The TMJ Association and The TMD Alliance:

An open letter to the TMJ Association

Review of  the TMJ Association         
TMJ Association Ltd
13625 Bishop's Woods Ct # 101, Brookfield, WI

  I am currently Chair of the Alliance of TMD Organizations which represents multiple groups involved in treatment of TMD.  When we contacted the TMJ Association they had no interest in working with us to better the health of all TMD patients.  The following is directly from the website of the TMD Alliance.

Alliance of TMD Organizations Fundamental Principles

Founded in 1995 on behalf of patients’ well-being, the Alliance of TMD Organizations’ mission is to support and protect the right and freedom of clinicians to practice in the field of TMD within the scope of their care, skill, judgment, and scientific information.

The Alliance of TMD Organizations has been created to represent the broad interests of professional organizations and their member practitioners who understand the importance of effective diagnosis and treatment of cranio-oro-facial disorders.
1. The Alliance of TMD Organizations supports ethical and professional patient centered care.

2. Treatment should be based upon individual patient needs.

3. TMD and associated facial pain disorders/diseases may encompass physical, functional, cognitive, and psycho-social factors all of which may contribute to patient’s symptoms and complaints. Dental occlusion may have a significant role in TMD; as a cause, precipitating, and/or perpetuating factor. Any or all aspects may be taken into consideration when developing diagnoses and treatments accepting that TMD and associated co-morbidities including other pain disorders may be multi-factorial in nature.

4. Diagnoses and treatments should be based upon scientific information in conjunction with the skill, knowledge, and judgment of the providing clinician within the scope of their care.

5. Patient care should progress from initially minimally invasive treatment with gradations of increased intervention weighing risk versus benefit within reasonable standards of care.

6. The diagnosis and treatment of TMD should be considered an emerging science accepting that approaches for diagnoses and treatments may change based upon scientific evidence, clinical evidence. Reasonable standards of care should always be considered in the differential diagnosis of all head, neck and facial pain.

7. Efforts should be made to allow for continuity of care between multi-disciplinary health care providers.

8. Although not gender specific, TMD symptoms and associated pain disorders are gender biased and found to be reported predominately in females.

9. Since TMD and associated pain disorders are by nature gender biased affecting a significant portion of the female population, they should also be considered a women’s health issue.

10. Third party payers should not discriminate based upon gender, body part, location of symptoms, specific dysfunction, or professional degree of the licensed health care provider.

These 10 basic principles were developed by the majority of the representatives of TMD Alliance members.

I understand that Ms Cowley the founder of the organization was the victim of a surgical disaster but her organization actually disuades patients from care that could improve their quality of life.

I believe that if the TMJ Association is really vested in the best interest of all patients then  the TMJA should accept the offer to work with the TMD Alliance and its member organizations.

This is an open invitation to the TMJ Association it to work with the dentists who treat TMJ disorders, the individual groups that further the scientific aims of those groups and with the TMD Alliance that represents the intrests of patients with TMJ Dysfunction.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations

Accupuncture vs Topiramate: New Study in October Cephalgi ( Oct 21, 2011)Shows Superior Results With Accupunture

Neuromuscular Dentistry and accupuncture bot work by restoring normal physiologic states to the body compared to drug treatments that can destroy chemical balance. The current study shows accupuncture to be superior to topiramate but of greater importance is the frequency of side effects. (abstract below)

I will state that Neuromuscular Diagnostic orthotics almost always give better results than either therapy. I frequently work with patients on extremely high levels of medication that is gradually reduced by their physician following treatment. One of the most difficult issues in treating headache patients is medication withdrawal.

Topiramate had adverse events or side effects in 66% of patients compared to 6% in accupuncture group. This level of side effects for drug therapy is enormous considering it did not work as well as accupunture.

The reduction in headaches days was significantly greater with accupuncture.

Cephalalgia. 2011 Oct 21. [Epub ahead of print]

Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial.

Yang CP, Chang MH, Liu PE, Li TC, Hsieh CL, Hwang KL, Chang HH.

Source

Kuang Tien General Hospital and Chang Gung University, Taiwan.

Abstract

Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n = 33); and 2) topiramate group: a 4-week titration, initiated at 25 mg/day and increased by 25 mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n = 33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2 ± 1.5 days to 9.8 ± 2.8 days was observed in the acupuncture group compared with 19.8 ± 1.7 days to 12.0 ± 4.1 days in the topiramate group (p < .01) Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.

PMID:

22019576

[PubMed - as supplied by publisher]

LinkOut - more resources

Are Trigger Point Injections More Effective Than Botox In Treating TMD (TMJ) Myofascial Pain

A recent study in Pain. 2011 Apr 21 looked at botulinum toxin type A for treatment of persistent myofascial TMD pain. Saline was used as the placebo-control in this double blind study. The crossover study examined 21 patients Myofascial TMD with inadequate pain control.

The study was done to evaluate the effectiveness of botulinum toxin type A for treatment of persistent myofascial TMD pain but actually showed that Saline is normally considered an excellent placebo because there are no direct biological changes associated with saline. There was statistically no advantage to botulinum toxin type A over saline.

I hypothesize that the improvement in pain showed in the study with saline was a direct result of the injection, not what was injected. Dry needling has also been shown to be very effective treatment for myofascial trigger points associated with TMD. I utilize both dry needling and lidocaine injections for treating MPD. Treatment of myofascial trigger points is an extremely effective treatment for TMD pain.

Trigger Point Injections and Dry Needling remain on of the most effective treatments for myofascial TMD.


Pain. 2011 Apr 21. [Epub ahead of print]
Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain: a randomized, controlled, double-blind multicenter study.
Ernberg M, Hedenberg-Magnusson B, List T, Svensson P.
Source

Unit of Clinical Oral Physiology, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE 141 04 Huddinge, Sweden.
Abstract

Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P=.163), but there was a significant time effect (P<.001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1month and by 23 (30%) after 3months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1month and 7 after 3months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3months after saline injection (P<.05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain. Botulinum toxin type A is not an effective adjunct to conventional treatment in persistent myofascial temporomandibular disorders.

Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

PMID:
21514731
[PubMed - as supplied by publisher]

VESTIBULAR MIGRAINE; THE SIGNS AND SYMPTOMS HAVE LARGE OVERLAP TO TMJ (TMD). ARE VESTIBULAR MIGRAINES BEST TREATED BY NEUROMUSCULAL DENTAL ORTHOTIC

A recent article in HEADACHE (June 2011)"Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine" looks at patients who have an overlap of vestibular symptoms, such as lightheadedness, unsteadiness, vertigo, balance disturbance and headache.

The study showed just under half of the patients had onset of pain and vestibular symptoms together. This is frequently seen in patients withcraniomandibular neuromuscular disorders and usually responds extremely well to a neuromuscular orthotic, use of ULF TENS, Trigger point injections, spray and stretch elimination of TP's and SPG (Sphenopalatine Ganglion) Blocks.

NEUROMUSCULAR DENTISTRY SHOULD PROBABLY BE A FIRST LINE TREATMENT FOR PATIENTS EXPERIENCING VESTIBULAR SYMPTOMS AND HEADACHE OR MIGRAINE AFTER ORGANIC DISEASE IS RULED OUT.

TMJ DISORDERS HAVE LONG BEEN CALLED "THE GREAT IMPOSTER" because they mimic so many other disorders. All patients with vestibular symptoms and head or neck pain shoud read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IN SLEEP AND HEALTH JOURNAL.
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor


The article's conclusions are not diagnostic at all. They cover episodic, acute onset and chronic disorders. The authors stated "Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM"


Headache. 2011 Jun 7. doi: 10.1111/j.1526-4610.2011.01934.x. [Epub ahead of print]
Migraine and Vestibular Symptoms-Identifying Clinical Features That Predict "Vestibular Migraine"
Cohen JM, Bigal ME, Newman LC.
Source

From Roosevelt Hospital, Headache Institute, New York, NY, USA (J.M. Cohen and L.C. Newman); Merck, Sharp & Dohme Corp., Whitehouse Station, NJ, USA (M.E. Bigal).
Abstract

Background.- Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms-VS) often co-exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.- To determine common clinical features that may be associated with "vestibular migraine" (VM). Methods.- We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.- Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), "light-headedness" (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.- Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.

© 2011 American Headache Society.

PMID:
21649658
[PubMed - as supplied by publisher]

Related citations

MIGRAINE TREATMENT WITHOUT DRUGS. MIGRAINES ARE USUALLY RELATED TO THE TRIGEMINAL NERVES, THE BEST TREATMENT IS TO CORRECT NEURAL INPUT.

There are many different kinds of Migraines and headaches. They all share the same basic features, a common pattern that is frequently seen with migraine is an initial dull ache that develops into a constant, throbbing and pulsating pain that can be experienced in the temples, front or back of one side (or both sides)of the head. The pain is usually accompanied by nausea and vomiting, and sensitivity to light and noise.

A common factor in almost all headaches and migraines is the involvement of the Trigeminal Nerve. Treating migraines and other headaches without drugs can frequently be easily accomplished by changing the neural input into the trigeminal nervous system. TMJ disorders (TMD) are often called "The Great Imposter" I strongly recommend that anyone who suffers from Migraines, Tension-Type Headaches, Chronic Daily Headaches or other chronic head and neck pain read
"SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

Two of the most common types of migraine are "migraine with aura" or "Classic Migraine" and "migraine without aura" or "common migraine".

Frequently patients with severe headaches are diagnosed as having "migraine" when they actually have a severe tension headache, muscular headache or cervicogenic headache which can present as a migraine. Many patients and physicians can are fooled into thinking every severe headache is a migraine. Severe headaches are frequently neuromuscular in orgin and easy to alleviate or eliminate. This can lead to the wrong treatments being utilized that while helpful they are not ideal and can increase headache frequency and/or drug overuse.

Rebound headaches and drug overuse headaches are among the most difficult to treat because in addition to the original problems we now are also dealing with a medication caused disorder.

The Common Migraine or Migraine without Aura
because the headache is associated with changes in the size of the arteries inside the skull and in the head and neck. The blood flow to the anterior two thirds of the meninges of the brain is controlled by the trigeminal nerve and this type of headache can frequently be eliminated without drugs with a neuromuscular orthotic that stops the nociceptive input to the brain from the fifth cranial nerve or trigeminal nerve. Neuromuscular Dentistry is most effective when it is ussed to intervene before the pre-headache phase when blood vessels constrict; at the time vascular dilation occurs the migraine begins. The The inflamed as well as swollen blood vessels are believed to be the cause of migraine pain and are caused by neurally mediated inflammationand by increasing the pressure on the swollen walls of the blood vessels. Neuromuscular Dentistry is more effective at preventing or eliminating migraines then a stopping them in the middle of an acute attack.

Migraine sufferers may experience only occasional episodes while others have repetitive migraines two to four times per month. Other patients can get continuous migraines that very in intensity. Most migraine headaches last at least four hours, although very severe ones can last up to a week. I recently treated the wife of a physician who had a continuous headache for over 50 years that was eliminated after only two visits. This is unusual but not unheard of when utilizing neuromuscular dental orthotics. Headaches may begin at any time of the day or night; but when they has a TMJ (TMD) disorder and/or sleep apnea. Migraines rarely awaken a person from sleep but morning headaches frequently can convert into full blown migraines. These morning migraines are especially easy to treat with a neurmucular diagnostic orthotic.

Classic Migraine or Migraine with Aura are about a third of the migraine population. These are also trigeminally innervated migraines and when treated by a neuromuscular orthotic may give a different response. I have seen patients who still experience the aura but the pain never follows. Depending on the triggers that percipitate the migraines the orthotic will often decrease the severity and frequency of these headaches but not completely eliminate them

Migraine sufferers frequently experience visual problems during the headache. Migraine that begins with an aura is usually a manifestation of neurological symptoms. These symptoms are most frequently associated with the trigeminal nerve and the aura begins from five to thirty minutes before the actual onset of the headache. Neuromuscular dentists will frequently use Sphenopalatine ganglion blocks to head off this type of migraine before it hits. Once these migrines are in full swing standard migraine medications are the best way to limit and control pain.

I usually will teach patients how to self administer SPG blocks (sphenopalatine ganglion blocks) with local anaesthetic intranasally applied with a Q-tip. Patients may see wavy or jagged lines,wierdly moving blobs reminescent of Lava lamps, squiggles, worms, polka dots or strobe like flashing lights. Any time patients have flashing lights in their eyes they must consider the possibility of a detatched retina. Other symptoms include tunnel vision or blind spots in one or both eyes or vision going black and white and dimming that is similar to being lost in the fog.

Auras can also be non-visual in nature and can involve sounds , dizziness or strange bodily aches or the feeling like something is crawling thru you. It is not uncommon for smells and tastes to be part of an aura and some patients report that the Aura sonunds , tastes and odors can percipitate attacks when they are encountered in real life.

Feelings of numbness or a "pins-and-needles" sensation as well as difficulty in recalling or speaking the correct word can be experienced with migraine but can also be neurological symptoms of a stroke and must be considered serious at all times. Other less common types of migraine include Hemiplegic Migraine, Ophthalmoplegic Migraine, Retinal Migraine, Basilar Artery Migraine and Abdominal Migraine

Many of these other types of migraines can be very difficult to diagnose but it is important to remember they are are mediated by the Trigeminal nervous system and may respond well to treatment with a neuromuscular diagnostic orthotic which can eliminate or drastically decrease both frequency and severity.

Intense Migraines: Trigeminal Neuralgia, Trigeminal Neuropathy or a simple problem best addressed through Neuromuscular Dentistry and an orthotic.

Carolyn: Intense migrane headaches with jaw, neck, shoulder, face, sinues,eye and ear pain, also numb feeling on face. I had MRI's done of my head and neck and was diagnosed with Trigeminal Neuralgia, seeked Gamma Knife, was told I wasn't a canidate and to have an MRI of my neck, had that done, nothing showed up, then was told I had Trigeminal Neuropothy. I was diagnosed with TMJ a long time ago and had a mouth piece...it didn't do much and as time went on things got worse. I am convienced that my problem is with the Tri nerves and TMJ...no doctor has caught on. I am at my wits end and need to find out what is wrong with my neck and face. Please help me in finding a doctor who could figure out my problem. Thank you!!

Dr Shapira response: Carolyn, I am sorry your life is being destroyed by what sounds like horrible pain. I would strongly suggest avoiding Gamma Knife surgery as a first line treatment.

You did not mention trying non-invasive or minimally invasive treatment such as massage therapy, chiropractic adjustment or Ice Down Therapy which can be helpful. The beauty of Neuromuscular Dentistry is that results can be rapid, amazing and life changing in just a few visits. I would suggest starting with very simple diagnostic evaluation such as spray and stretch with vapo-coolant for myofascial pain, trigger point injections SPG blocks and most importantly a diagnostic neuromuscular orthotic.

I frequently see long distance patients and we can sometimes produce amazing results in just wo to three days of intensive therapy. We do our consultation , work-up and exam the morning of the first day and deliver an orthotic that afternoon. We deactivate trigger point injections with spray and stretch techniques as described by Dr Janet Travell. The second morning we adjust the appliance and do diagnostic/treatment trigger points and blocks and adjust again that afternoon. I work closely with an Atlas orthoganol DC who can address the cervical vertebrae during your stay.

There is no "CURE" for these problems but rapid relief is possible and the orthotic lets you maintain comfort. A real "CURE" would mean you could get back the years you lost to pain, reverse the effects on your life, your relationships and your family. The best we can do is give you a brighter future.

All of the symptoms you descibed are why TMJ disorders are called "The Great Imposter"

Read "Suffer No More: Dealing With The Great Imposter" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

Contact my office if you would like to schedule a 3 day series of appointments for rapid evaluation and treatment or I will try to find you a knowledgable doctor in your area.

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

ICCMO STANDS FOR THE INTERNATIONAL COLLEGE OF CRANIO MANDIBULAR ORTHOPEDICS. ICCMO IS THE ORGANIZATION FOR NEUROMUSCULAR DENTISTRY

ICCMO, THE INTERNATIONAL COLLGE OF CRANIO MANDIBULAR ORTHOPEDICS IS THE ORGANIZATION THAT REPRESENTS THE ART AND SCIENCE OF NEUROMUSCULAR DENTISTRY. DR BARNEY JANKELSON THE FATHER OF NEUROMUSCULAR DENTISTRY IS ALSO A FOUNDER OF ICCMO.

NEUROMUSCULAR DENTISTRY UTILIZES SOPHISTICATED INSTRUMENTATION TO ASSESS AND CORRECT THE PHYSIOLOGIC POSITIONING OF THE JAWS, MUSCLES, OCCLUSION AND POSTURE TO ADDRESS CHRONIC TMJ,TMD AND MYOFASCIAL PAIN PROBLEMS IN A PHYSIOLOGIC FRAMEWORK.

NEUROMUSCULAR DENTISTRY CAN VASTLY IMPROVE RESULTS IN COSMETIC, IMPLANT AND RECONSTRUCTIVE DENTISTRY. THE BASIC THEORY OF NEUROMUCULAR DENTISTRY IS THAT IDEALING THE OCCLUSION SO THAT FUNCTION DOES NOT REQUIRE PATHOLOGIC MUSCLE DAPTATION. CREATING AN IDEAL ENVIRONMENT FOR NORAM MUSCLE FUNCTION CREATES NORMAL PHYSIOLOGIC RESPONSES AND HEALTHY MUSCLES.

THE NEUROMUSCULAR SYSTEM INVOLVES THE TEETH, JAW MUSCLES, JAW JOINTS, HEAD POSTURE, SWALLOWING VESTIBULAR FUNCTION, BREATHING, SLEEPING, PERIPHERAL NERVOUS SYSTEM AND THE CENTRAL NERVOUS SYSTEM. THE TRIGEMINAL NERVES AND TRIGEMINOVASCULAR SYSTEM ARE INTIMATELY INVOLVED NOT JUST IN TMJ DISORDERS BUT ALSO IN CHRONIC DAILY HEADACHE, TENSION-TYPE HEADACHE AND MIGRAINE.

I TREAT ALL OF THESE CONDITIONS IN MY GURNEE, IL OFFICE. I AM ALSO THE SECRETARY OF ICCMO AND THE ICCMO REPRESENTATIVE TO THE ALLIANCE OF TMD ORGANIZATIONS.

FORWARD HEAD POSTURE, MYOFASCIAL TRIGGER POINTS, TMJ, TMD, AND TENSION-TYPE HEADACHE ALL CLOSELY RELATED

A PRIMARY DIAGNOSTIC FINDING IN TMJ, TMD, TMJ DISORDERS IS MYOFASCIAL TRIGGER POINTS. THEY ARE FREQUENTLY ASSOCIATED WITH FORWARD HEAD POSTURE A COmMON FINDING IN TMJ PATIENTS. A 2006 ARTICLE "Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache." IN HEADACHE JOURNAL CLEARLY DESCRIBES HOW TRIGGER POINT IN "upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH CHRONIC TENSION-TYPE HEADACHES)"

NEUROMUSCULAR DENTISTRY UTILIZES A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS TO ELIMINATE THE FACTORS THAT CAUSE TRIGGER POINTS TO FORM AND PROPAGATE. ELIMINATION OF THESE TRIGGER POINTS CAN PREVENT TMJ DISORDERS, TREAT TMD AND CHRONIC TENSION TYPE HEADACHES. PATIENTS WITH INCREASED MYOFASCIAL TRIGGERS ALSO HAVE INCREASED INTENSITY AND DURATION OF HEADACHE ATTACKS.

A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC IS A SAFE AND EFFECTIVE FIRST STEP IN THE DIAGNOSIS, TREATMENT AND ELIMINATION OF MYOFASCIAL TRIGGERS AND RELATED TMJ AND HEADACHE DISORDERS.

Headache. 2006 Sep;46(8):1264-72.
Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache.

Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA.

Universidad Rey Juan Carlos, Physical Therapy, Alcorcon, Madrid, Spain.
Abstract

OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency.

BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role.

DESIGN: A blinded, controlled, pilot study.

METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.

RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01).

CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.

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]

CHRONIC DAILY HEADACHES AND MIGRAINE ASSOCIATED WITH TMD ACCORDING TO NEW ARTICLE IN CLINICAL JOURNAL OF PAIN.

THIS NEW ARTICLE SHOWS THAT ALL TYPES OF HEADACHES ARE ASSOCIATED WITH TMD . THE ABSTRACT OF "Temporomandibular Disorders are Differentially Associated With Headache Diagnoses: A Controlled Study." IS REPRINTED BELOW. WHILE IT IS GENERALLY ACCEPTED THAT TENSION HEADACHES, EPISODIC TENSION-TYPE HEADACHES ARE COMMONLY CAUSED BY SORE MUSCLES IN TMD PATIENTS IT IS ACTUALLY THE CHRONIC NATURE OF TMD THAT IS SO DANGEROUS.

CHRONIC PAIN CAN CAUSE CENTRAL SENSITIZATION. THIS CAN LEAD PROBLEMS LIKE ALLODYNIA, AND HYPERALGESIA BUT THE CENTRAL SENSITIZATION IS NOT NECESSARILLY PERMANENT . UNTREATED IT IS ALSO MAY RESULT IN COMPLEX REGIONAL PAIN SYNDROME. TMD WHEN UNTREATED FREQUENTLY BECOMES CHRONIC. THERE ARE SOME RESEARCHERS WHO BELIEVE THAT TMD PROBLEMS ARE MENTAL NOT MEDICAL AND "EXPERTS" SOMETIMES PRESCRIBE BIOSOCIAL THERAPY OR PSYCHOTHERAPY BUT IGNORE THE UNDERLYING PHYSICAL CAUSES AND TRIGGERS . MANY PATIENTS WITH CHRONIC PAIN DO HAVE DEPRESSION AND OTHER PSYCHOLOGICAL DISABILITIES BUT THEY ARE USUALLY CAUSED BY PATIENTS LIVING WITH PAIN.

IT CAN BE VERY DIFFICULT TO FIND PRACTITIONERS WHO SEE THAT HEADACHES, TMD, AND OTHER PROBLEMS ARE REAL DISORDERS. MANY PATIENTS FEEL THAT THEIR DOCTORS DON'T BELIEVE THEM OR UNDERSTAND THE SEVERITY OF THEIR PROBLEMS.

I FREQUENTLY SEE PATIENTS WHO RESPOND TO VERY SIMPLE TECHNIQUES ADDRESSED AT RELIEVING PAIN FROM MASTICATORY MUSCLES. THE PATIENTS ARE QUITE OPEN AND TELL ME THAT THEY WERE TOLD THAT THEY DID NOT HAVE TMJ BECAUSE THEY DID NOT HAVE CLICKING OR LOCKING.

MANY PATIENTS HAVE MASTICATORY DISORDERS AND MUSCLE PAIN THAT REPSONDS BEAUTIFULLY TO A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC AND TENS.

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]

Mandibular advancement, nasal breathing and swallowing.

Swallowing disorders are frequently associated with TMJ disorders. Abnormal breathing patterns are also associated with both TMJ disorders and Sleep apnea and snoring. This new study "The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex." in the Journal of Oral Rehabilitation (see abstract below) concludes "that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.

This inhibition of movement may be a partial explanation of why anterior positioning appliances help muscle problems. The patients may just be breathing easier in this new position. It is another example of convergence between TMD and Sleep Apnea

J Oral Rehabil. 2010 May 1;37(5):336-45. Epub 2010 Mar 10.
The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex.
Ayuse T, Ayuse T, Ishitobi S, Yoshida H, Nogami T, Kurata S, Hoshino Y, Oi K.

Department of Special Care Dentistry, Nagasaki University Hospital, Nagasaki, Japan.
Abstract
The coordination between nasal breathing and non-nutritive swallowing serves as a protective reflex against potentially asphyxiating material, i.e. saliva and secretions, entering the respiratory tract. Although this protective reflex is influenced by positional changes in the head and body, the effect of mandible position on this reflex is not fully understood. We examined the effect of mandible advancement associated with mouth opening on the coordination between nasal breathing and non-nutritive swallowing induced by continuous infusion of distilled water into the pharyngeal cavity. The combination of mandible advancement and mouth opening increased the duration of swallowing apnoea and submental electromyographic burst duration. When the mandible was advanced with the mouth open, the duration of swallowing apnoea increased significantly compared with the centric position (0.79 +/- 0.23 vs. 0.64 +/- 0.12 s, P < 0.05, n = 12), and the duration of submental electromyographic activity increased significantly (2.11 +/- 0.63 vs. 1.46 +/- 0.25 s, P < 0.05, n = 12). Mandible advancement with mouth opening altered the respiratory phase resetting during swallowing and the timing of swallow in relation to respiratory cycle phase. We conclude that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.

PMID: 20337868 [PubMed - indexed for MEDLINE]

TMJ Treatment: Is Neuromuscular Dentistry the TMJ Treatment?

Neuromuscular Dentistry treats TMJ disorders by correcting the underlying problems rather than just treating the symptoms. The old fashioned mechanical approach to TMD treatment only addresses the current symptoms. Long term correction of chronic headaches, joint pain and muscle pain is actually the result of healing when underlying pathology is eliminated. Neuromuscular Dentistry is the best way to correct function and permit long term healing.

Coming to Chicago for Treatment

I have had numerous patients come to Chicago for treatment at my Gurnee office. We do have a hotel close to the office that offers special rates to our patients. It is the same hotel that I hold my courses at ane they give us a discounted rate. Patients flying in can use O'hare Airport or Milwaukee's Mitchell Field. We have found that treatment is more efficient for long distance patients if patients are seen on three consecutive days.