Lake Forest TMJ, Headaches, Migraines and Neuromuscular Approach To Definitive Personalized Treatment

The relationship of TMJ Disorders to Headaches and Migraines are well documented in both medical and dental literature.  The primary connection is via the Trigeminal Nerve.  The Trigeminal Nerve is often called the "Dentists Nerve" but the Trigeminal nerve is also at the center of each and every headache and migraine treated by physicians and neurologists.  The science behind this connection is two-fold.  The Trigeminal nerve also controls the blood flow to the anterior two thirds of the meninges of the brain.

Sinus headaches are usually treated by ENT's or Otolaryngologists but the Trigeminal Nerve is also front and center in both acute and chronic sinus pain.  Multiple studies have shown that most diagnosis of sinus infections causing pain are in fact incorrect.  

There are many documented cases of complete relief of all of these disorders with eliminated with Neuromuscular Dental Orthotics especially when combined with treatment of Myofascial Pain Disorders (MPD).  There are over 100 Chicago patient Testimonials at: 

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

WWW.ThinkBetterLife.com is the website of my new office dedicated to treatment of both TMJ Disorders, Sleep Disorders including Snoring & Sleep Apnea and chronic headaches and migraines.

The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) has published a report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" that should be read by every patient with TMJ disorders, Morning Headaches, Chronic Daily Headaches, Sleep Apnea, Snoring and migraines.

 https://www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf

Sphenopalatine Ganglion Blocks are an amazing adjunct for treating chronic pain disorders.  It works via the autonomic nervous system and turns off the "Fight or Flight" reflex that is implicated in tension headaches, chronic anxiety and panic attacks.  www.sphenopalatineganglionblocks.com

Find A TMJ Dentist: Who is The Academy of Applied Myofunctional Sciences and where do they fit in TMJ treatment?

There are several excellent ways to locate a TMJ Dentist.

There are several schools of thought in TMJ Dysfunction.  The Alliance of TMD Organizations represents all of the major groups who treat TMJ Disorders.

I am current the Chair, Alliance of TMD Organizations.  It represents groups with several schools of thought.

Personally, I would recommend starting with a Neuromuscular Dentist who is a member of ICCMO.  These doctors are dedicated to the neuromuscular concepts discussed throughout the I Hate Headaches website.

I also belong to the American Equilibration Society and the American Academy of Craniofacial pain, both groups have wonderful courses and I love seeing problems from all angles.  I find I learn more from people outside the primary focus in my practice.  The AES is primarily centered on Centric Relation as a starting point for treatment.  While I don't agree with Centric Relation as the best starting points there are excellent doctors who are well trained in treating TMJ disorders.   The AES puts on a fantastic yearly meeting but the underlying focus is CR as taught by Peter Dawson.  That will change gradually when Dr Dawson retires and leaves the field.  He is much less visible than in the past due to increasing age.  Centric Relation is losing popularity in the age of precise measurement.  The concept of CR has had at least 26 different definitions over the years.

The American Academy of Pain Management is no longer a member of the Alliance but dentists who are also Diplomats of the AAPM tend to be very knowledgable on medical aspects of pain.  The problem in recent years is the AAPM has moved further in the direction of medication as a primary treatment rather than correcting underlying pathology.

The Academy of Orofacial Pain takes this type of treatment to the extreme.  There is a tendency to ignore the physiology of the muscles, TMJoints and Occlusal factors.

The International Association of Physiologic Aesthetics also holds excellent meetings.  It tend toward being a user group of LVI, The Las Vegas Institute that teaches neuromuscular dentistry primarily for use in esthetic dentistry.  LVI teaches excellent cookbook neuromuscular dentistry but does not delve into the science like ICCMO  does.  My preference is find a neuromuscular dentist who belongs to IAPA and ICCMO.

All of the basic principles and top educators at LVI are ICCMO members.  LVI recruited from ICCMO specifically due to their excellence in Neuromuscular Dentistry.  Many ICCMO doctors, myself included went to LVI to increase efficiency in reconstructive dentistry.

The Kois Center and Dr John Kois are similar to LVI in teaching his version of Centric Relation as a way to reconstruct patients.  Interesting, is that while he calls it CR it is actually very very similar to the neuromuscular position.   Dr Kois give excellent courses on technical aspects of dentistry.  

There are other groups teaching Neuromuscular Dentistry.  OcclusionConnections is one such group, its founder learned neuromuscular dentistry at ICCMO and later taught at LVI before going on his own.  Clayton teaches his form of neuromuscular dentistry and I again suggest seeing doctors who also belong to ICCMO.

Ther are other groups who belong to the TMD Alliance including Sacro Occipital Technique Organization or SOTO an excellent Chiropractic group very interested in TMJ treatment as part of whole body biomechanics, Tennessee Cranio and The International Association for Orthodontics who teach functional orthodontics to create healthy physiology and TMJoints.

The newest member is the Academy of Applied Myofunctional Sciences. Their first meeting is September 9-13.  I have been very impressed with their organization and I am enjoying the meeting.  I really belong to too many organizations but feel this is one more I must join not because of the work with adult TMJ patients but because of their commitment to grow healthy children into healthy adults without TMJ, sleep or breathing problems.  I expect great good to come from their efforts and I am proud to be at their first meeting.

Myofuntional Therapists work with patients oral habits and oral function and treat patients by correcting pathological patters.  regardless of which doctors are treating you Myofunctional Therapy can help the process.

TMJ Specialists and Migraine Treatment

Neuromuscular Dentistry is an ideal treatment for TMJ disorders, Myofascial Pain Disorders and Migraines. The organization  ICCMO was founded by Barney Jankelson the father of Neuromuscular Dentistry to advance knowledge and excellence in dentistry and specifically the treatment of TMJ disorders and chronic pain.

ICCMO stands for the International College of CranioMandibulr Orthopedics.

 There is no specialty in in TMJ but training in Neuromuscular Dentistry allows dentists to control nociceptive input into the trigeminal nervous system.  The Trigemino-Vascular System is responsible for almost 100% of headaches and migraines.

Neurologists treat these disorders chemically with drugs which unfortunately have frequent and sometimes dangerous side effects.  Many patients do not see significant lasting relief from drug oriented treatment.

Neuromuscular Dentistry also changes brain chemistry by elimination of nociceptive input to the brain.  This changes the neurotransmitter chemistry without dangerous medications.

The first step in TMJ treatment is a thorough history and exam.  Treatment is begun with a diagnostic neuromuscular orthotic.  It is designed so it can be adjusted by grinding or additions in the initial phase of therapy.

Initial therapy is directed at reduction of pain and return to normal function.

Patients should avoid irreversible therapy until they have had significant lasting relief of pain.  The diagnostic orthotic is designed as a trial occlusion device.

In addition to orthotic therapy neuromuscular dentists often utilize diagnostic blocks and trigger point injections.

Sphenopalatine Ganglion Blocks can prevent migraines and chronic daily headaches when used prophylactically.

Learn more at www.ThinkBetterLife.com

www.ICCMO.org  

View patient testimonials at:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

While there is no speciality of TemporoMandibular Disorders there are very special doctors who learn to improve the lives of their patients.

Highland Park Dentist is New Chair of The American Alliance of TMD Organizations. New Highland Park Office Focuses on TMJ Disorders, Sleep Apnea, Snoring, Chronic Daily Headaches and Migraines

The Alliance of TMD Organizations' mission is to support and protect the rights and freedom of patients and their doctors. A grave new threat is now looming that may have very negative effects on patients and doctors.

The American Alliance of TMD held its annual meeting on February 26-27 at the Chicago Marriott. Long Time Highland Park resident Ira L Shapira became the new Chair of the TMD Alliance.

The Alliance (http://www.tmdalliance.org/index.html) is dedicated to protecting the rights of TMD patients to receive the care they need. According to Dr Shapira there is a grave new threat has arisen that may effect both the patients rights and ability to have their care reimbursed by insurance. The threat is from a new board claiming the right to grant specialty outside the auspices of the American Dental Association which is and always has represented the dental profession and public safety.

The American Dental Association is the voice of organized dentistry and Specialty recognition in the U.S. The American Dental Association has recognized several dental specialties including: American Board of Dental Public Health, American Board of Endodontics, American Board of Oral and Maxillofacial Pathology, American Board of Oral and Maxillofacial Radiology, American Board of Oral and Maxillofacial Surgery, American Board of Orthodontics, American Board of Pediatric Dentistry, and American Board of Periodontology.

A new group, the American Board of Dental Specialties (ABDS) is acting outside of organized dentistry to create and grant specialty status to groups that have either not met the ADA standards for specialty or had their application rejected by the Ameican Dental Association.

The following Dental Specialty Boards have been granted recognition by the ABDS:

American Board of Oral Implantology. Implant Dentistry; this so called specialty is already well represented by both The American Board of Oral and Maxillofacial Surgery & The American Board of Periodontology.

American Board of Orofacial Pain. This group has been repeatedly denied specialty by the American Dental Association for multiple reasons. There have been other groups who have also been denied specialty in the TMD field by the American Dental Association. All Diplomats of the ABOP will become instant (just add water) specialists. Many of these doctors have previously been involved in questionable groups that unfairly (and possibly fraudulently) deny patients legitimate insurance claims. Specialty Status, however dubious will embolden them to unfairly attempt to restrict medical benefits to patients. This group actually discounts the effect of dentistry and occlusion on oral facial pain. The promote utilizing drugs and psychotherapy to treat TMJ disorders.

Two additional boards seeking specialty are:
American Dental Board of Anesthesiology
American Board of Oral Medicine.

The TMD Alliance and it's individual members have multiple other concerns over any specialty designation in TMD or Oral Facial Pain.

Dr Shapira could not comment further on specifics of the problems associated with this group but the Alliance of TMD Organizations has long been opposed to specialty. Dr Shapira believes this specialty will hurt patients, TMD practitioners as well as the entire dental profession.

The so called specialties being created will need to be approved by each and every state dental board across the country. Dr Shapira urges the ADA and all of its constituents to do all it can to protect the American Public from this dangerous development. State Dental Boards across the country need to reject these questionable new specialties to protect the public until they have been properly vetted. The ADA should consider taking a strong stance in this issue before it is too late.

When the American Dental Association creates a new specialty it Grandfathers in doctors working within the specialty as specialists. The DANGER WITH SELF-DECLARED SPECIALTIES IS ONLY MEMBERS OF A SELECT GROUP ARE ADMITTED AND THEN THAT GROUP IS IN CHARGE OF WHO CAN LATER BECOME A SPECIALIST. The ABOP has been restrictive in the past in who could become members.

THIS IS A REAL DANGER TO THE AMERICAN PUBLIC AND SHOULD BE DISCUSSED IN AN OPEN FORUM.

The Alliance of TMD Organizations includes the following organizations:

American Academy of Craniofacial Pain
(Previously American Academy of Head, Neck and Facial Pain

American Equilibration Society
(The first organization dedicated to TMJ disorders)

International Association of Physiologic Aesthetics
(previously International Association of Comprehensive Esthetics)

International College of Cranio-Mandibular Orthopedics
(The original Neuromuscular dental group)

International Association for Orthodontics

Sacro Occipital Technique Organization-USA
(The only Chiropractic group in the Alliance)

Tennessee CRANIO

The following organizations have lapsed membership in the Alliance but Dr Shapira hopes to bring them back to full membership status:

American Academy of Pain Management
American College of Prosthodontics

Treatment of TMJ and Sleep Disorders has been a consuming passion for Dr Shapira for 35 years who is a Fellow of the International College of CranioMandibular Orthopedics as well as Secretary and the representative from ICCMO to the TMD Alliance along with Dr Barry Cooper, who is Past President of ICCMO, A Life Member of the AES and one of the founding members of the Alliance and past chair. Dr Cooper has an impressive history in the TMD field.
http://www.tmjtmd.com/curriculum-vitae2.html

As a Diplomat of the American Academy of Pain Management and a long time member of both the American Equilibration Society and the Academy of CranioFacial Pain, and a previous member of the IACA Dr Shapira is well versed in all of the pholosophies of each group. As a member Dr Shapira urges the ADA, the Illinois State Dental Society and the Chicago Dental Society to see these pseudo-specialties as a threat to the profession and the public.

Dr Shapira is a founding member of The American Academy of Dental Sleep Medicine (formerly the Sleep Disorder Dental Society), a Diplomate of the American Board of Dental Sleep Medicine and a founding and charter member of DOSA, The Dental Organization for Sleep Apnea. The AADSM should, in Dr Shapira's opinion, join the TMD Alliance this year.

Dr Shapira is the Dental Editor of Sleep and Health Journal.

Dr Shapira did research on the similarities in jaw position in sleep apnea and TMJ patients in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.
His research showed that TMJ and Sleep Apnea patients had very similar jaw postures.

Dr Shapira has maintained a general dental practice with a special emphasis on sleep and pain in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates in Highland Park. More information on Sleep, TMJ and Headache Treatment can be found on his websites.

http://www.thinkbetterlife.com (Highland Park office)

http://www.delanydentalcare.com (Gurnee Office)

http://www.ihateheadaches.org

http://www.chicagoland.ihatecpap.com.

http://www.Sleepandhealth.com

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, President of Sleep Well Illinois,
 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. He is currently working with Dr Tom Diekwisch at the University of Illinois and Baylor University to prove these stem cells can change peoples lives for the better. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.
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TMJ Disorders, Headaches, Migraines treated in Dr Ira Shapira's new Highland Park, Illinois office.

I have been treating TMJ Disorders  and associated tension headaches, chronic daily headaches and migraines for over 30 years in my Gurnee office.  My new office at 3500 Western Ave in Highland Park will be dedicated to the treatment of chronic pain and sleep disorders.

I have been practicing and teaching the art and science of Neuromuscular Dentistry and Sleep Disorder Dentistry long before it became well known.

Doing research at Rush MedicalSchool in the mid 1980's I discovered the physiologic similarities in the bires of patients with sleep apnea and TMD.

While I will continue my general practice in Gurnee the new office will be dedicated to treatment and elimination of pain and sleep disorders.  The DNA Appliance and Epigenetic Orthodontics actually offer an non-surgical cure for obstructive sleep apnea.

The new office website is still under construction but is www.thinkbetterlife.com.

This name was chosen to because the goal of our treatment is to offer solutions that lead to a better life.  The location in Highland Park  will make it easier for my Chicago patients to visit as it is across the street from the Fort Sheridan Metra Station.

I will announce the Grand Opening Soon

Thank You Dr Ira L Shapira

POSTUROLOGY AND TMD (TMJ) DISORDERS: WHY THIS IS IMPORTANT TO PATIENTS WITH CHRONIC DAILY HEADACHES, MIGRAINES AND TENSION-TYPE HEADACHES.

THE JAW IS ESSENTIAL IN THE REGULATION OF NORMAL BODY POSTURE. THE SWALLOW SERVES AS A NEUROMUSCULAR RESETTING MECHANISM THAT CAN CORRECT OR CAUSE POSTURAL PROBLEMS THROUGHOUT THE ENTIRE BODY.

THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.

THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.

IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.

THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.

ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"

UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.

NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.

THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,

THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.

FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.

THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.

Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.

PMID: 16128357 [PubMed - indexed for MEDLINE]

NEUROMUSCULAR DENTAL INSTITUTE: ANNOUNCING A NEW NEUROMUSCULAR DENTAL TRAINING INSTITUE IN CHICAGO AREA

NEUROMUSCULAR DENTAL INSTITUTE: ANNOUNCING A NEW NEUROMUSCULAR DENTAL TRAINING INSTITUTE IN CHICAGO AREA. TMJ patients in Chicago will benefit from the combined expertise of Neuromuscular Clinicians.
Treatment of Migraines, Chronic Daily Headache, TMJ, SUNCT, TMD, Tension Type Headaches, Facial Pain and Sleep Disorders

Treating patients with Migraines, Chronic Daily Headaches, Tension-Type Headache,TMJ, TMD, TMJ disorders, Fibromyalgia, Facial Pain has long been a major emphasis of my Gurnee practice, Delany Dental Care Ltd. NEUROMUSCULAR DENTAL INSTITUTE: ANNOUNCING A NEW NEUROMUSCULAR DENTAL TRAINING INSTITUTE IN CHICAGO AREA. TMJ patients in Chicago will benefit from the combined expertise of Neuromuscular Clinicians.
Treatment of Migraines, Chronic Daily Headache, TMJ, SUNCT, TMD, Tension Type Headaches, Facial Pain and Sleep Disorders

Treating patients with Migraines, Chronic Daily Headaches, Tension-Type Headache,TMJ, TMD, TMJ disorders, Fibromyalgia, Facial Pain has long been a major emphasis of my Gurnee practice, Delany Dental Care Ltd.
http://www.delanydentalcare.com/neuromuscular.html
http://www.ihateheadaches.org
http://www.ihatecpap.com

I am pleased to announce the opening of "THE INSTITUTE FOR THE STUDY NEUROMUSCULAR DENTISTRY". I have been treating patients utilizing Neuromuscular Dentistry Techniques for over 30 years after being trained by Dr Barney Jankelson the Father of Neuromuscular Dentistry, DR DAYTON KRAJAC, DR JIM GARRY, DR BARRY COOPER, DR ED DUNCAN, DR NORMAN THOMAS, DR BOB JANKELSON, DR HAROLD GELB, DR BRENDAN STACK, DR PETER NEFF are just a few of the Dental Greats I can thank for advanced training in treatng TMJ disorders over the last 34 years

I currently teach my two day sleep apnea course to small groups of dedicated dentists. I have found that true education is best in small group sessions and have limited my class size to 6 new doctors per course. (All doctors can take repeat sessions at future courses). I have given introduction to many facets of Neuromuscular Dentistry, Trigger Point Injections, Treatment of Myofascial pain during my courses. My Dental Sleep Medicine courses have always included lectures by Dr Alexander Golbin MD, PhD D,AASM and visits to the sleep lab at the Sleep and Behavioral Medicine Institute.


My exciting new development is that I have just talked to Dr Barry Cooper who has agreed to to join me and the Neuromuscular Dentistry Institute as an instructor. Dr Cooper currently teaches Neuromuscular Occlusion Workshop NOW® in New York. I have frequently referred my students to Dr Cooper as the best way to be introduced to the exciting field of Neuromuscular Dentistry. My partner Dr Mark Amidei and I are currently preparing to move into our new offices that will be better suited for educational purposes. Dr Amidei is one of the finest technical dentists who utilizes Neuromuscular Dentistry in creating exceptional cosmetic results.

Common Symptoms of Neuromuscular Dysfunction of the head and neck that can be alleviated or eliminated through Neuromuscular Dentistry include the following TMJ/TMD Symptoms:
Headaches
Migraines
Tension-type headaches
Sinus Pain and stuffiness
Facial Pain
Jaw Pain
Ear Pain
Pressure in the ears and sinuses
Clicking/Popping in Jaw Joints
Snoring
Sleep Apnea
Upper Airway Resistance Syndrome UARS or RERA's
Difficulty Chewing
Limited Mouth Opening
Uncomfortable bite
Changing bite
Tinnitus
Muffled Ears
Worn-down Teeth
Clenching/Bruxing
Neck Pain
Dizziness
Numbness in hands and arms
Myofascial Pain
Fibromyalgia
Swallowing problems
Equilibrium problems
Tics and Twitches of facial muscles
Dyskinesias
and numerous other symptoms

Dr Amidei and I have both trained at the Las Vegas Institute and the Neuromuscular Dental Institute will not be competing with LVI but rather will give doctors a jump start at achieving excellence in Neuromuscular Dentistry. We hope that many of our doctors will continue to seek out the advanced educational opportunities at the Las Vegas Institute. To understand how important I consider the addition of Dr Cooper to the Neuromuscular Dental Institute I am including his Curriculum Vitae below:

BARRY C. COOPER, DDS, First and most important Barry is a good friend and long term colleague who has been both a mentor and confidant. He is internationally recognized in the field of electronic measurements used in the treatment of TMJ / TMD, is a uniquely respected practitioner, author, researcher and educator. An innovator in the treatment of TMJ / TMD, Dr. Cooper has contributed to the knowledge and practice of dentistry as it enters a new era of advanced technology.

His accomplishments in the field of Neuromuscular Dentistry are unsurpassed including the following academic and professional appointments:

*Clinical Associate Professor, (1999-present), Department of Oral Biology & Pathology, School of Dental Medicine, SUNY, Stony Brook

*Clinical Associate Professor of Dentistry (1991-1994), Department of Prosthodontics, Temple University School of Dentistry
Associate Professor of Clinical Otolaryngology (1982-1994), Department of Otolaryngology, New York Medical College
Director, Center for Myofacial Pain/TMJ Therapy (1982-1993), Department of Otolaryngology, Head and Neck Surgery, New York Eye and Ear Infirmary

*Assistant Clinical Professor of Dentistry (1964-1970), Division of Stomatology, Columbia Univ. School of Dental & Oral Surgery

International President (1993-1999), International College of Cranio-Mandibular Orthopedics

Editorial Board of The Journal of Craniomandibular Practice (1993-96) (2000-03) (2007-present)

Co-chairman of the American Alliance of TMD Organizations (2000-4 )
Guest Consultant to U.S. FDA Dental Advisory Panel 1997
Medical Staff Appointment as Consultant: South Nassau Communities Hospital, Oceanside, NY
Medical Staff Appointment as Consultant: Manhattan Eye, Ear & Throat Hospital, New York, NY


Barry belongs to the follwing distinguished professional organizations:
American Dental Association
The New York State Dental Association
Nassau County & New York County Dental Societies
International College of Cranio-Mandibular Orthopedics
American Equilibration Society
American Academy of Pain Management
Alpha Omega Dental Fraternity

FELLOWSHIPS AND AWARDS

Fellow of the American College of Dentists (FACD)
Fellow of the International College of Dentists (FICD)
Fellow of the International College of Cranio-Mandibular Orthopedics
Mastership International College of Cranio-Mandibular Orthopedics
Diplomate of the American Academy of Pain Management


DR COOPER HAS BEEN A LIFELONG RESEARCHER AND HAS PUBLISHED THE FOLLOWING SCIENTIFIC PUBLICATIONS


Cooper, B. et al: Myofacial Pain Dysfunction: Analysis of 476 Patients. Laryngoscope: Oct 1986, 96:1099-1106. Presented at the Eastern Section of the American Laryngological, Rhinological and Otological Society, January 1986 (Phila., PA) American Equilibration Society Compendium 21:155-162, 1988
Cooper, B. and Rabuzzi, D.: Myofacial Pain Dysfunction Syndrome: A Clinical Study of Asymptomatic Subjects: Laryngoscope, 1984, 94(1). Presented at the Eastern Section Meeting of the American Laryngological, Rhinological, and Otological Society, January 1983 (New York, NY)
Cooper, B. and Mattucci, K.: Myofacial Pain Dysfunction: A Clinical Examination Procedure. International Surgery, 1985, 70:165-9.
Cooper, B.: Myofacial Pain Dysfunction: Cause, Clinical Appearance, Current Therapy. Primary ENT, Fall 1987 3(3):2-7. Reprinted in Compendium Vol 21, American Equilibration Society 1988, p.57-62
Cooper,B.: Craniomandibular Diseases. in Essentials of Otolaryngology, 3rd edition, eds. Lucente, F. and Sobel, S. New York, Raven Press 1993
Cooper, B. and Lucente F., eds. Management of Facial, Head and Neck Pain, Philadelphia: W.B.Saunders Company, April 1989
Cooper, B.C.: Craniomandibular Disorders, In: Cooper, B. and Lucente F., eds. Management of Facial, Head & Neck Pain, Phila.: W.B.Saunders Co., April 1989
Cooper, B.C.: Intraoral Pain, In: Cooper, B. and Lucente F., eds. Management of Facial, Head & Neck Pain, Philadelphia: W.B.Saunders Company, April 1989
Cooper, B.: Orofacial Development and Nasal Obstruction. in Otolaryngologic Clinics of North America (Nasal Obstruction issue), Kimmelman, C. ed., Philadelphia, W.B.Saunders Company, April 1989
Lunn,R., Cooper, B., Coy, R., et.al. White Paper of the Committee on Principles, Concepts and Procedures, Management of Craniomandibular Diseases. American Equilibration Society-Compendium, 20:177-237,1987
Cooper, B.: Guest Editorial. Journal of Craniomandibular Practice July 1988.
Cooper, B.: Myofacial Pain Dysfunction: A Case Report. Journal of Craniomandibular Practice 6: (4) 346-351, October 1988
Cooper, B.: Letter. Journal of Prosthetic Dentistry .61 (3):388-390, 1989
Cooper, B. and Cooper, D.: Multidisciplinary approach to the management of facial, head and neck pain. Presented at the Sixth Annual Convocation of the International College of Cranio-Mandibular Orthopedics, Florence, Italy April 1989. Pathophysiology of Head and Neck Musculoskeletal Disorders, Frontiers of Oral Physiology Volume 7, Bergamini,M. and Prayer Galletti, S. eds, Basil, Karger 1990, 76-82
Thomas, M. and Cooper, B.: Recognition of Craniomandibular Disorders. New York State Dental Journal 55(10)26-28, 1989
Cooper, B.: Neuromuscular Occlusion: Concept and Application. New York State Dental Journal 56:(4) 24-28, 1990
Cooper, B. and Cooper, D.: Electromyography of masticatory muscles in craniomandibular disorders. Presented at the American Laryngological, Rhinological and Otological Society, Palm Beach, FL, May 1990 Laryngoscope, 101:(2) 150-157, 1991.
Cooper, B. and Cooper D.: Multidisciplinary Approach to the Management of Facial Head and Neck Pain. The Journal of Prosthetic Dentistry 66(1). In Coy, R.E ed Anthology of Craniomandibular Orthopedics, Seattle, International College of Cranio-Manidibular Orthopedics, Vol.3.
Cooper, B.: Recognition and Management of Craniomandibular Disorders. in Otolaryngologic Clinics of North America (Otolaryngologic Office Evaluation and Management issue), Kimmelman, C.P. ed., Philadelphia, W.B.Saunders Company, 25(4) 867-887, August 1992
Cooper, B.: Electromyography of Masticatory Muscles in Craniomandibular Disorders. Presented at the 7th Convocation of the International College of Craniomandibular Orthopedics and the 5th Annual Congress of the Japan Association of Cranio-Mandibular Orthopedics, September 1991 (Osaka, Japan) in Coy, R.E ed Anthology of Craniomandibular Orthopedics, Seattle International College of Cranio-Mandibular Orthopedics, 2:127-144, 1992. In American Equilibration Society Compendium, 25: 70-77, Chicago, 1992
Cooper, B.C. Cooper, D.L.: Differentialdiagnostik bei Gesichts,- Kopf- und Nackenschmerzen. Philip Journal Vol 10 p337-344, July/August 1993 (in German)
Moses, A.J. & Cooper, B.C.: Understanding Temporomandibular Disorders and Whiplash. 2 part article CLAIMS July and September 1993
Cooper, B.C., Cooper, D.L.: Recognizing Otolaryngologic Symptoms in Patients with Temporomandibular Disorders. The Journal of Craniomandibular Practice: 11(4)260-267, October 1993. Presented at the 8th International Congress of the International College of Cranio-Mandibular Orthopedics. October 10, 1993 Banff, Alberta, Canada. In Coy, R.E ed Anthology of Craniomandibular Orthopedics, Seattle International College of Craniomandibular Orthopedics, Vol.3 , 1994
Cooper, B.C.: Objective Documentation of Post-Traumatic Craniomandibular (TMJ) Disorders. Trial Lawyers Quarterly, N.Y.State Trial Lawyers Institute., Vol.24, No.4 Summer 1994, p. 12-15
Cooper, B.C.: The Role of Bioelectronic Instruments in the Management of TMD. New York State Dental Journal, 61 (9) 48-53,November 1995
Cooper, B.C.: Who represents the TMD practitioner, Guest Editorial, The Journal of Craniomandibular Practice 14 (4) 251-253, 1996
Cooper, B.C.: Chronic Pain and Temporomandibular Disorders, in A Practical Approach to Pain Management, Lefkowitz, M. and Lebovits, A., eds. Little, Brown and Co. Boston, New York, Toronto, London, 1996, Chapter 28, 248-254.
Cooper, B.C.: Intraoral Pain, in A Practical Approach to Pain Management, Lefkowitz, M. and Lebovits, A., eds. Little, Brown and Co. Boston, New York, Toronto, London, 1996, Chapter 30, 259-264
Cooper, B.C. TMJ , in Lawyers' Guide to Medical Proof, Chapter 1106, Matthew Bender Publisher, October 1996
Cooper, B.C.: The Role of Bioelectronic Instrumentation in Documenting and Managing Temporomandibular Disorders. JADA 127 (11) 1611-1614, 1996
Cooper, B.C.: The Role of Bioelectronic Instrumentation in the Documentation and Management of Temporomandibular Disorders. Oral Surgery, Oral Pathology, Oral Medicine, Oral Radiology and Endodontics, Mosby- Yearbook, Inc. 83 (1) 91-100, 1997
Cooper, B.C.: Temporomandibular Disorders, Healthline, December 1997
Cooper, B.C.: The Role of Bioelectronic Instrumentation in the Management of TMD, Dentistry Today, 17 (7) 92-97, July 1998
Cooper, B.C.: Scientific Rationale for Biomedical Instrumentation. Neuromuscular Dentistry-The Next Millennium, Anthology V, D. Hickman,ed., The International College of Cranio-Mandibular Orthopedics, Seattle, WA 11-32, 1999
Cooper, B.C.: Temporomandibular Disorders Module, Otolaryngology National Resident Curriculum, Amer. Acad. of Otolaryngology, Head & Neck Surgery Foundation, November 2002, Revised 2007.
Cooper, B.C.: The Role of Bioelectronic Instruments in the Management of TMD. New York State Dental Journal, 61 (9) 48-53, November 1995
Cooper, B.C.: Parameters of an Optimal Physiological State of the Masticatory System: The Results of a Survey of Practitioners Using Computerized Measurement Devices. The Journal of Craniomandibular Practice, 22 (3), 220-233 July 2004
Cooper, B.C.: Dental Records Chapter, Medical Legal Aspects of Medical Records, Iyer Levin & Shea Editors, Lawyers & Judges Publishing Company, Fall 2005.
Cooper, B.C. and Kleinberg I.: Examination of a large patient population for presence of symptoms and signs of temporomandibular disorders. The Journal of Craniomandibular Practice 2007; 25 (2): 114-126.
Cooper, B.C. and Kleinberg I.: Establishment of a Temporomandibular Physiological State with Neuromuscular Orthosis Treatment Affects Reduction of TMD Symptoms in 313 Patients. . The Journal of Craniomandibular Practice April 2008; 26(2): 104-117
Cooper,B.C and Kleinberg, I: Relationship of Temporomandibular Disorders to Muscle Tension-Type Headaches and a Neuromuscular Orthosis Approach to Treatment, The Journal of Craniomandibular Practice, April 2009; 27 (2): 101-108


SCIENTIFIC PRESENTATIONS

Cooper, B. and Mattucci, K.: Myofacial Pain Dysfunction in Children and Adolescents. Presented at the Eastern Section Meeting of the American Laryngological, Rhinological, and Otological Society, January 1985 (Syraúcuse, NY).
Cooper, B C: Otolaryngologic Implications of Myofacial Pain Dysfunction. Presented at the 4th Convocation of the International College of Cranio-Mandibular Orthopedics 1985 (Kyoto, Japan)
Cooper, B C, et al: Recovering Lost Vertical Dimension of the Face Due to Occlusal Position. Presented at the Eastern Section of the American Academy of Facial Plastic and Reconstructive Surgery, January 1987 (Boston, Mass) and at the 5th Convocation of the International College of Craniomandibular Orthopedics, Honolulu, Hawaii, March 1987
Cooper, B C : Neuromuscular Concepts and the Utilization of Bioelectronics in Prosthetic Treatment. Presented at the 6th International Meeting of the College National D'Occlusodontologie March 1989 (Paris, France)
Cooper, B C: Orofacial Development and Nasal Obstruction. Presented to the Department of Otolaryngology of Mt. Sinai Medical College, New York, Dec. 1989
Cooper, B C: Neuromuscular Occlusion incorporated into everyday dental practice. Presented at the 66th Annual Greater New York Dental Meeting, Nov. 1990
Cooper, B., Cooper, D. and Lucente, F.: The importance of recognizing Myofacial Pain Dysfunction in the otolaryngologic population. Presented at the Meeting of the American Laryngological, Rhinological and Otologiúcal Society, February 2, 1991
Cooper, B C: The use of electronic data to determine Rest Position of the Mandible and the Neuromuscular Occlusal Position. Presented at the 7th Convocation of the International College of Craniomandibular Orthopedics & 5th Annual Congress of the Japan Assoc. of Cranio-Mandibular Orthopedics, Sept. 1991 (Osaka, Japan)
Cooper, B C: Neuromuscular Occlusion in Restorative Dentistry and the Treatment of Craniomandibular Disorders. Presented at the Graduate Prosthodontics Department of Temple University School of Dentistry, October 16, 1991
Cooper, B C: Neuromuscular Occlusion in Restorative Dentistry and the Treatment of Craniomandibular Disorders. Presented at the Second District Dental Society, Brooklyn, New York, October 25, 1991
Cooper, B C: Electromyography-Computerized Mandibular Scan-Sonography. Presented at the 9th Annual International Symposium on Clinical Management of Head, Facial Pain & TMJ Disorders. American Academy & Board of Head, Neck Facial Pain & TMJ Orthopedics. July 24, 1993 Anaheim, CA.
Cooper, B C & Duncan W E: Electronic Testing for TMJ Disorders. Presented at the Annual Conference of the American Academy of Pain Management. October 15, 1993 Knoxville, TN.
Cooper, B C: Neuromuscular Occlusion in Restorative Dentistry and in the Treatment of Temporomandibular Disorders. Presented at the Greater New York Dental Meeting. December 1, 1993 New York, NY
Cooper, B C: The Role of Electronic Measurement in the Documentation and Management of TMD. Presented at the International Workshop on TMDs and Related Pain Conditions. Sponsor: NIDR/NIH Baltimore, MD April 17-21, 1994
Cooper, B C: The Role of Electronic Instruments in the Management of Temporomandibular Disorders. Presented to the US Food and Drug Administration Dental Products Panel Hearing on "Muscle Monitoring Devices" October 13, 1994, Gaithersburg, MD
Cooper, B C: Otolaryngologic Symptoms in Patients with TMD and Their Treatment. Presented at the 40th Annual Meeting/Scientific Session of the American Equilibration Society, February 23, 1995, Chicago, Illinois.
Cooper, B C: Differential Diagnosis of Temporomandibular Disorders: Presented at the 40th Annual Meeting/Scientific Session of the American Equilibration Society, February 23, 1995, Chicago, Illinois.
Cooper, B C: Temporomandibular Disorders, Clinical Presentation, Cause and Current Therapy. Presented as a Grand Rounds Lecture, Department of Otolaryngology, Manhattan Eye, Ear & Throat Hospital, April 23, 1995, New York.
Cooper, B C: The Use of Bioelectronic Instrumentation in the Management of Temporomandibular Disorders (TMD) and Restorative Dentistry. Presented at the Greater Long Island Dental Meeting, April 27, 1995, Melville, New York.
Cooper, B C: The Use of Bioelectronic Instrumentation in the Management of Temporomandibular Disorders (TMD) and in Restorative Dentistry. Presented at the American Equilibration Society and Greek Prosthodontic Society Joint Satellite Program, July 1, 1995, Athens, Greece.
Cooper, B C: Otologic Symptoms in Patients with TMD and Their Treatment. Presented at the Ninth International Congress of The International College of Cranio-Mandibular Orthopedics, October 14, 1995, Toulouse, France.
Cooper, B C: Developing a TMD Treatment Protocol. Presented at the Ninth Annual Bernard Jankelson Memorial Forum of the International College of Cranio-Mandibular Orthopedics, November 18, 1995 Phoenix, Arizona.
Cooper, B C: The Use of Electronic Instrumentation in TMD Management. Presented at the Greater New York Dental Meeting. November 25, 1995, New York, NY
Cooper, B C: The Role of Bioelectronic Instrumentation in the Documentation and Management of Temporomandibular Disorders. Presented at the NIDR/NIH Technology Assessment Conference on the Management of Temporomandibular Disorders, National Institutes of Health, Bethesda, MD April 29, 1996
Cooper, B C :The ADA Seal Program for Measurement Devices used as diagnostic aids in TMD, Presented to ADA Council on Scientific Affairs, Chicago Sept. 19, 1996
Cooper, B C: Introduction of The ICCMO Protocol for the Management of Temporomandibular Disorders. Presentation at the 10th Annual Bernard Jankelson Forum of the American Section of the International College of Cranio-Mandibular Orthopedics, Arlington Va. October 18, 1996
Cooper, B C: Otolaryngologic Symptoms in a TMD Population, Neuromuscular Occlusion in Restorative Dentistry and in the management of TMD, The Role of bioelectronic instruments in the documentation and management of TMD, Presented as the Lectio Magistralis at the joint meeting of the Academia Italiana di Kinesiografia ed Elettromiografia Cranio Mandibolare & Italian section of The International College of Cranio-Mandibular Orthopedics, Alessandria, Italy. November 17, 1996
Cooper, B C: The Role of Neuromuscular Occlusion in the Treatment of Temporomandibular Disorders: Presented at the 42nd Annual Meeting/Scientific Session of the American Equilibration Society, Feb. 20, 1997, Chicago, Illinois
Cooper, B C: Neuromuscular Occlusion and Bioelectronic Instrumentation in the Treatment of Temporomandibular Disorders: Presented at the 10th International Congress of The International College of Cranio-Mandibular Orthopedics, Osaka, Japan April 13, 1997
Cooper, B C: Restoring the Compromised Dentition: Through Neuromuscular Occlusion, Presented at Cordent Trust Conference, London,England, June 6-7, 1997
Cooper, B C: The Role of Bioelectronic Measurement and Neuromuscular Occlusion in the Management of Temporomandibular Disorders: Presented at the Greater New York Dental Meeting, New York, NY, November 30, 1997.
Cooper, B C: Temporomandibular Disorders: Concepts and Current Management, Presented at the Department of Otolaryngology Manhattan Eye, Ear & Throat Hospital, New York, December 3, 1998. Presented at the Department of Otolaryngology SUNY Downstate College of Medicine, September 26, 2002.
Cooper, B C: Temporomandibular Disorders and Orofacial Pain: Clinical and Research Findings, Presented: Eastern Pain Assoc. Conference, NY, Dec.11, 1998
Cooper, B C: Temporomandibular Disorders and Electronic Instrumentation. Presented at the American College of Dentists Lecture Program Series at:
Columbia Univ. School of Dental & Oral Surgery, New York, February 10, 1999.
State University of NY, Stony Brook, School of Dental Medicine, March 25, 1999.
New York University School of Dentistry, April 14, 1999.
Cooper, B C: Neuromuscular Occlusion & Bioelectronic Instruments in TMD Management & in Restorative Dentistry. Greater NY Dental Meeting, Nov. 2000.
Cooper, B C: Integrating Neuromuscular Occlusion into a Dental Practice. 15th Annual Bernard Jankelson Forum of the American Section of the International College of CranioMandibular Orthopedics, Vancouver, BC, November 2, 2002.
Cooper, B C: Temporomandibular Disorders: Current Concepts and Management, Presented at the Department of Otolaryngology SUNY Downstate College of Medicine, July 8, 2004.
Cooper, B C: Temporomandibular Disorders: Cause, Clinical Presentation and Conservative Treatment. Presented at the Department of Otorhinolaryngology, New York Presbyterian Hospital, Weill Medical College of Cornell University, August 5, 2004.
Cooper, B C: Successful Integration of Neuromuscular Occlusion into the General Practice, Myotronics, Inc., 38th Anniversity Seminar, Seattle, WA, August 16, 2004.
Cooper, B C: Documenting Efficacy of Neuromuscular Dentistry, International College of Craniomandibular Orthopedics, 17th Annual Jankelson Memorial Lecture Forum, Newport Beach, CA, October 16, 2004.
Cooper, B C: Neuromuscular Occlusion in TMD and Restorative Dentistry, Greater New York Dental Meeting, New York, NY, November 30, 2004.
Cooper, B C,: Quantitive Valuation of TMD Patients from Basic Research to Clinical Application, Advances in Oral Physiopathology, University of Turin, Congresso Internazionale, Turin, Italy, December 11, 2004.
Cooper, B: Neuromuscular Occlusion in Restorative Dentistry & The Treatment of TMD. Presented at the Nassau County Dental Society, April 5, 2006
Cooper, B: Temporomandibular Disorders: Concepts and Current Management. Presented at the Department of Otolaryngology of New York Eye & Ear Infirmary, New York Medical College, April 19, 2006
Cooper, B C: Integrating Neuromuscular Occlusion into a Dental Practice. 18th Annual Bernard Jankelson Forum of the American Section of the International College of CranioMandibular Orthopedics, Orlando, FL, October 27, 2006.
Cooper, B C: Neuromuscular Occlusion in TMD and Restorative Dentistry. Greater New York Dental Meeting, New York, NY, November 26, 2006.
Cooper, B C: Neuromuscular Occlusion Workshop: Neuromuscular Dentistry TMJ/TMD & Restorative Dentistry. The Center for Occlusal Studies, Parkersburg, WV., March 8-10, 2007.
Cooper, B C: Neuromuscular Occlusion in TMD and Restorative Dentistry, AGD College Station, Texas, November 2, 2007.
Cooper, B C: Examination of a large patient population for presence of symptoms and signs considered to characterize temporomandibular disorders, and Integrating Neuromuscular Dentistry into a Dental Practice Change. 14th International Congress of The College of CranioMandibular Orthopedics, Vicenza, Italy, November 16-18, 2007.
Cooper, BC: Integrating Neuromuscular Dentistry (NMD) Into a Dental Practice. Myotronics 42nd Anniversary Seminar, Seattle, WA July 19,2008
Cooper, B.C: Introduction to Neuromuscular Dentistry. Presentation at the 20th Annual Bernard Jankelson Memorial Forum of the American Section of the International College of Cranio-Mandibular Orthopedics, Denver, CO September 25, 2008
Cooper,B.C: Temporomandibular Disorders, Grand Rounds Lecture Department of Family Practice, South Nassau Communities Hospital, Oceanside, NY, December 19, 2008

Are there tmj specialists? Is neuromuscular dentistry a specialty? Are neuromuscular Dentists Headache Specialists?

The answer to all of the above is no. There is no specialty in treatmrnt of TMJ disorders (TMD). Specialties are decided by the American Dental Society and individual state laws. There are however many trained Neuromuscular Dentists who devote a major part of their practice to treating TMJ patients, chronic pain patients, headache patients etc.

Neuromuscular Dentistry is unique in that it uses biomedical instrumentation to aid in the diagnosis and treatment of TMJ disorders, TMD, Myofascial pain (MPD) and referred head and neck pain.

Should there be a TMJ or orofcial pain specialty? Absolutely not!

There are often many approaches to dealing with a chronic pain problem involving the teeth and jaws. Research has shown that different approaches can be successful. Creation of a specialty is almost certain to prevent patients from a full choice of therapeutic options. There are many educational and scientific societies dedicated to treating chronic pain. The Alliance of TMD organizations has taken a stand against specialty.

I firmly believe that neuromuscular dentistry is the best method for treating most fuctional disorders of the masticatory system including MPD, TMJ, TMD and occlusion. I will be happy to respond to specific questions on this blog why I believe it is the best approach.

I am a Fellow of ICCMO the group representing Neuromuscular Dentistry but I also go to yearly meetings of the AES or American Equilibration society. I belong to the American Academy of craniofaciall pain and have attended many meetings over the years. I also belong to IACA, the international academy of comprehensive esthetics that combines function and esthetics and I am a Diplomate of the academy of pain management.

Many of these groups overlap and share common goals and ideas and there are also major disagreements between groups as to what is the best treatment.

Almost universally they show great success in treatment.

Neuromuscular dentistry at Delany Dental Care in Gurnee, Il

Check out my dental website for additional information on Neuromuscular Dentistry

http://www.delanydentalcare.com/neuromuscular.html

What to expect at your headache or TMJ disorder consult.

When you see a doctor for the first time for a TMJ disorder you should expect to have to give lengthy and detailed history. There are usually forms to fill out. What is important is that this history should be reviewed with the patient and how the history relates to the current problem should be explored. The initial consult is usually at least 45 minutes but can last for several hours.

In most cases the doctor can provide instant relief of some of the painful conditions by deactivating muscular trigger points. This is usually done by use of a technique called Spray and Stretch that utilizes a vapocoolant spray. These techniques were developed by President Kennedy's personal physician Dr Janet Travell. In most patients it is possible to connect their symptoms to their history in an understandable fashion.

If there is a acute close-lock of the TM Joint time is of the essence and immediate reduction is best if possible. Prescribing anti-inflamatories should never take the place of attempting to reduce an acute disc dislocation.

Permanent and/or irreversible treatment should rarely be the initial treatment. Adjusting the teeth or doing equilibration of the back teeth should be avoided when there s acute muscle spasm. The exception is if a recently placed restoration is in hyperocclusion and percipitated the problem. It should be carefully evaluated because acute spasm can change the bite.

A thorough examination of the muscles and joints is usually performed before initiating treatment. A Neuromuscular Dentist will usually take impressions and a bite utilizing TENS (transcutaneous electrical neuro stimulation) as well as EMG and computerized mandibular scans. This information helps the dentist understand all aspects of the problem before initiating treatment.

Many insurance companies deny coverage of TMJ disorders and Neuromuscular diagnostic work-ups. This is done to "save money" but in reality it has a heavy toll in the quality of patients lives and their future health and welfare. Insurance companies are not in the business of caring for patients. Insurance companies are in business to make money for their shareholders. The larger the premiums they collect and the less they pay in benefits the better the bottom line. A healthy bottom line is the primary concern of insurance companies. These companies are in business to creat profit and shareholder value. The executive of insurance companies make millions of dollars in bonuses for increasing profitability. Unfortunately for patients increasing profitability usally is done by denying patients medical benefits. The more effective an insurance company is in reducing payments for care the more profitable they become.

The insurance companies often use terms such as reasonable and customary to explain why patients are not given the coverage they were promised. I have been treating sleep apnea with oral appliances for close to 30 years. In the early years I was the only dentist in the state of Illinois doing this type of treatment. I would still receive letters telling me my fees were more than "usual and customary" even though I was the only doctor doing these treatments.

TMD and Sleep Disorders and Idiopathic Pain Disorders

An article from Johns Hopkins School of Medicine evaluated TMD patients relative to sleep disorders and pain sensitivity. The study found two or more sleep disorders in 43% of patients. Insomnia and sleep bruxism were the two most commonly found sleep disorders. Both Primary Insomnias (PI) and Respiratory Disturbance Index (RDI) were associated with increased pain sensitivity.

The authors concluded Primary Insomnia and Sleep Apnea were at such high rates that any TMD patients complaining of sleep distubances should be rferred for polysomnography (sleep test). They also felt that Primary Insomnia was highly associate with hyperalgesia and may be linked to the onset of central sensitivity and be the underlying etiology in idiopathic pain disorders. The authors also stated "The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes."

The NHLBI has previously published a report "Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders" Which details the numerous problems related to TMD problems. The majority of problems are related to sleep apnea (http://www.ihatecpap.com/sleep_apnea_dangers.html) and to disturbances in the trigeminal nervous system and the trigeminal vascular effects.

It is becoming more apparent that TMJ joint pain and headaches related to TMD are only the tip of the iceberg. Correction of the neuromuscular function of the stomatognathic system could lead to widespread improvements in health and function in sites often not associated with TMD problems. An excellent article on neuromuscular dentistry can be found in Sleep and Health Journal at http://www.sleepandhealth.com/neuromuscular-dentistry.

PubMed abstract below:
Sleep. 2009 Jun 1;32(6):779-90.
Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder.
Smith MT, Wickwire EM, Grace EG, Edwards RR, Buenaver LF, Peterson S, Klick B, Haythornthwaite JA.

Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA. msmith62@jhmi.edu
STUDY OBJECTIVES: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. DESIGN: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. SETTING: Orofacial pain clinic and inpatient sleep research facility. PARTICIPANTS: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). CONCLUSIONS: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a nonorofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes.

PMID: 19544755 [PubMed - indexed for MEDLINE]