ahead of print]

Cluster headache with ptosis responsive to intranasal lidocaine application : a case report.

Bakbak B, Gedik S, Ekinci Koktekir B, Okka M.

Abstract

ABSTRACT: INTRODUCTION: The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. Cases presentation: A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased. CONCLUSION: Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

PMID:

22335966

[PubMed - as supplied by publisher]

Free full text

Otolaryngol Pol. 2007;61(3):319-21.

[Atypical facial pains--sluder's neuralgia--local treatment of the sphenopalatine ganglion with phenol--case report].

[Article in Polish]

Olszewska-Ziaber A, Ziaber J, Rysz J.

Source

Poradnia Chorób Nosa Uniwersyteckiego Szpitala Klinicznego im. WAM Uniwersytetu Medycznego w Lodzi.

Abstract

AIM:

Chronic reccuring head and facial pain can be very difficult for successful treatment. Such a pain can be in some rare cases Sluder's sphenopalatine ganglion neuralgia. The aim of the study was to obtain the pain relief by local treatment in patients with Sluder's sphenopalatine ganglion neuralgia.

METHODS:

We described three cases of Sluder's neuralgia among all the seventeen patients with reccuring head and face pain that were seen in our department. In all these cases 4% Xylocaine was applied intranasally, into the region of shenopalatine ganglion, behind the posterior tip of the middle turbinate four times for ten minutes. According to Kern, the diagnosis of Sluder's neuralgia was confirmed only in cases where local anesthetic block of the sphenopaltine ganglion was successful. It means the patients were pain-free for at least an hour after application of Xylocaine, so they were qualified for phenolization and 88% phenol was applied on the cotton carriers (number of the applications depended on the patient).

RESULTS:

The total relief of pain of different duration was obtained in all the presented cases.

CONCLUSION:

The relief of pain obtained by intranasal phenolization of sphenopalatine ganglion in three patients shows it could be the effective treatment of Sluder's neuralgia. The patients were totally free from the pain and accompanying symptoms like nasal obstruction, rhinorrhea, epiphora or conjunctivitis. The relief period was different but the patients were satisfied with the effectiveness and simplicity of the treatment. They did not need to take the additional medications for months and were able to continue work.

PMID:

17847789

[PubMed - indexed for MEDLINE]

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