Migraines, Cluster Headaches and Tension-Type Headaches: What is Fastest and Most Effective Treatment? What is the Safest Treatment?

The pain, agony and suffering associated with headaches of all types can rapidly destroy your quality of life.   The suffering while waiting for medication to take effect can be maddening.  This is even more true when an individual has chronic severe headaches.

The most common approach of patients is to try over the counter medications that all have similar issues with slow onset and negative side effects.  Effectiveness varies and often only minimal or partial relief is obtained.

Non-steroidal anti-inflamatories  (NSAID) are probably the most common headache medication used.  This includes aspirin (Bayer), ibuprofen (Advil or Motrin), naproxen  (Allieve) and etedolac.  All of these drugs are excellent anti-inflamatories and all of them have serious side effects including GI disturbances including gastric reflux, burning, ulcers, esophageal burns, and increased bleeding times. 

 The biggest issue is not the negative and often dangerous side effects but the  lack of effectiveness and slow onset.

Tylenol or Acetaminophen is even less effective but usually does not cause GI distress but can cause permanent liver damage especially if taken with alcohol.  Again the biggest issue is poor pain relief and  the  considerable time it takes  to reach effective blood levels to treat the pain.

Pain is felt in the Limbic System where we feel emotion.  When patients are suffering severe pain their emotional level plummets. 

The National Headache Foundation recommends a Triple-Combination Medication  of acetylsalicylic acid, (aspirin), acetaminophen, and caffeine for tension-type headaches.  Unfortunately, this still requires absorption in thee GI tract and carries the same risks as the individual drugs.  Excedrin is a combination medication with these ingredients.  Excedrin and Excedrin Migraine are actually the same medication.

Compare these OTC Drugs and response time to Self-Administered Sphenopalatine Ganglion (SPG) Blocks which typically utilize 2% lidocaine, a natural anti-inflammatory that is often given to stabilize a patients heart beat but is best known  as dental anesthetic.  

Patient's can self-administer an SPG lidocaine block in minutes and relief for Migraine and Cluster Headaches can be almost immediate.  SPG Blocks are especially effective for Tension-Type Headaches and other Trigeminal Nerve associated headaches.

Sphenopalatine Ganglion Blocks can be administered in physicians offices and in Emergency Departments utilizing a nasal catheter such as a Sphenocath, Allevio or TX360.  These are all specialized catheters designed to "squirt" lidocaine to the mucosa covering the Sphenopalatine Ganglion where it sits in the pterygopalatine fossa.  The Sphenopalatine is also known as the Pteerygopalatine Ganglion, named for where it is found.

 While these "squirt gun technique" blocks are effective and can also give almost immediate relief they are also expensive and the patients life is disrupted by the headache and the need to travel for the  headache treatment.

The use of cotton-tipped nasal catheters allows the patient to self-administer SPG Blocks.  This  can be used prophylactiically to prevent headache occurrence as well as to alleviate headaches at initial onset before their increasing severity disrupt patient's lives.

Most physicians do not train patients to self-administer these blocks but it is an easily learned procedure utilized for  over 100 years.

The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head and is part of the Autonomic Nervous System.  The Sympathetic nerves are also part of the autonomic nervous system and are involved in the "fight or flight" reflex which is also known as the stress reflex. 

 The Sphenopalatine Ganglion is also known as the SPG, the Pterygopalatine Ganglion, the Nasal Ganglion, Meckel's Ganglion and Sluder's Ganglion after the physician who first described it's role in treating headaches in 1908.

While many medications can be utilized with SPG Blocks there is no study that has shown anything to be more effective than lidocaine.  Lidocaine is a natural anti-inflamatory with positive cardiac effects in the presence of irregular heart rhythm.  It is commonly utilized as dental anesthetic.

Drugs.com list 66 drugs to treat migraines, including triptans but none have been shown to be more effective than SPG Blocks though there is a massive amount of drug side effects associated with these medications.  All of these medications can be helpful and  SPG Blocks are safe to be used in combination with any headache or migraine medication.

Most importantly,  SPG Blocks can give the fastest relief possible with the lowest risk of medication side effects.  Patient may find that if they self-administer SPG Blocks they require far lower doses of medication if they need it at all.

There are side effects to Sphenopalatine Ganglion Blocks but in general they are positive.  About 1/3 of essential hypertension can be cured with SPG Blocks.  SPG Blocks can relieve anxiety, depression and stress.  The blocks can relieve a wide range of eye, ear, nose , sinus and jaw pains.  A 1930 article "Sphenopalatine Phenomena"  by Hiram Byrd in Annals of Internal Medicine (JAMA) showed almost 100% success in 10,000 blocks in 2000 patients with virtually no negative side effects.

This amazing technique almost became lost as part of forgotten medicine when Big Pharma and pharmaceuticals changed medicine starting in the 1940's.  This technique may have been lost forever but returned after the publication of a popular book "Miracles on Park Avenue" which detailed the practice of Dr Milton Reder an octogenerian  New York City Otolaryngologist whose entire practice focused on treating patients utilizing only Sphenopalatine Ganglion Blocks.

Injection of the Sphenopalatine Ganglion may be a way to increase effectiveness of the block in an acute severe headache.  Dentists are the experts at the intraoral injection through the greater palatine canal.  Extra-oral injections may be done via the Suprazygomatic Approach without fluoroscopy, usually by a Neuromuscular dentist trained in treating TMJ /TMD and orofacial pain or ENT's with extensive experience in treating chronic pain patients.

Sphenopalatine Ganglion Blocks are also very effective for treating TMJ disorders and associated Myofascial Pain and Dysfunction.  TMD and MPD are the primary underlying cause of all tension headaches and muscle contraction headaches.  

Neuromuscular Dentistry utilizes the Myomonitor that has a fifty year safety record as a neuromodulation unit for the trigeminal and facial nerves as well as the sympathetic and parasympatheetic fibers of the autonomic system that pass thru the SPG.

The use of a Diagnostic Neuromuscular Orthotic is often the first step in permanently eliminating Tension-Type Headaches.

Learn more at www.SphenopalatineGanglionBlocks.com

TMJ Lake Forest: Neuromuscular Dentistry has a Physiologic Approach to Treating TMJ Disorders

Treatment of TMJ Disorders, Headaches, Migraines and Sleep Disorder are focus in new practice serving Lake Forest and Highland Park TMJ patients.

  Dr  Shapira  created www.IHateHeadaches.org website to bring the Physiologic Approach to treating TMJ Disorders with Neuromuscular Dentistry to a wider audience and has over 10,000 unique visitors on a monthly basis.

Diagnosis and Treatment of TMJ disorders requires a wide variety of skills that most general dentists don’t acquire. The treatment of TMJ disorders is far more advanced than just the mechanical approach of mouth guard and bite adjustments. In fact, many patients get worse because invasive treatment is done at the beginning of treatment.

Drastic Improvements in the Quality of a Patient’s Life require the ability to utilize a wide range of treatment modalities and diagnostic modalities.

His new office is dedicated to treatment of TMJ disorders, Chronic headaches / migraines and sleep disorders including snoring and sleep apnea.  WWW.ThinkBetterLife.com

Dr Shapira has been a leader in the field TMJ treatment and research for many years and is the current Chair of the Alliance of TMD Organizations. He served for many as a an Assistant Professor at Rush Medical School and is a Diplomate of the Academy of Pain Management.

Patient Testimonials Videos on TMJ, Migraines, Trigeminal Neuralgia Sleep Apnea and Snoring https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

He has practised Physiological Neuromuscular Dentistry and trained with Barney Jankelson the Father of Neuromuscular Dentistry. Dr Shapira has served as a Fellow and Regent of ICCMO: The International College of CranioMandibular Orthopedics and is their representative to the TMD Alliance.

He has lectured extensively on Sleep and TMJ disorders and is scheduled to lecture in Buenos Aires, Argentina in 2017 on Sphenopalatine Ganglion Blocks. He previously lectured on the “Common Development Aspects of TMJ Disorders, Sleep Apnea, Headaches, Migraines and ADD (ADHD) in Buenos Aires.

Dr Shapira’s paper on Neuromuscular Dentistry was written for the American Equilibration Society and has been republished by ICCMO and was presented at an SOT research meeting.

The Myofascial Pain and Dysfunction components of TMJ disorders are vital to understanding how to achieve the best results. Dr Shapira trained with Dr Janet Travell and has taught courses in treating MPD and TMJ.

Dr Shapira has been published in Cranio Journal, The Journal of CranioMandibular Practice and has a chapter in a textbook of Anti-Aging Medicine dealing with anti-aging aspects of dental treatment. He currently does editorial reviews of new articles submited to Cranio prior to acceptance for publication.

TMJ, TMD: Patient Friendly Video Explains TMJ, TMD, Posture, NUCCA, Atlas-Orthogano, Sleep Apnea and Snoring

My friend Curtis does an excellent job of explaining TMJ Disorders or TMD and how they are addressed with Neuromuscular Dentistry.  I like to always refer to the Neuromuscular Orthotic as a Diagnostic Neuromuscular Orthotic because we use it not just to help in the diagnosis of a patients but to evaluate the new diagnostic position and the effect it has on body posture.

I am into fascinated with the  science of TMJ, TMD and MPD and the postural effects of changing the bite.  Curtis does fabulous job in explaining difficult concepts in a simple easy to understand and entertaining format.  I enjoy watching his video every time I play it.  There is an amazing body of evidence and science into his postural discussion that includes the work of Nobel Prize winning Sherrington and the work of Tallgren.
As a Regent and Secretary of ICCMO I am currently having the pleasure of reviewing his excellent mastership thesis of ICCMO

View his you tube video @

https://www.youtube.com/watch?v=oAdKVu6vS20 

The Aqualizer Appliance, Neuromuscular Dentistry and Muscle Engrams

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

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

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

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

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

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

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

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

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

Lerman MD.

Source

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

Abstract

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

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]

Quality of Life Destroyed By Chronic Daily Headache according to Cephalgia article. Neuromuscular Dentistry can improve Quality of Life

A total of 34 studies were reviewed in this paper. Chronic Daily Headache (CDH) and Chronic Daily Headache with Medication Overuse (MOH) consistently created a lower quality of life. The Cephagia Article "Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: A systematic review." include 25 studies of patients and 9 studies of the general population.

I strongly recommend Neuromuscular Intervention as soon as possible when chronic headaches begin. These studies clarify the importance of utilizing a diagnostic neuromuscular orthotic early in the course of the problem. Almost every study done on headache treatment with a neuromuscular diagnostic orthotic shows at least a 50-80% improvement with NMD and frequently far superior results than medication.

Chronic Daily Headache frequently responds extremely well to Neuromuscular Dentistry but unfortunately a diagnostic orthotic is rarely offered to patients in pain centers and neurology offices. The biggest complaint about Neuromuscular Dentistry is that it can be expensive and time consuming when compared to writing a perscription. Long term savings and improvement in quality of life are essential considerations that must be taken into consideration. Insurance companies frquently are uncooperative using sneaky contract language to deny medically necessary treatment. One of the most common and unquetionably fraudulant techniques is to call all headaches and migraines treated by a dentist TMJ or TMD and then place an artificially low coverage maximum on that treatment. The article clearly states "Chronic Daily Headache was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than Episodic Headache, it is essential."

The principal conclusions of this review were"the findings of this review underline the detriment to Quality of Life and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache."

Reducing medication use and overuse is one of the real advantages of Neuromuscular Dental treatment of Chronic Migaine and Chronic Daily Headache. The side effects of massive drug use in headache and migraine often worsen the problem.

Prior to treating migraines, Tension -type headaches sinus headaches, and chronic daily headaches with dangerous medications it is logical to utilize a Dignostic Neuromuscular Orthotic, if relief is obtained the Medication Overuse is diminished. Medication Overuse Headaches are one of the worst headache types in destroying quality of Life.

The Neuromuscular Dental Institute (Institute for the Study of Neuromuscular Dentistry) is my answer to this disaster. Dr Barry Cooper, a leading Neuromuscular Dentistry Educator will teach his introduction to Neuromuscular Dentistry course to small groups of 4-6 dentists. We hope large numbers of these students will continue their Neuromuscular Dental Education at ICCMO (International College of CranioMandibular Orthopedics) meetings and at the Las Vegas Institue (LVI)

This wll be in addition to the current course I give on Sleep Apnea Treatment with oral appliance (Dental Sleep Medicine) as well as coverage of nerve blocks including the SPG block. The SPG or Sphenopalatine Ganglion Block can be incredibly effective in preventing and eliminating migraines. Ideally patients can learn to utilze and self administer SPG blocks to prevent or Amelliorate migraine headaches early in their course. It is simple, inexpensive and frequently incredibly effective.

The Alliance of TMD organizations (I am the ICCMO representative to the TMD Alliance) is working to prevent patients from being denied care that will mprove their overall quality of life and subsequently result in enormous long term savings in costs and expenses associates with chronic headaches and migraines.

The way TMJ, TMD and Neuromuscular Dentistry is dealt with by insurance companies is an example of Discrimination against women since the vast majority of patients with headaches, migraines and TM Joint disorders are female.

I will continue to treat patients at my Gurnee Dental practice, Delany Dental Care Ltd in our current locatin and in our new location that has a better layout for giving continuing educational courses to dentists, physicians and allied medical practitioners. Contact my office at 847-623-5530 for information on becoming a patient.

We do make special arrangements for long distance patients to make treatment requre less time and travel.

Ira L Shapira DDS, D,ABDSM, D, AAPM, FICCMO


Pub Med Abstract follows:

Cephalalgia. 2011 Apr 4. [Epub ahead of print]
Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: A systematic review.
Lantéri-Minet M, Duru G, Mudge M, Cottrell S.

CHU de Nice - Hôpital Pasteur, France.
Abstract
Objective : To evaluate the evidence for quality of life (QoL) impairment, disability, healthcare resource use and economic burden associated with chronic daily headache (CDH), focusing on chronic migraine (CM) with or without medication overuse. Methods : A systematic review and qualitative synthesis of studies of patients/subjects with CDH that included CM, occurring on at least 15 days per month. Main findings: Thirty-four studies were included for review (25 studies of patients and nine of subjects from the general population). CDH and CDH with medication overuse headache (MOH) were consistently associated with a lower QoL compared to control or episodic headache (EH) and CDH without MOH. CDH was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than EH. Data were not amenable to statistical pooling. Principal conclusions : The findings of this review underline the detriment to QoL and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache.

PMID: 21464078 [PubMed - as supplied by publisher]

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

Severe Headaches in Temples and Throbbing pain in teeth and joints after dental work.

Ruby: Headache in right temple. Throbbing in teeth and tm joint. Neck pain. Had a splint put in 10 days ago. Went for Pt, massage, chiro and today pain management dr who I didn't like much and jumped to wanting to do a nerve block. Just trying to find the right person to treat me. Chronic grinder, had crowns put on all uppers and didn't make night guard fast enough. Tmj dentist only does splints and says jaw position is 80% better. Help! Haven't been able to work in almost 2 weeks.

Dr Shapira Reponse: Dear Ruby,

I am sorry to learn of your ordeal.

Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a neuromuscular dentist. Blocks can be very effective but they are rarely a first line of treatment. MASSAGE THERAPY, CHIROPRACTIC OR OSTEOPATHIC ADJUSTMENTS CAN BE HELPFUL BUT THEY DO NOT ADDRESS THE UNDERLYING CAUSES OF THE PROBLEM ABD ARE MERELY PALLIATIVE IN NATURE. Frequently, you may also have long-standing underlying postural problems that these therapies will correct.

To say your jaw position is 80% better when you are in the pain you describe is ludicrous. Quality of life is always a primary concern and it does not appear that you are doing well from the little information you have given me. I normally hold off on permanent dental work until the pain is under control but I do not know if the pain was there prior to your dental work.

The use of spray and stretch with vapocoolant and trigger point injections can speed results but the utilization of the Low Frequency TENS to reduce spasm and pain is very important.

The headache in the temple area and throbbing pain in the teeth following dental work indicates that this probably is myofascial pain or TMD that should respond well to Neuromuscular Dental Treatment. A Diagnostic neuromuscular orthotic will be made to allow your muscles to function in a physiologic zone. An orthotic is designed to correct orthopedic and physiologic funtion rather than just protect the teeth like a "splint:.

Good Luck with your treatment.

I am forwarding your information to Dr **** ******. I hope that he will be able to help you improve your quality of life quickly.. I am available in Chicago if you do not find answers but Dr **** is an excellent practitioner. If for any reason it does not work out I can help you find another doctor but I know Dr **** and he can consult with me if there are any questions.

I am willing to see long distance patients but to be effective I try to schedule you so that we can initiate treatment and control your pain and correct orthopedics as quickly as possible. This requires a significant amount of time being scheduled in advance.

Dr Ira L Shapira

Why you want to find the most experienced Neuromuscular Dentist to Treat TMJ, TMD, Headaches and Migraines.

Neuromuscular Dentistry can give incredible relief of headaches, TMJ symptoms migraines and numerous other chronic pain disorders. It is important to chose your Neuromuscular Dentist wisely.

The International College of CranioMandibular Disorders is dedicated to the field of Neuromuscular Dentistry. It was founded by Dr Barney Jankelson the father of Neuromuscular Dentistry and all the great teachers and researchers in the field have supported ICCMO. The ICCMO website is http://www.iccmo.org/

I strongly suggest that you search for an experienced neuromuscular dentist but also a dentist who is well versed in other areas of pain management and treatment. I am a Diplomate of the American Academy of Pain Management, and a member of American Academy of Craniofacial pain, The American Equilibration Society and well as a Fellow of ICCMO. I utilize Neuromuscular Dentistry whenever I treat chronic pain but I have learned many valuable techniques from my colleagues in these other groups as well. I know that when I attend the AES meeting later this month many of the top neuromuscular dentists will be in attendance. The AES is primarily comprised of Centric Relation dentists but they tops in their field as well.
While I firmly believe the Neuromuscular approach is ideal many of these practioners have excellent results as well. It is incredibly important that your dentist is always in search of continuing knowledge. Excellence demands that practitioners are constantly learning as well as evaluating and reevaluating their techniques and beliefs.

The treatment of Myofascial pain, trigger point injections, spray and stretch, spenopalatine ganglion blocks, prolotherapy are just a few of the effective treatments that are used in conjuction with Neuromuscular Dentistry to improve patients lives. Over the last 35 years of continuing education after graduating dental school I have learned many of these procedures from excellent practitioners who are not neuromuscular dentists. Many of my teachers were physicians, osteopaths, massage therapists, accupuncturists, psychologists, ENT's, Chiropracters and othe diverse mainstream and alternative practitioners.

The American Equilibration Society asked me to contribute an article on Neuromuscular Dentistry for publication. They have graciously allowed it to be reprinted in the ICCMO anthology and in Sleep and Health Journal where it is available at no charge @ http://www.sleepandhealth.com/neuromuscular-dentistry

Neuromuscular Dentistry is a valuable tool that helps clinicians in diagnosing and treating craniomandibular disorders. It is not the only tool. The expression that if you only have a hammer everyone looks like a nail describes what happens when a neuromuscular dentist does not remove his/her blinders and see the big picture. The hammer is an extremely effective tool, but only one of many.

Do not let your life slip by marred by chronic pain that may be alleviated or eliminated by judicious application of neuromuscular dentistry.

In the same way Neuromuscular Dentistry is an important tool (maybe even the most important tool) but it is certainly not the only tool. Experienced neuromuscular dentists utilize a wide variety of approaches in treating their patients to a neuromuscular position to obtain the best possible results.

intense jaw pain on left side, swollen jaw and cheek, no dental issues per dentist and endodontist...tmj or trigeminal neuralgia?

I recently received a e-mail from a patient with the following complaint:

intense jaw pain on left side, swollen jaw and cheek, no dental issues per dentist and endodontist...tmj or trigeminal neuralgia?

The question TMJ or Trigeminal Neuralgia is very limited. 95% of all pain that patients experience is muscle pain. Many patients have severe or even excruciating pain but their TM Joints are normal. These are neuromuscular problems and may have many contributing factors. Trigeminal Neuralgia is rarely the cause of pain and when it is there is usually very specific triggers. The pain usually comes and goes going from normal to intense pain after stimulating trigger.

KI have seen patients with similar symptoms that are later tracked back to cracked toooth syndrome that was not evident early on. Vacumn sinusits can also give similar symptoms.

That said, the most common cause of pain is myofascial pain acute muscle spasm, myositis or other pain of muscular orgin.

A simple test that all general dentists and/or endodontists should know is how to do trigger point deactivation with a vapocoolant and stretch that can often give instanyt pain relief. Use of a diagnostic block to the muscle can also correct these problems when used to make a differential diagnosis.

The patient did not describe whether the pain was affected by jaw movement, if there was limited opening, or many other vital facts to know if there was joint involvement.

The correct approach is to make an accurate diagnosis. This involves a thorough evaluation of the jaw musclesand (TMJ) joints but also the head and neck musculature.

The best route is to seek out a neuromuscular dentist who is trained to evaluate and correct these problems.

I frequently see patients in Chicago who have not found help locally.

Diagnosis is the key to successful treatment. Treatment should be reversible until significant pain relief is accomplished and both the patient and the doctor are comfortable with primary and secondary diagnosis.

Temporal Arteritis misdiagnosed as migraine leading to tragic conditions for patient

Drug herapy always carries some risks. The following abstract details how a patient was treated for migraines with ergotamine. The patient was suffering from tiredness and weight loss and fever after a single dose of ergotamine. A second dose led to tongue necrosis (necrosis means death of the tissue) The authors felt that the necrosis of the tongue could have been the result of undiagnosed temporal arteritis a condition that can also cause blindness. A clinical sign of temporal arteritis is an elevated sed rate.

Ergotamine is a well known drug in migraine treatment and this is an unusual case. With neuromuscular dentistry we are always on the look out for red herrings. The patient who has a serious disorder that is causing symptoms or a serious disordersthat is not causing the symptoms but is covered up by the pain disorder.

My favorite patients to treat are patients who have had MRI's, CAT scans, Brain Scans, numerous blood tests ruling out organic diseases. These patients are "safe" because all the severe problems have been eliminated as possible causes of the problem.

Neuromuscular Dentistry cannot treat temporal arteritis which is usually treated with steroid but often dissapears after a biopsy.

PUBMED Abstract
Ugeskr Laeger. 2009 Jan 12;171(3):125-6.
[Necrosis of the tongue triggered by ergotamine in unrecognized temporal arteritis]
[Article in Danish]

Olesen JB.

Regionshospitalet Horsens, Medicinsk Afdeling. Jesper.blegvad@ki.au.dk
Tongue necrosis is a rare complication in arteritis temporalis. Our case is a 74-year-old patient who presented with weight loss, tiredness and fever during a 2-3-month period after ingestion of 2 mg ergotamine to treat her migraine. Tongue necrosis then occurred after ingestion of another 2 mg of ergotamine. Our patient had no preexisting diagnosis of arteritis temporalis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. It is possible that ergotamine can cause necrosis due to vasoconstriction of blood vessels which have an unstable blood flow.

PMID: 19174020 [PubMed - indexed for MEDLINE]