Cluster Headaches and Sleep Apnea. Cluster Headaches caused by sleep apnea and sleep apnea sequelae may be eliminated with treatment of apnea

All patients with cluster headaches that have onset during sleep should be evaluated for sleep apnea. Sleep apnea causes hypoxia (drop in oxygen) and a rise in CO2. Oxygen therapy is a recognized and effective treatment for sleep apnea. Prevention of many cluster headaches can be addressed by correcting sleep problems.

During apneic events the patients quit breathing oxygen drops followed by hypercapnia or a rise in carbon dioxide levels. This can cause acidosis that could trigger cluster headaches. This leads to an awakening and patients gasping and is associated with adrenaline release or fight or flight reflex. Repetition throughout the night can also be the trigger.

Patients with untreated sleep apnea have abnormal cortisol levels and this disturbs the ability to cope with normal life stresses. There is also an increase in insulin resistance and changes in blood sugar can also be a cluster headache trigger. The article
Timing patterns of cluster headaches and association with symptoms of obstructive sleep apnea." from Sleep Res Online. 2000;3(3):107-12 concludes that "in some patients, physiological consequences of OSA may trigger CH during the first few hours of sleep and thereby influence the timing of subsequent daytime headaches."

The National Heart Lung and Blood Institute (NHLBI) considers sleep apnea to be a Temporomandibular Disorder. The NHLBI report "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" discusses effects of sleep apnea in detail. Learn more about the dangers of sleep apnea and oral appliance treatment at http://www.ihatecpap.com

A section of the report titled The Craniofacial Complex and its Impact on Control of Upper Airway Resistance and Cardiopulmonary Function- Jaw Biomechanics and Function" discusses sexual dimorphism and may explain why cluster headaches are more common in men. Part of that report follows: "These compartments are activated differently during the production of different oral behaviors, suggesting that they function as output elements used in different combinations by the nervous system. These muscles are complex and unique, containing fibers of phenotypes not found in limb muscles. They are smaller, and express myosin heavy chain isoforms found only in limb muscles during development. The cardiac alpha-myosin heavy chain isoforms of the masseter and temporalis muscles are unique to skeletal muscle and resemble heart muscle. Considerable sexual dimorphism has been identified in these muscles with regard to the slow and fast fibers types of the masseter. Males have predominately fast fiber types while females predominately slow fiber types. These sex differences arise in response to androgens in males but persist even in the absence of androgens."

It is widely accepted that the Trigeminal Nervous system that controls the jaws teeth and associate dental structures is implicated in the majority of all headaches including cluster headache.

Control of the upper airway often decrease or fails during sleep as seen in this excerpt: "Control of Upper Airway Collapsibility During Sleep
The upper pharyngeal airway in humans has relatively little bony or rigid support. Since there is variability in soft tissue and bony structures of the head and neck, there must be mechanisms in place that enable the pharyngeal dilator muscles to adjust for these anatomic differences. Animal and human studies indicate that there are at least three mechanisms to control the activity of the genioglossus muscle. First, negative pressure has substantial impact on this muscle and a clear linear relationship exists between negative pressure in the airway and genioglossal activation. Second, there is pre-motor neuron input to these muscles from respiratory pattern generating circuits as shown by the pre-activation of these muscles that occurs prior to the development of negative pressure in the airway. Third, tonic activity in the muscle is consistently evident, although the mechanisms that determine the level of this activity have not been studied. During sleep, the mechanisms that control upper airway resistance are importantly impacted. Specifically, tonic activity drops markedly and the negative pressure reflex is substantially attenuated or completely lost. These findings have important implications in the pathophysiology of SDB." They probably also have important implications in the physiology and pathology of cluster headaches.

The report also discusses physiological pain processes and central sensitization found in TMJD patients that is similar to findings in cluster and headache patients in this excerpt: "Craniofacial/Deep Tissue Persistent Pain and Relationships to Cardiovascular and Pulmonary Function and Disease.
Injury to peripheral tissues following trauma or surgery often results in hyperalgesia that is characterized by increased sensitivity to painful stimuli. This is a common problem in patients with TMD. Until recently, it was thought that the increase in pain was due to changes at the site of injury but it is now known that it involves central nervous system hyper-excitability leading to long-term changes in the nervous system. Animal models of hyperalgesia produced by inflammation or nerve injury that mimic persistent pain conditions have shown that an increased neuronal barrage into the central nervous system (CNS) leads to central sensitization involving activation of excitatory amino acid transmitters and their receptors. The activation of N-methyl- D-aspartate (NMDA) receptors leads to influx of calcium into neurons, the activation of protein kinases, and phosphorylation of receptors. The net effect of these responses is increased gene expression of NMDA receptors, an alteration in the sensitivity of receptors, increased excitability, and an amplification of pain. These responses appear to be most robust in response to deep tissue injury such as occurs in TMD patients.
Modulation by descending pathways from the CNS importantly influences these events. Under normal conditions, the net effect of the descending neural projections from the brain stem to the spinal cord is to inhibit or counterbalance the hyper-excitability produced by tissue injury. It is now understood that this balance can shift to a net excitatory effect whereby descending modulation results in more hyper-excitability and more pain after injury. This central sensitization appears to be a prominent component in patients suffering from deep pain conditions such as TMD and fibromyalgia. It is believed that the diffuse nature and amplification of pain is in part due to this imbalance and that these findings have important functional implications relevant to the survival of the organism in response to the presence of persistent tissue injury. It is therefore now believed that persistent pain can be attacked both at the site of injury and where it is elaborated in the nervous system."

The report also documents connections with autonomic system derangements that are normally found in headaches, migraines and cluster headaches. These autonomic symptoms are the ones that Sphenopalatine Ganglion Blocks can relieve or eliminate. The relevant section is excerpted below:
" Alteration in Baroreceptor Activity - Impact on Pain, Autonomic Function, Motor Output, and Sleep":

"Evidence has emerged that several regions of the CNS interact in complex ways to integrate sensory perception, autonomic function, motor output, and sleep architecture. The outcomes of a number of recent studies also suggest that several of the signs and symptoms associated with TMD may result, at least in part, from impairments in neural networks that coordinate the interplay between sensory systems, autonomic function, motor output, and sleep architecture. Many of the central pathways that are critically involved with the integration of these systems are regulated by visceral afferent input, including input from cardiopulmonary, carotid sinus, and aortic arch baroreceptors. In addition, abnormalities in the function and central integration of baroreceptor afferent information has been associated with abnormalities in pain perception, autonomic function, motor output, and sleep architecture, and thus may contribute to the development and maintenance of TMD and other related disorders (e.g., fibromyalgia). There is a need for additional studies that systematically examine whether abnormal baroreceptor function contributes to the pathogenesis of TMD."

Several relevant studies on TMD and Sleep Apnea are included below:

Cranio. 1997 Jan;15(1):89-93.
Cluster-like signs and symptoms respond to myofascial/craniomandibular treatment: a report of two cases.
Vargo CP, Hickman DM.

Raleigh Regional Center for Head, Neck and Facial Pain in Beckley, West Virginia, Morgantown, USA.
Abstract
Two cases with pain profiles characteristic of cluster-like headache, both within and outside the trigeminal system, are reported. One male patient would typically awaken from sleep with severe unilateral temporal head pain and autonomic signs of ipsilateral lacrimation and nasal congestion. A female patient exhibited severe unilateral boring temporal and suboccipital head pain with associated ipsilateral lacrimation and rhinorrhea. In addition, both patients presented with signs and symptoms of masticatory and/or cervical disorders. These two cases illustrate possible treatment alternatives, as well as possible influences from cervical and masticatory structures in the development of cluster or cluster-like headache.

PMID: 9586493 [PubMed - indexed for MEDLINE]

Cranio. 1995 Jul;13(3):177-81.
Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.
Peterson JN, Schames J, Schames M, King E.

Headache and Pain Center, Hollywood Community Hospital, Los Angeles, CA 90028, USA.
Abstract
The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.

PMID: 8949858 [PubMed - indexed for MEDLINE]



Ned Tijdschr Tandheelkd. 2006 Nov;113(11):474-7.
[Spontaneous pain attacks: neuralgic pain]
[Article in Dutch]

de Bont LG.

Universitair Medisch Centrum, Groningen. l.g.m.de.bont@kchir.umcg.nl
Abstract
Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. Neuralgic pain is distinguished into trigeminal neuralgia, glossopharyngeal neuralgia, Horton's neuralgia, cluster headache and paroxysmal hemicrania. In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is available.

PMID: 17147031 [PubMed - indexed for MEDLINE]


Sleep Res Online. 2000;3(3):107-12.
Timing patterns of cluster headaches and association with symptoms of obstructive sleep apnea.
Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM.

Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Harbor, Michigan, USA. chervin@umich.edu
Abstract
Cluster headaches (CH) frequently recur at the same point in the circadian cycle, often during sleep. They may, in some cases, represent a susceptible individual's response to hypoxemia or other physiological changes induced by obstructive sleep apnea (OSA). If and when this mechanism exists, timing of CH close to the onset of sleep-and therefore OSA-might be expected. We questioned 36 subjects with CH about the times at which their CH usually occurred and about several symptoms known to be predictive of OSA, including habitual snoring, loud snoring, observed apneas and excessive daytime sleepiness. We then used logistic regression to determine whether occurrence of CH in each of six time periods was associated with OSA symptoms. The 23 subjects (64%) who reported CH in the first half of a typical night's sleep also tended to report headaches during the midday/afternoon period. Symptoms of OSA, and in particular habitual snoring, were predictive of both first-half-of-the-night and midday/afternoon CH (p<.05). Thirty-one subjects (86%) reported that their CH were sleep-related, usually occurring during any part of the night or on awakening, but symptoms of OSA were not predictive of this timing pattern. In short, several OSA symptoms showed an association with CH occurrence in the first half of the night but not with sleep-related CH in general. These findings suggest that in some patients, physiological consequences of OSA may trigger CH during the first few hours of sleep and thereby influence the timing of subsequent daytime headaches.

PMID: 11382908 [PubMed - indexed for MEDLINE]

One in Six patients perceive that wrong diagnosis have been made.

An interesting study from the Archives of Internal Medicine (abstract below)reports that 1one in six patients percieve that their doctors have made wrong diagnosis. The study reported "Patients with chronic back pain, higher educational attainment, and poor physical health were at increased odds of perceiving mistakes".

This leads to two questions, were there actual mistakes in diagnosis and treatment or was this just a patient perception. Is it possible that there were multiple diagnosis and they were not yet all discovered?

I frequently see Headache and Migraine patients with numerous diagnosis and medications. I treat these patients with neuromuscular dentistry and their pain is rapidly eliminated. This does not mean that the previous diagnosis were wrong but rather treatment was ineffective. Typically patients with TMJ problems that lead to headaches have seen a minimal of six doctors prior to seeing the dentist, sometimes dozens of physicians. That is why TMJ Disorders are called "THE GREAT IMPOSTER" SEE http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor to read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER"

Elimination of the headaches does not necessarily mean that other diagnosis were wrong but rather they were not the true cause of the pain. The expression "you can't see the forest for the trees" describes this type of problem. Relieving the headaches and Neuromuscular symptoms makes the patients feel great but frequently remaining symptoms not related to the Trigeminal Nervous system can also be discovered.

Dr Mercola of Mercola.com stated "One in Six Patients Report Getting Wrong Diagnosis
With each survey, study, and statistical review, the answer remains the same: Patients beware, because conventional medicine may inadvertently lead to you or your family's premature demise." It is important to note that this study was talking about patient perceptions about their diagnosis not actual diagnosis.

Solving chronic pain problems is like peeling an onion, as you relieve one layer of the onion you come to the next. Different layers of the onion may need different practioners or treatment. Sometimes it is necessary to treat one problem before progress can be made in other problems.

I frequently see patients who also go to chiropracters or osteopaths for spine adjustments that relieve their headaches but the adjustments do not hold. Combining a diagnostic neuromuscular orthotic with the chiropractic treatment eliminates the trigeminal system problems but also allows the spine to stabilize. Neither treatment works as well alone as the two treatment work combined.

I once had a patient who had constant daily headaches that were completely relieved by a neuromuscular orthotic with the exception of a pain in the right occipital area. The patient stated that was the first pain when the problem started, but did not remember that until the rest of the pain was gone. I could not find any trigger points in the muscle to duplicate the pain but the patient said that he first experienced the pain while playing golf and taking a back swing. When we had him repeat that motion the trigger point became active and we could locate, inject and eliminate it with complete relief of years of pain. That was probably the original injury but would never have been found without first getting him off of medications that masked the pain, correcting occlusal problems (TMD not TMJ this patient had no TM Joint problems just neuromuscular problems)

This patient had had several cat scans and an MRI and was told he has Multiple Sclerosis due to an abnormal MRI and symptoms. He refused to return to the neurologist but I explained that the MRI changes were real. When he revisted a new neurologist the MRI was still abnormal but because there were no symptoms no diagnosis of MS was made. The neurologist did say it could be a problem in the future but for many years the pain did not return. This case is one where the symptoms plus the abnormal MRI combined were used for the diagnosis but taken seperately a very different outcome. If there had never been pain the MRI would not have been taken and the accidental discovery of a questionable area on the brain would not be seen"

The study mentioned patients with back pain. Radiographic imaging of a patient with back pain frequently shows abnormalities which the pain is the attributed to. Patient with these same abnormalities are walking around pain free for years but no imaging is ever done until the pain occurs. Finding pain and radiographic changes does not always imply cause and effect. Studies have shown that the bell curves of pain and bell curves of radigraphic changes are not the same. Some patients with terrible arthritis have no pain and some with miserable pain have little objective evidence of pain. When the pain is labeled frequently other causes of pain are no longer even considered. The diagnosis of arthritis is correct but is just not the cause of pain. Arch Intern Med. 2010 Sep 13;170(16):1480-7.

Patient perceptions of mistakes in ambulatory care.

Kistler CE, Walter LC, Mitchell CM, Sloane PD.
Division of Geriatrics, Department of Medicin, University of California-San Francisco, USA. umanohone@yahoo.com
Arch Intern Med. 2010 Sep 13;170(16):1487-9.
Abstract
BACKGROUND: Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. We aimed to learn about the perceptions of medical mistakes, what factors were associated with perceived mistakes, and whether the participants changed physicians because of these perceived mistakes.

METHODS: We conducted a cross-sectional survey at 7 primary care practices in North Carolina of English- or Spanish-speaking adults, aged 18 years and older, who saw a health care professional during 2008. Main outcome measures were 4 questions about patient perceptions of medical mistakes in the ambulatory care setting, including (1) overall experience with a medical mistake; type of mistake, such as a (2) diagnostic mistake or (3) treatment mistake, and its associated harm; and (4) effect of this mistake on changing physicians.

RESULTS: Of 1697 participants, 265 (15.6%) responded that a physician had made a mistake, 227 (13.4%) reported a wrong diagnosis, 212 (12.5%) reported a wrong treatment, and 239 (14.1%) reported having changed physicians because of a mistake. Participants perceived mistakes and harm in both diagnostic care and medical treatment. Patients with chronic back pain, higher educational attainment, and poor physical health were at increased odds of perceiving mistakes, whereas African American patients were less likely to perceive mistakes.

CONCLUSIONS: Patients perceived mistakes in their diagnostic and treatment care in the ambulatory setting. These perceptions had a concrete effect on the physician-patient relationship, often leading patients to seek another health care professional.

PMID: 20837835 [PubMed - in process]

My Headaches are throbbing, nausea, stabbing ....Renee

Heeadaches related to the trigeminal nerves and jaw function frequently have all of those qualities. This relates to the vascular, hemodynamic and autonomic functions of the trigeminal nerve. Neuromuscular dentistry can frequently allieve and eliminate these sypmtoms as well as the more common tender, aching, and penetrating headaches. Painful TM Joint symptoms may or may not be present.

Waking with sinus pain or pressure.

Patient: I Wake up with sinus type headache and pressure around eyes.

This is a frequent area for patients to have referred pain from both jaw muscles and neck muscles. It is frequently secondary to clenching or grinding of the teeth. Another common cause for morning headaches is sleep apnea.

HEADACHES, MIGRAINES, FIBROMYALGIA AND TMJ DISORDERS

There is an intimate cooection between TMD and Fibromyalgia and Tension-type and Muscle contraction headaches. These can also serve as triggers for many types of migraines and chronic daily headaches.

The connection is the Trigeminal Nerve that controls blood flow to the brain and contributes over half of all input to the brain an central nervous system from the body.

It is generally recognized by neuroscientists and neurologists that almost all headaches and migraines are primarily trigeminal in nature or influenced by the trigeminal nerve.

Neuromuscular dentistry may be the best prevention for these problems that frequently relate to sleep disorders as well.

Neuromuscular dentistry my be the ideal method to improve the your quality of lyour life without excessive medication. Both chiropractic and osteopathic medicine depend on the jaw for stability of the spine and holistic and or alternative health care methods like massage have longer lasting results when postural correction and neurofeedback from the trigemnal nerve are use as a stabilizing force rather than a continuing irritation that prevents healing and interferes with quality of life.

Sphenopalatine (nasal) Ganglion (SPG) can be responsible for much more than headaches.

I came across this interesting abstract (below) on the spenopalatine ganglion and how it can cause remote effects. According to the article published in Arch Phys Med Rehabil. 1979 Aug;60(8):353-9 it can be responsible for wide ranging disorders. "Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others." I must disagree that the symptoms are "psychosomatic", I would venture that doctors facing idiopathic conditions sometimes label what they do not understand as psychosomatic. I have not read the original article only the abstract at this time and I am not sure how the authors are using the term psychosomatic.

All of the symptoms are mediated by the autonomic nervous system. The authors point out the connections to the Trigeminal Nerve, facial nerve and to the internal carotid artery plexus of the sympathetic nervous system. these connections could explain how the SPG is ntimately involved in TMD (TMJ) disorders and facial pain, migraines, tension headaches and other problems.

Neuromuscular dentistry will have effects on the trigeminal and facial nerves that travel thru the SPG but use of intranasal spenopalatine blocks will be a valuable tool in treating these autonomic aspects of chronic pain. Neuromuscular Dentists and all physicians and dentists treating chronic pain should be well versed in utilization of intranasal SPG blocks.

The rage reaction may also be affected by the SPG which may explain chemical changes seen in the brains of chronic pain patients. The connections to the pituitary gland could have effects on a wide variety of hormonal conditions.

I have seen remarkable results in some patients while utilizing SPG intranasal blocks while in other patients they seem ineffective. This may actually constitute a diagnostic evaluation for how large an autonomic effect is in a given patient.

Neuromuscular dentistry can evaluate the changes that take place in the masticatory muscles by utilizing EMG measurements of the masticatory muscles before and after SPG blocks. However we will only be able to measure the effects on voluntary muscles but not on visceral muscles or autonomic function. The field of neuromuscular dentistry has tremendous effects on the trigeminal nerve input to the brain. The Trigemnal nerve (fifth cranial nerve) is responsible for over 50% of the total input to the brain. the autonomic components are still not well understood by clinicians treating migraines, tension headaches, TMD, myofascial pain and other disorders. RSD (Reflex sympathetic Dystrophy) or CRPS (complex regional pain syndrome) are autonomic manifestations are some some of the most troubling in clinical treatment of pain.

The authors presents arguments supporting the following hypotheses:" 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered."

I am sometimes amazed at the effectiveness that we achieve utilizing a neuromuscular orthotic while we still do not have a good grasp on the underlying neurology. I believe why we are so successful in eliminating, preventing and treating chronic migraines and headaches is that the correction of the proprioceptive input accomplished by neuromuscular dental orthotics or occlusal corrections is such an emormous reduction in noxious neural input that we accidentally produce vast beneficial effects throughout the trigeminovascular system, the autonomic nervous system, the hormonal systems influenced by the pituitary gland and in the part of the brain (retained) that is involved in rage reflexes found in lower animals.

Arch Phys Med Rehabil. 1979 Aug;60(8):353-9.
Sphenopalatine (nasal) ganglion: remote effects including "psychosomatic" symptoms, rage reaction, pain, and spasm.
Ruskin AP.

Many articles implicate the nasal ganglion in the production of remote symptoms and discuss treatment. Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others. All these symptoms appear to have 2 common denominators. They are mediated by the autonomic nervous system and at least in some instances can be "psychosomatic." The sphenopalatine ganglion (SPG) is a major autonomic ganglion located superficially in the pterygopalatine fossa, with major afferent distribution to the entire nasopharynx and important connections with the trigeminal nerve, facial nerve, internal carotid artery plexus of the sympathetic nervous system and, as shown in the rat, direct connection with the anterior pituitary gland. This paper presents arguments supporting the following hypotheses: 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered.20

PMID: 464779 [PubMed - indexed for MEDLINE]

TMJ and Sleep Apnea

All patients with TMJ disorders especially if they get morning headaches or are tired during the day should be evaluated for sleep apnea. Sleep apnea (see www.ihatecpap.com) is a collapse of the airway during sleep.

Patients with clicking or popping TM joints will frequently have resolution of the TM Joint (temporomandibular joint) clicking if they wear a sleep apnea oral appliance.

The appliance stabilizes the condyle of the TMJ forward and if the disc is reduced allows time for the soft tissues to heal and stabilze the disc.

This stabilization will require the use of a daytime neuromuscular (splint) orthotic to maintain joint stability during the day.

IMPROVING THE QUALITY OF LIFE WITH TMD TREATMENT. NEW ARTICLE IN ACTA ODONTOL SCAND.

IMPROVEMENT IN QUALITY OF LIFE WITH TMD TREATMENT HAS RECENTLY BEEN PUBLISHED. THIS STUDY USED EVIDENCED BASED ARTICLES FROM Medline and Cochrane Library databases. This severely limited the number of studies considered and eliminates publications of exciting clinical work and case reports. This type of search tends toward bias toward drug therapy.

The study showed almost universal improvement in the quality of life with TMD treatment. The twelve papers reviewed showed that the more symptoms and the worse the condition was to begin with the greater the improvement in the quality of life. These results are unmatched in most of medicine where even a 50% improverment is touted. Men and women appeared to improve equally.

The study concluded that: "The reviewed studies convincingly demonstrated that OHRQoL (quality of life) was negatively affected among TMD patients. this coincides with other known materials including Shimshak et al who published in Cranio Journal a 300% increase in medical spending in all medical fields.

An excellent article on how TMD affects the quality of life can be fond in Sleep and Health Journal at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor Neuromuscular dentistry has begun to exhibit exponential growth as measured facts are replacing opinions.


AN EXCITING NEW ARTICLE ON IMActa Odontol Scand. 2010 Mar;68(2):80-5.
Temporomandibular disorders and oral health-related quality of life. A systematic review.
Dahlström L, Carlsson GE.

Research Center, Public Dental Service, Clinic of Odontology, Göteborg, Sweden. lars.dahlstrom@vgregion.se
OBJECTIVE: Oral health-related quality of life (OHRQoL) is considered an important aspect of different oral conditions. It has also gained increased attention in temporomandibular disorders (TMDs) in recent years. The purpose of this study was to systematically review the literature on OHRQoL and TMDs. MATERIAL AND METHODS: A systematic search of the dental literature was performed using the Medline and Cochrane Library databases, supplemented by a hand search. Various combinations of search terms related to OHRQoL and TMDs were used. Among numerous titles found in Medline, abstracts and eventually full papers of potential interest were reviewed. Twelve papers fulfilled the inclusion criteria and were included in the review. RESULTS: Most studies used the Oral Health Impact Profile, an instrument with good psychometric properties, for evaluation. All articles described a substantial impact on OHRQoL in TMD patients. Only a small proportion of all patients, a few percent, reported no impact at all. The difference between men and women was small and not significant. The impact appeared to be more pronounced in patients with more signs and symptoms. The perceived impact of pain on OHRQoL seems to be substantial. Two studies found that the impact increased with age among TMD patients. CONCLUSIONS: The reviewed studies convincingly demonstrated that OHRQoL was negatively affected among TMD patients.

PMID: 20141363 [PubMed - in process]