POSTUROLOGY BRINGS TOGETHER OF OF THE GROUPS WHO WORK WITH MUSCLES, BONES, JOINTS, POSTURE, BITES, LEGS AND FEET. CHIROPRACTERS, OSTEOPATHS, DENTISTS, MASSAGE THERAPISTS, EXERCISE THERAPISTS AND OTHER THAT DO MANUAL BODY WORK MEET ON COMMON GROUND.
WHAT MANY OF THESE OTHER SPECIALTIES MISS THAT IS WELL UNDERSTOOD BY NEUROMUSCULAR DENTISTS IS THE IMPORTANCE OF AIRWAY AND BREATHING DURING WAKING HOURS AND DURING SLEEP.
PARADOXICAL BREATHING DESTROYS NORMAL POSTURE AS DOES A DEVIATE SWALLOW. THESE SAME PATIENTS FREQUENTLY HAVE SNORING AND SLEEP APNEA DURING THE NIGHT.
POSTUROLOGY AND BREATHING CORRECTLY DURING SLEE AND AWAKE HOURS CAN HAVE AN INCREDIBLY POWERFUL EFFECT ON OVERALL HEALTH.
CHECK OUT MY I HATE CPAP.COM SITE TO UNDERSTAND HOW TMJ AND BREATHING ARE INTIMATELY CONNECTED.
Monday, May 30, 2011
SEVERE HEADACHES, MIGRAINES, FACIAL PAIN or TMD RELIEF : DR SHAPIRA CAN ARRANGE THREE DAY EVALUATION AND TREATMENT APPOINTMENT IN HIS OFFICE.
DON'T KNOW WHERE TO GO FOR PAIN RELIEF?
I frequently receive requests for referrals from across the country for patients with severe pain problems. While I usually try to find a Neuromuscular Dentist close to where you live some patients need more a very experienced practioner. I have been treating chronic pain for over 34 years since graduating dental school. While in school I was a pain patient and often experienced severe headaches and facial pain that even excessive doses of Fiorinal #3 did not touch.
Some patients who have been in severe pain want relief as soon as possible and I understand wanting to experience relief as soon as possible. A "JUMP START" appointment in my office is possible. My team can arrange a 3 day visit where we start with diagnostics on the first morning and deliver a neuromuscular orthotic in the afternoon. We can utilize SPG blocks, trigger point injections and other modalities to achieve rapid results.
I work with Dr Mark Freund who can arrange for an Atlas Axis evaluation and do Atlas-Orthogonol adjustments, if indicated.
Prior to making an appointment I require that patients submit an extensive history as well as fill out some forms.
I like patients to give me a complete history of their pain, what age it started, any history of trauma and/or surgical proceedures as well as a list of previous treatments, length of treatment and success of treatment. I will personally review this information before you are accepted as a patient. I see a maximum of two patients/month for "JUMP START" treatment due to time and scheduling constraints.
My team will arrange for a convenient hotel near the office. This is the same hotel I use for doctors and their teams when I give course. My patients fly in Sunday I meet with them at 8 AM and do an exam followed by a neuromuscular work-up. This takes approximately 4 hours. I then customize a Diagnostic Neuromuscular Orthotic in the afternoon.
I clearly want all patients to understand that there are no guarantees of success.
If we are successful in eliminating or relieving your pain and dysfunction significantly and you believe that you are substantially improved we will schedule ongoing visits as needed. The Diagnostic Orthotic is for initial treatment, healing and short-term stabilization. Long term stabilization is frequently required and can take many different forms. These alternatives will be discussed but may take many forms such as long-term orthotics, orthodontics, reconstruction, surgery. Each patient is unique so your treatment will be customized for you.
I frequently receive requests for referrals from across the country for patients with severe pain problems. While I usually try to find a Neuromuscular Dentist close to where you live some patients need more a very experienced practioner. I have been treating chronic pain for over 34 years since graduating dental school. While in school I was a pain patient and often experienced severe headaches and facial pain that even excessive doses of Fiorinal #3 did not touch.
Some patients who have been in severe pain want relief as soon as possible and I understand wanting to experience relief as soon as possible. A "JUMP START" appointment in my office is possible. My team can arrange a 3 day visit where we start with diagnostics on the first morning and deliver a neuromuscular orthotic in the afternoon. We can utilize SPG blocks, trigger point injections and other modalities to achieve rapid results.
I work with Dr Mark Freund who can arrange for an Atlas Axis evaluation and do Atlas-Orthogonol adjustments, if indicated.
Prior to making an appointment I require that patients submit an extensive history as well as fill out some forms.
I like patients to give me a complete history of their pain, what age it started, any history of trauma and/or surgical proceedures as well as a list of previous treatments, length of treatment and success of treatment. I will personally review this information before you are accepted as a patient. I see a maximum of two patients/month for "JUMP START" treatment due to time and scheduling constraints.
My team will arrange for a convenient hotel near the office. This is the same hotel I use for doctors and their teams when I give course. My patients fly in Sunday I meet with them at 8 AM and do an exam followed by a neuromuscular work-up. This takes approximately 4 hours. I then customize a Diagnostic Neuromuscular Orthotic in the afternoon.
I clearly want all patients to understand that there are no guarantees of success.
If we are successful in eliminating or relieving your pain and dysfunction significantly and you believe that you are substantially improved we will schedule ongoing visits as needed. The Diagnostic Orthotic is for initial treatment, healing and short-term stabilization. Long term stabilization is frequently required and can take many different forms. These alternatives will be discussed but may take many forms such as long-term orthotics, orthodontics, reconstruction, surgery. Each patient is unique so your treatment will be customized for you.
Sunday, May 29, 2011
POSTUROLOGY AND TMD (TMJ) DISORDERS: WHY THIS IS IMPORTANT TO PATIENTS WITH CHRONIC DAILY HEADACHES, MIGRAINES AND TENSION-TYPE HEADACHES.
THE JAW IS ESSENTIAL IN THE REGULATION OF NORMAL BODY POSTURE. THE SWALLOW SERVES AS A NEUROMUSCULAR RESETTING MECHANISM THAT CAN CORRECT OR CAUSE POSTURAL PROBLEMS THROUGHOUT THE ENTIRE BODY.
THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.
THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.
IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.
THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.
ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"
UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.
NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.
THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,
THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.
FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.
THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.
Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.
PMID: 16128357 [PubMed - indexed for MEDLINE]
THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.
THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.
IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.
THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.
ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"
UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.
NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.
THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,
THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.
FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.
THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.
Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.
PMID: 16128357 [PubMed - indexed for MEDLINE]
TMJ disorders, headaches and facial pain frequently involve cervical musculature. Acute pain relief is accomplished with cervical muscle injection
An article (pubmed abstract below) in the Journal of Orofacial Pain. "Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients." dicusses the use of cevical intramuscular injections to turn off acute pain in the ER. The study showed that 94% of patients had complete of partial relief with injection of a long acting anaesthetic.
There is a connection between the jaw and the neck that is incredibly important in the treatment of muscular headaches, facial pain, migraines, chronic daily headaches and TMJ disorders (TMD). The jaw acts as a counter-balance to the head and allows maintenance of head posture minimal excessive muscle adaptation. This is well described mathematically in engineering terms in the "Quadrant Theorem of Guzay". The jaw position is vital to body posture and abberations in jaw position can act as a descending disorder that can effect the entire body.
Forward head posture is frequently seen in TMJ and Headache patients. This forward posture cause exponential increases in muscle work just to maintain head posture.
Rcobado estimated that it takes double the muscle work from cervical muscles to low back for every centimeter of forward head posture, Three centimeters forward head posture would increase chronic muscle adaptation 8 fold (2X2X2=8) while a 5 centimeter forward head posture would increase it 32 times (2X2X2X2X2=32). The reason muscular injections work so well in relieving acute and chronic headaches and facial pain is that these muscles are grossly overworked in TMD patients.
Treating the muscles can give relief of acute pain but returning the system to a more normal physiologic state can give long term relief to patients.
A diagnostic neuromuscular orthotic allows the jaw to function in an ideal physiologic position. This allows gradual restoration of normal head posture and a return to normal physiologic function of the neck. I work closely with Atlas Orthogonal and/or NUCCA Chiropracters to correct the first two vertebrae early in treatment. These areas are especially prone to problems in TMD patients. As the foward head posture occurs the patient must rotate their head on the Atlas and Axis (first to vertebrae) to maintain sight lines. This is well explained by the Quadrant Theorem of Guzay which shows that the actual center of rotation for the jaw when both rotation and traslation movements are calculated is on the odontoid process of the Axis (2nd vertebrae)
Patients with TMD who are in car accidents never recover fully if their jaw issues are not addressed.
Posturology is the study of whole body posture. Posturology recognizes the importance of the jaw position. The normal swallow is a neuromuscular resetting procedure but most TMD patients have deviant or reversed swallows and are not even aware they swallow wrong. This can lead to GI problems but is primarily a structural problems that makes long term successful treatment of pain impossible without correction of neuromuscular jaw issues. A diagnostic orthotic allows patients to experience relief of head and neck pain prior to and permenant occlusal alterations.
J Orofac Pain. 2008 Winter;22(1):57-64.
Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients.
Mellick LB, Mellick GA.
Source
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA. lmellick@mcg.edu
Abstract
AIMS:
To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.
METHODS:
A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.
RESULTS:
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.
CONCLUSION:
This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.
There is a connection between the jaw and the neck that is incredibly important in the treatment of muscular headaches, facial pain, migraines, chronic daily headaches and TMJ disorders (TMD). The jaw acts as a counter-balance to the head and allows maintenance of head posture minimal excessive muscle adaptation. This is well described mathematically in engineering terms in the "Quadrant Theorem of Guzay". The jaw position is vital to body posture and abberations in jaw position can act as a descending disorder that can effect the entire body.
Forward head posture is frequently seen in TMJ and Headache patients. This forward posture cause exponential increases in muscle work just to maintain head posture.
Rcobado estimated that it takes double the muscle work from cervical muscles to low back for every centimeter of forward head posture, Three centimeters forward head posture would increase chronic muscle adaptation 8 fold (2X2X2=8) while a 5 centimeter forward head posture would increase it 32 times (2X2X2X2X2=32). The reason muscular injections work so well in relieving acute and chronic headaches and facial pain is that these muscles are grossly overworked in TMD patients.
Treating the muscles can give relief of acute pain but returning the system to a more normal physiologic state can give long term relief to patients.
A diagnostic neuromuscular orthotic allows the jaw to function in an ideal physiologic position. This allows gradual restoration of normal head posture and a return to normal physiologic function of the neck. I work closely with Atlas Orthogonal and/or NUCCA Chiropracters to correct the first two vertebrae early in treatment. These areas are especially prone to problems in TMD patients. As the foward head posture occurs the patient must rotate their head on the Atlas and Axis (first to vertebrae) to maintain sight lines. This is well explained by the Quadrant Theorem of Guzay which shows that the actual center of rotation for the jaw when both rotation and traslation movements are calculated is on the odontoid process of the Axis (2nd vertebrae)
Patients with TMD who are in car accidents never recover fully if their jaw issues are not addressed.
Posturology is the study of whole body posture. Posturology recognizes the importance of the jaw position. The normal swallow is a neuromuscular resetting procedure but most TMD patients have deviant or reversed swallows and are not even aware they swallow wrong. This can lead to GI problems but is primarily a structural problems that makes long term successful treatment of pain impossible without correction of neuromuscular jaw issues. A diagnostic orthotic allows patients to experience relief of head and neck pain prior to and permenant occlusal alterations.
J Orofac Pain. 2008 Winter;22(1):57-64.
Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients.
Mellick LB, Mellick GA.
Source
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA. lmellick@mcg.edu
Abstract
AIMS:
To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.
METHODS:
A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.
RESULTS:
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.
CONCLUSION:
This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.
Severe Continuous Headache. Look for Trigeminal Nerve involvement
DIANA: Hi, for the past 2 1/2 weeks, I am experiencing major headaches about every other day. They are always right in the center of my head and don't go away unless I take a strong Ibuprofen dosage. And sometimes come back a few hours later. Sometimes I don't get them until night time, but I have woken up with them occasionally. I suffer from migraines off an on ,but typically that would be once every couple of months. Never this often. I'm also extremely exhausted all day long. I wake up tired, and I go to bed tired. Also experiencing a lot of anxiety, more so than normal which was triggered around the same time. I don't feel depressed so I don't think it's that, but I'm not sure. Not sure what triggered all of this, but I can't get over it. My doc did blood work on my thyroid, vit D, and one other thing (I can't remember) and it was all normal. She wanted me to take migraine medicine to stop the headaches but I wasn't comfortable taking it. Plus I wanted to find out why it was happening, not just take the pain away. I'm scared it may be a tumor or something similar. I'm 29 and have 2 small children.
Dr Shapira response: Diana,
I am sorry to hear you are having some much pain. Checking thyroid function is a good step, but it is important to look not just if you are in the normal range but where in the range are your numbers. Normal is a range for a population not an individual. If you are at the bottom of the normal range it could still be a problem.
I would suggest having a sleep study since your tiredness is a major problem.
I obviously cannot diagnose on the internet but frequently neuromuscular dentists use "spray and stretch techniques" that can quickly relieve the pain and diagnose a muscular orgin. I normally start with a consultation and can relieve most pain using those techniques, This helps to understand where the pain is coming from.
Other possible treatments to stop a continuous headache are SPG blocks that work well for autonomic pain and trigger point injections. Stopping the pain is usually easy but more importantly it lets us understand where it is coming from and learn more about the nature of the pain.
There is very little history to this pain, and I would like to know much more about the onset and any unusual events a week or two before it began.
An aqualizer oral appliance is also an inexpensive way to evaluate whether the pain is jaw related.
Most of my patients are fitted with a 24 hour diagnostic orthotic if it appears there is trigeminal nerve involvement in the headache. This is true for the majority of severe continuous headaches as well as headaches and migraines in general
;
Dr Shapira response: Diana,
I am sorry to hear you are having some much pain. Checking thyroid function is a good step, but it is important to look not just if you are in the normal range but where in the range are your numbers. Normal is a range for a population not an individual. If you are at the bottom of the normal range it could still be a problem.
I would suggest having a sleep study since your tiredness is a major problem.
I obviously cannot diagnose on the internet but frequently neuromuscular dentists use "spray and stretch techniques" that can quickly relieve the pain and diagnose a muscular orgin. I normally start with a consultation and can relieve most pain using those techniques, This helps to understand where the pain is coming from.
Other possible treatments to stop a continuous headache are SPG blocks that work well for autonomic pain and trigger point injections. Stopping the pain is usually easy but more importantly it lets us understand where it is coming from and learn more about the nature of the pain.
There is very little history to this pain, and I would like to know much more about the onset and any unusual events a week or two before it began.
An aqualizer oral appliance is also an inexpensive way to evaluate whether the pain is jaw related.
Most of my patients are fitted with a 24 hour diagnostic orthotic if it appears there is trigeminal nerve involvement in the headache. This is true for the majority of severe continuous headaches as well as headaches and migraines in general
;
Saturday, May 28, 2011
Chronic Headaches and facial pain are often incorrectly blamed on chronic sinusitis
TMD (TMJ) is frequntly an undiagnosed cause of Headache and Facial Pain according to an article in the Annals of Allergy, Asthma and Immunology. The article " Temporomandibular dysfunction: an often overlooked cause of chronic headaches. " is found in Ann Allergy Asthma Immunol 2007 Oct;99(4):314-8. states that
"many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy"
I have seen this frequently in patients for years who are constantly taking antibiotics for sinus infections that cause their headaches. I have found that when we place these patients in a neuromuscular diagnostic orthotic that nthe headaches subside, as do the "sinus infections" . There is tremendous danger associated with the unnecessary overuse of antibiotics.
An article in Sleep and Health Journal, "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses in detail how patients frequently have the TMD diagnosis missed leading to years of needless suffering. The article can be found at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
The article states "studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches." I believe this is grossly under-rating the frequency where TMD either causes the headache directly, is a trigger to a secondary cause of headache or is involved in increasing the degree of pain the patient suffers. Nearly all headaches and migraines are trigeminally mediated and these headaches are TMD related.
Many patients do not have joint clicking , noise , locking or pain but have muscular disorders of the stomatognathic system.
Neuromuscular dentists are a small group of highly educated dentists in the field. They are able to deal with more complex issues due to sophisticated tools such as ULF-TENS, EMG, Computerized Mandibular Scans (MKG) and Sonography or JVA.
The article concludes "The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities."
WHAT THIS MEANS IS, IF YOUR HEADACHES ARE NOT CLEARLY IDENTIFIED BY OBJECTIVE STUDIES (MRI, CST SCANS, CULTURE, BLOOD TESTS, ETC ) THAN YOU SHOULD BE EVALUATED FOR TMD.
A Neuromuscular Dentist is probably an excellent starting point for patients with chronic daily headaches, sinus headaches and migraines which do not have objective causes identified by medical testing.
Ann Allergy Asthma Immunol. 2007 Oct;99(4):314-8.
Temporomandibular dysfunction: an often overlooked cause of chronic headaches.
Lupoli TA, Lockey RF.
Source
Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, University of South Florida College of Medicine, James A. Haley Veteran's Hospital, Tampa, Florida 33612, USA. tlupoli@hsc.usf.edu
Abstract
OBJECTIVE:
To review and discuss the role of temporomandibular dysfunction (TMD) as a cause of chronic headaches and facial pain.
DATA SOURCES AND STUDY SELECTION:
A literature review was performed using the PubMed database for English-language articles published between January 1, 1981, and August 31, 2006, using the following keywords: temporomandibular dysfunction, temporomandibular disorder, temporomandibular joint, and chronic headache. Additional information was obtained from a review of current medical texts.
RESULTS:
Allergists and immunologists are frequently called on to evaluate patients with chronic headaches and facial pain. TMD is known to cause recurrent facial discomfort and headaches. Many individuals with the disorder present with headache or facial discomfort as their only chief complaint. They mistakenly think it is a "sinus" headache. Nearly 10 million Americans are affected by the disorder, and early studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches.
CONCLUSIONS:
TMD is a likely underdiagnosed cause of chronic headache and facial discomfort. As such, many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy. TMD can be readily diagnosed by a careful history and physical examination. Patients typically respond well to conservative therapy, which includes behavioral modification and nonsteroidal anti-inflammatory drugs. The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities.
PMID: 17941277 [PubMed - indexed for MEDLINE]
"many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy"
I have seen this frequently in patients for years who are constantly taking antibiotics for sinus infections that cause their headaches. I have found that when we place these patients in a neuromuscular diagnostic orthotic that nthe headaches subside, as do the "sinus infections" . There is tremendous danger associated with the unnecessary overuse of antibiotics.
An article in Sleep and Health Journal, "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" discusses in detail how patients frequently have the TMD diagnosis missed leading to years of needless suffering. The article can be found at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
The article states "studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches." I believe this is grossly under-rating the frequency where TMD either causes the headache directly, is a trigger to a secondary cause of headache or is involved in increasing the degree of pain the patient suffers. Nearly all headaches and migraines are trigeminally mediated and these headaches are TMD related.
Many patients do not have joint clicking , noise , locking or pain but have muscular disorders of the stomatognathic system.
Neuromuscular dentists are a small group of highly educated dentists in the field. They are able to deal with more complex issues due to sophisticated tools such as ULF-TENS, EMG, Computerized Mandibular Scans (MKG) and Sonography or JVA.
The article concludes "The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities."
WHAT THIS MEANS IS, IF YOUR HEADACHES ARE NOT CLEARLY IDENTIFIED BY OBJECTIVE STUDIES (MRI, CST SCANS, CULTURE, BLOOD TESTS, ETC ) THAN YOU SHOULD BE EVALUATED FOR TMD.
A Neuromuscular Dentist is probably an excellent starting point for patients with chronic daily headaches, sinus headaches and migraines which do not have objective causes identified by medical testing.
Ann Allergy Asthma Immunol. 2007 Oct;99(4):314-8.
Temporomandibular dysfunction: an often overlooked cause of chronic headaches.
Lupoli TA, Lockey RF.
Source
Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, University of South Florida College of Medicine, James A. Haley Veteran's Hospital, Tampa, Florida 33612, USA. tlupoli@hsc.usf.edu
Abstract
OBJECTIVE:
To review and discuss the role of temporomandibular dysfunction (TMD) as a cause of chronic headaches and facial pain.
DATA SOURCES AND STUDY SELECTION:
A literature review was performed using the PubMed database for English-language articles published between January 1, 1981, and August 31, 2006, using the following keywords: temporomandibular dysfunction, temporomandibular disorder, temporomandibular joint, and chronic headache. Additional information was obtained from a review of current medical texts.
RESULTS:
Allergists and immunologists are frequently called on to evaluate patients with chronic headaches and facial pain. TMD is known to cause recurrent facial discomfort and headaches. Many individuals with the disorder present with headache or facial discomfort as their only chief complaint. They mistakenly think it is a "sinus" headache. Nearly 10 million Americans are affected by the disorder, and early studies estimate that TMD pain is the cause of chronic headaches in 14% to 26% of individuals with recurrent headaches.
CONCLUSIONS:
TMD is a likely underdiagnosed cause of chronic headache and facial discomfort. As such, many patients with the disorder are routinely mislabeled as experiencing chronic sinusitis and are unnecessarily subjected to multiple courses of broad-spectrum antibiotics and other unnecessary therapy. TMD can be readily diagnosed by a careful history and physical examination. Patients typically respond well to conservative therapy, which includes behavioral modification and nonsteroidal anti-inflammatory drugs. The disorder should be suspected in individuals with a long-standing history of chronic daily headaches and facial pain without objective evidence of sinus, neurologic, or intracranial abnormalities.
PMID: 17941277 [PubMed - indexed for MEDLINE]
Thursday, May 26, 2011
MIGRAINE TREATMENT WITHOUT DRUGS. MIGRAINES ARE USUALLY RELATED TO THE TRIGEMINAL NERVES, THE BEST TREATMENT IS TO CORRECT NEURAL INPUT.
There are many different kinds of Migraines and headaches. They all share the same basic features, a common pattern that is frequently seen with migraine is an initial dull ache that develops into a constant, throbbing and pulsating pain that can be experienced in the temples, front or back of one side (or both sides)of the head. The pain is usually accompanied by nausea and vomiting, and sensitivity to light and noise.
A common factor in almost all headaches and migraines is the involvement of the Trigeminal Nerve. Treating migraines and other headaches without drugs can frequently be easily accomplished by changing the neural input into the trigeminal nervous system. TMJ disorders (TMD) are often called "The Great Imposter" I strongly recommend that anyone who suffers from Migraines, Tension-Type Headaches, Chronic Daily Headaches or other chronic head and neck pain read
"SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
Two of the most common types of migraine are "migraine with aura" or "Classic Migraine" and "migraine without aura" or "common migraine".
Frequently patients with severe headaches are diagnosed as having "migraine" when they actually have a severe tension headache, muscular headache or cervicogenic headache which can present as a migraine. Many patients and physicians can are fooled into thinking every severe headache is a migraine. Severe headaches are frequently neuromuscular in orgin and easy to alleviate or eliminate. This can lead to the wrong treatments being utilized that while helpful they are not ideal and can increase headache frequency and/or drug overuse.
Rebound headaches and drug overuse headaches are among the most difficult to treat because in addition to the original problems we now are also dealing with a medication caused disorder.
The Common Migraine or Migraine without Aura
because the headache is associated with changes in the size of the arteries inside the skull and in the head and neck. The blood flow to the anterior two thirds of the meninges of the brain is controlled by the trigeminal nerve and this type of headache can frequently be eliminated without drugs with a neuromuscular orthotic that stops the nociceptive input to the brain from the fifth cranial nerve or trigeminal nerve. Neuromuscular Dentistry is most effective when it is ussed to intervene before the pre-headache phase when blood vessels constrict; at the time vascular dilation occurs the migraine begins. The The inflamed as well as swollen blood vessels are believed to be the cause of migraine pain and are caused by neurally mediated inflammationand by increasing the pressure on the swollen walls of the blood vessels. Neuromuscular Dentistry is more effective at preventing or eliminating migraines then a stopping them in the middle of an acute attack.
Migraine sufferers may experience only occasional episodes while others have repetitive migraines two to four times per month. Other patients can get continuous migraines that very in intensity. Most migraine headaches last at least four hours, although very severe ones can last up to a week. I recently treated the wife of a physician who had a continuous headache for over 50 years that was eliminated after only two visits. This is unusual but not unheard of when utilizing neuromuscular dental orthotics. Headaches may begin at any time of the day or night; but when they has a TMJ (TMD) disorder and/or sleep apnea. Migraines rarely awaken a person from sleep but morning headaches frequently can convert into full blown migraines. These morning migraines are especially easy to treat with a neurmucular diagnostic orthotic.
Classic Migraine or Migraine with Aura are about a third of the migraine population. These are also trigeminally innervated migraines and when treated by a neuromuscular orthotic may give a different response. I have seen patients who still experience the aura but the pain never follows. Depending on the triggers that percipitate the migraines the orthotic will often decrease the severity and frequency of these headaches but not completely eliminate them
Migraine sufferers frequently experience visual problems during the headache. Migraine that begins with an aura is usually a manifestation of neurological symptoms. These symptoms are most frequently associated with the trigeminal nerve and the aura begins from five to thirty minutes before the actual onset of the headache. Neuromuscular dentists will frequently use Sphenopalatine ganglion blocks to head off this type of migraine before it hits. Once these migrines are in full swing standard migraine medications are the best way to limit and control pain.
I usually will teach patients how to self administer SPG blocks (sphenopalatine ganglion blocks) with local anaesthetic intranasally applied with a Q-tip. Patients may see wavy or jagged lines,wierdly moving blobs reminescent of Lava lamps, squiggles, worms, polka dots or strobe like flashing lights. Any time patients have flashing lights in their eyes they must consider the possibility of a detatched retina. Other symptoms include tunnel vision or blind spots in one or both eyes or vision going black and white and dimming that is similar to being lost in the fog.
Auras can also be non-visual in nature and can involve sounds , dizziness or strange bodily aches or the feeling like something is crawling thru you. It is not uncommon for smells and tastes to be part of an aura and some patients report that the Aura sonunds , tastes and odors can percipitate attacks when they are encountered in real life.
Feelings of numbness or a "pins-and-needles" sensation as well as difficulty in recalling or speaking the correct word can be experienced with migraine but can also be neurological symptoms of a stroke and must be considered serious at all times. Other less common types of migraine include Hemiplegic Migraine, Ophthalmoplegic Migraine, Retinal Migraine, Basilar Artery Migraine and Abdominal Migraine
Many of these other types of migraines can be very difficult to diagnose but it is important to remember they are are mediated by the Trigeminal nervous system and may respond well to treatment with a neuromuscular diagnostic orthotic which can eliminate or drastically decrease both frequency and severity.
A common factor in almost all headaches and migraines is the involvement of the Trigeminal Nerve. Treating migraines and other headaches without drugs can frequently be easily accomplished by changing the neural input into the trigeminal nervous system. TMJ disorders (TMD) are often called "The Great Imposter" I strongly recommend that anyone who suffers from Migraines, Tension-Type Headaches, Chronic Daily Headaches or other chronic head and neck pain read
"SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
Two of the most common types of migraine are "migraine with aura" or "Classic Migraine" and "migraine without aura" or "common migraine".
Frequently patients with severe headaches are diagnosed as having "migraine" when they actually have a severe tension headache, muscular headache or cervicogenic headache which can present as a migraine. Many patients and physicians can are fooled into thinking every severe headache is a migraine. Severe headaches are frequently neuromuscular in orgin and easy to alleviate or eliminate. This can lead to the wrong treatments being utilized that while helpful they are not ideal and can increase headache frequency and/or drug overuse.
Rebound headaches and drug overuse headaches are among the most difficult to treat because in addition to the original problems we now are also dealing with a medication caused disorder.
The Common Migraine or Migraine without Aura
because the headache is associated with changes in the size of the arteries inside the skull and in the head and neck. The blood flow to the anterior two thirds of the meninges of the brain is controlled by the trigeminal nerve and this type of headache can frequently be eliminated without drugs with a neuromuscular orthotic that stops the nociceptive input to the brain from the fifth cranial nerve or trigeminal nerve. Neuromuscular Dentistry is most effective when it is ussed to intervene before the pre-headache phase when blood vessels constrict; at the time vascular dilation occurs the migraine begins. The The inflamed as well as swollen blood vessels are believed to be the cause of migraine pain and are caused by neurally mediated inflammationand by increasing the pressure on the swollen walls of the blood vessels. Neuromuscular Dentistry is more effective at preventing or eliminating migraines then a stopping them in the middle of an acute attack.
Migraine sufferers may experience only occasional episodes while others have repetitive migraines two to four times per month. Other patients can get continuous migraines that very in intensity. Most migraine headaches last at least four hours, although very severe ones can last up to a week. I recently treated the wife of a physician who had a continuous headache for over 50 years that was eliminated after only two visits. This is unusual but not unheard of when utilizing neuromuscular dental orthotics. Headaches may begin at any time of the day or night; but when they has a TMJ (TMD) disorder and/or sleep apnea. Migraines rarely awaken a person from sleep but morning headaches frequently can convert into full blown migraines. These morning migraines are especially easy to treat with a neurmucular diagnostic orthotic.
Classic Migraine or Migraine with Aura are about a third of the migraine population. These are also trigeminally innervated migraines and when treated by a neuromuscular orthotic may give a different response. I have seen patients who still experience the aura but the pain never follows. Depending on the triggers that percipitate the migraines the orthotic will often decrease the severity and frequency of these headaches but not completely eliminate them
Migraine sufferers frequently experience visual problems during the headache. Migraine that begins with an aura is usually a manifestation of neurological symptoms. These symptoms are most frequently associated with the trigeminal nerve and the aura begins from five to thirty minutes before the actual onset of the headache. Neuromuscular dentists will frequently use Sphenopalatine ganglion blocks to head off this type of migraine before it hits. Once these migrines are in full swing standard migraine medications are the best way to limit and control pain.
I usually will teach patients how to self administer SPG blocks (sphenopalatine ganglion blocks) with local anaesthetic intranasally applied with a Q-tip. Patients may see wavy or jagged lines,wierdly moving blobs reminescent of Lava lamps, squiggles, worms, polka dots or strobe like flashing lights. Any time patients have flashing lights in their eyes they must consider the possibility of a detatched retina. Other symptoms include tunnel vision or blind spots in one or both eyes or vision going black and white and dimming that is similar to being lost in the fog.
Auras can also be non-visual in nature and can involve sounds , dizziness or strange bodily aches or the feeling like something is crawling thru you. It is not uncommon for smells and tastes to be part of an aura and some patients report that the Aura sonunds , tastes and odors can percipitate attacks when they are encountered in real life.
Feelings of numbness or a "pins-and-needles" sensation as well as difficulty in recalling or speaking the correct word can be experienced with migraine but can also be neurological symptoms of a stroke and must be considered serious at all times. Other less common types of migraine include Hemiplegic Migraine, Ophthalmoplegic Migraine, Retinal Migraine, Basilar Artery Migraine and Abdominal Migraine
Many of these other types of migraines can be very difficult to diagnose but it is important to remember they are are mediated by the Trigeminal nervous system and may respond well to treatment with a neuromuscular diagnostic orthotic which can eliminate or drastically decrease both frequency and severity.
Wednesday, May 25, 2011
Libertyville: TMJ Problems, Learn how Neuromuscular Dentistry can alleviate or eliminate your pain. Learn how Neuromuscular Dentistry can change you
TMJ disorders can cause sever migraines, facial pain, tension-type headaches as well as diverse symptoms like tinnitus, sinus pain and pressure, dizziness and neck pain.
Patients frequently spend years looking for an answer to their pain. All patients with chronic head and neck pain should read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal. Don't suffer needlessly.
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
I have been changing lives for years treating TMJ, Sleep and headache disorders wih neuromuscular dentistry. Ibegan utilizing the power of Neuromuscular Dentistry in 1980 to improve my patients lives.
Patients frequently spend years looking for an answer to their pain. All patients with chronic head and neck pain should read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" in Sleep and Health Journal. Don't suffer needlessly.
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
I have been changing lives for years treating TMJ, Sleep and headache disorders wih neuromuscular dentistry. Ibegan utilizing the power of Neuromuscular Dentistry in 1980 to improve my patients lives.
Intense Migraines: Trigeminal Neuralgia, Trigeminal Neuropathy or a simple problem best addressed through Neuromuscular Dentistry and an orthotic.
Carolyn: Intense migrane headaches with jaw, neck, shoulder, face, sinues,eye and ear pain, also numb feeling on face. I had MRI's done of my head and neck and was diagnosed with Trigeminal Neuralgia, seeked Gamma Knife, was told I wasn't a canidate and to have an MRI of my neck, had that done, nothing showed up, then was told I had Trigeminal Neuropothy. I was diagnosed with TMJ a long time ago and had a mouth piece...it didn't do much and as time went on things got worse. I am convienced that my problem is with the Tri nerves and TMJ...no doctor has caught on. I am at my wits end and need to find out what is wrong with my neck and face. Please help me in finding a doctor who could figure out my problem. Thank you!!
Dr Shapira response: Carolyn, I am sorry your life is being destroyed by what sounds like horrible pain. I would strongly suggest avoiding Gamma Knife surgery as a first line treatment.
You did not mention trying non-invasive or minimally invasive treatment such as massage therapy, chiropractic adjustment or Ice Down Therapy which can be helpful. The beauty of Neuromuscular Dentistry is that results can be rapid, amazing and life changing in just a few visits. I would suggest starting with very simple diagnostic evaluation such as spray and stretch with vapo-coolant for myofascial pain, trigger point injections SPG blocks and most importantly a diagnostic neuromuscular orthotic.
I frequently see long distance patients and we can sometimes produce amazing results in just wo to three days of intensive therapy. We do our consultation , work-up and exam the morning of the first day and deliver an orthotic that afternoon. We deactivate trigger point injections with spray and stretch techniques as described by Dr Janet Travell. The second morning we adjust the appliance and do diagnostic/treatment trigger points and blocks and adjust again that afternoon. I work closely with an Atlas orthoganol DC who can address the cervical vertebrae during your stay.
There is no "CURE" for these problems but rapid relief is possible and the orthotic lets you maintain comfort. A real "CURE" would mean you could get back the years you lost to pain, reverse the effects on your life, your relationships and your family. The best we can do is give you a brighter future.
All of the symptoms you descibed are why TMJ disorders are called "The Great Imposter"
Read "Suffer No More: Dealing With The Great Imposter" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
Contact my office if you would like to schedule a 3 day series of appointments for rapid evaluation and treatment or I will try to find you a knowledgable doctor in your area.
Dr Shapira response: Carolyn, I am sorry your life is being destroyed by what sounds like horrible pain. I would strongly suggest avoiding Gamma Knife surgery as a first line treatment.
You did not mention trying non-invasive or minimally invasive treatment such as massage therapy, chiropractic adjustment or Ice Down Therapy which can be helpful. The beauty of Neuromuscular Dentistry is that results can be rapid, amazing and life changing in just a few visits. I would suggest starting with very simple diagnostic evaluation such as spray and stretch with vapo-coolant for myofascial pain, trigger point injections SPG blocks and most importantly a diagnostic neuromuscular orthotic.
I frequently see long distance patients and we can sometimes produce amazing results in just wo to three days of intensive therapy. We do our consultation , work-up and exam the morning of the first day and deliver an orthotic that afternoon. We deactivate trigger point injections with spray and stretch techniques as described by Dr Janet Travell. The second morning we adjust the appliance and do diagnostic/treatment trigger points and blocks and adjust again that afternoon. I work closely with an Atlas orthoganol DC who can address the cervical vertebrae during your stay.
There is no "CURE" for these problems but rapid relief is possible and the orthotic lets you maintain comfort. A real "CURE" would mean you could get back the years you lost to pain, reverse the effects on your life, your relationships and your family. The best we can do is give you a brighter future.
All of the symptoms you descibed are why TMJ disorders are called "The Great Imposter"
Read "Suffer No More: Dealing With The Great Imposter" in Sleep and Health Journal http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
Contact my office if you would like to schedule a 3 day series of appointments for rapid evaluation and treatment or I will try to find you a knowledgable doctor in your area.
Friday, May 20, 2011
Cervicogenic Headache and TMD (TMJ): Treatment of TMD Improves Treatment Outcomes of Cervicogenic Headaches
A recent article on cervicogenic headaches published in Cranio (abstract below)titled "Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study." reports on treatment effectiveness being improved when the THJ component are also treated. Even more exciting is that long term improvement in the neck problems were tied to treating the TMD.
This makes perfect sense. The quadrant Theorem of Guszay showed that the center of rotation for the mandible (lower jay) was on the odontoid process of the second vertebrae. The lower jaw actually acts like a counterbalance to the head. As jaw position is corrected less muscle adaptation is required to maintain your head posture reulting in decreased muscle pain, decreased cervicogenic headaches and improved balance and posture.
Cranio. 2011 Jan;29(1):43-56.
Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study.
von Piekartz H, Lüdtke K.
Source
Faculty of Business, Management and Social Science, University of Applied Science, Osnabruck, Germany. H.von-Piekartz@hs-osnabrueck.de
Abstract
The present study was comprised of 43 patients (16 men) with cervicogenic headaches for over three months, diagnosed according to the International Classification of Diagnostic Criteria of Headaches (ICDH-II). The patients were randomly assigned to receive either manual therapy for the cervical region (usual care group) or additional manual therapy techniques to the temporomandibular region to additionally influence temporomandibular disorders (TMD). All patients were assessed prior to treatment, after six sessions of treatment, and at a six-month follow-up. The outcome criteria were: intensity of headaches measured on a colored analog scale, the Neck Disability Index (Dutch version), the Conti Anamnestic Questionnaire, noise registration at the mandibular joint using a stethoscope, the Graded Chronic Pain Status (Dutch version), mandibular deviation, range of mouth opening, and pressure/pain threshold of the masticatory muscles. The results indicate in the studied sample of cervicogenic headache patients, 44.1% had TMD. The group that received additional temporomandibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period. These improvements persisted during the treatment-free period (follow-up) and were not observed in the usual care group. This trend was also reflected on the questionnaires and the clinical temporomandibular signs. Based on these observations, we strongly believe that treatment of the temporomandibular region has beneficial effects for patients with cervicogenic headaches, even in the long-term.
PMID:
21370769
[PubMed - indexed for MEDLINE]
This makes perfect sense. The quadrant Theorem of Guszay showed that the center of rotation for the mandible (lower jay) was on the odontoid process of the second vertebrae. The lower jaw actually acts like a counterbalance to the head. As jaw position is corrected less muscle adaptation is required to maintain your head posture reulting in decreased muscle pain, decreased cervicogenic headaches and improved balance and posture.
Cranio. 2011 Jan;29(1):43-56.
Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study.
von Piekartz H, Lüdtke K.
Source
Faculty of Business, Management and Social Science, University of Applied Science, Osnabruck, Germany. H.von-Piekartz@hs-osnabrueck.de
Abstract
The present study was comprised of 43 patients (16 men) with cervicogenic headaches for over three months, diagnosed according to the International Classification of Diagnostic Criteria of Headaches (ICDH-II). The patients were randomly assigned to receive either manual therapy for the cervical region (usual care group) or additional manual therapy techniques to the temporomandibular region to additionally influence temporomandibular disorders (TMD). All patients were assessed prior to treatment, after six sessions of treatment, and at a six-month follow-up. The outcome criteria were: intensity of headaches measured on a colored analog scale, the Neck Disability Index (Dutch version), the Conti Anamnestic Questionnaire, noise registration at the mandibular joint using a stethoscope, the Graded Chronic Pain Status (Dutch version), mandibular deviation, range of mouth opening, and pressure/pain threshold of the masticatory muscles. The results indicate in the studied sample of cervicogenic headache patients, 44.1% had TMD. The group that received additional temporomandibular manual therapy techniques showed significantly decreased headache intensities and increased neck function after the treatment period. These improvements persisted during the treatment-free period (follow-up) and were not observed in the usual care group. This trend was also reflected on the questionnaires and the clinical temporomandibular signs. Based on these observations, we strongly believe that treatment of the temporomandibular region has beneficial effects for patients with cervicogenic headaches, even in the long-term.
PMID:
21370769
[PubMed - indexed for MEDLINE]
Post Traumatic Stress Disorder and Migraine. Is this an example of a neuromusclar Trigeminally mediated headache?
A recent article in "Headache" dated May 17, 2011 (see abstract below) discusses migraines and PTSD. It details how these types of problems are much more common in women and suggests a sex hormonal component to the pain. The statistics are very similar to what is found in MPD (Myofascial Pain and Dysfunction) and TMJ / TMD 9Temporomandibular Dysfunction). These are also found more frequently in women and associated with Migraine, Tension-Type Headache, and Chronic Daily Headache.
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
this article actually finds a stronger association between PTSD and Migraine in men than women. TMD disorders are frequently found in women and are tied to "Chronic Stress" in particular. The differences between men and women make woomen more prone to problems related to chronic stress. There are estrogen receptors in the TMJoint and Testosterone is importand in healing and muscle repair.
Both men and women usually respond extremely well to treatment of migraines and chronic daily headache when fitted with a neuromuscular diagnostic orthotic. The psychological stress is obviously not treated by an oral appliance but when the pain is eliminate the psychological problems are much easier to treat. Pain is felt in the same area of the brain where we feel emotions and pain can be considered the most negative of all emotions. Elimination of chronic pain thru neuromuscular dentistry can increase effectiveness of PTSD treatment.
Headache. 2011 May 17. doi: 10.1111/j.1526-4610.2011.01907.x. [Epub ahead of print]
Post-Traumatic Stress Disorder and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms.
Peterlin BL, Nijjar SS, Tietjen GE.
Source
From the Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USA (B.L. Peterlin and S.S. Nijjar); Department of Neurology, University of Toledo, Toledo, OH, USA (G.E. Tietjen).
Abstract
Migraine is a common, often disabling disorder associated with a significant personal and societal burden. The presence of post-traumatic stress disorder (PTSD) may increase this disability substantially. Migraine and PTSD are both up to 3 times more common in women than in men. The divergence in prevalence rates of migraine and PTSD that occurs between the sexes after puberty suggests that gonadal hormones play an important role. In addition, the preponderance of PTSD in women may be related to their higher rates of interpersonal trauma, the most common cause of PTSD. However, recent data suggest that although the odds of PTSD are increased in both women and men with episodic migraine, this association is stronger in men than women. In this paper, we examine the epidemiology of PTSD and migraine, with an emphasis on the known sex differences. We then discuss the neurobiological changes associated with PTSD, the current hypotheses for the mechanisms relating PTSD and migraine, and the treatment implications of these findings.
© 2011 American Headache Society.
PMID:
21592096
[PubMed - as supplied by publisher]
New research on Migriane Medication focuses on Trigeminal Nerve
A recent article in Cephalgia (see abstract below) focuses on the kynurenine family of compounds which are metabolites of tryptophan in treating migraines. The use of Neuromuscular Dentistry uses neural input to correct chemical imbalances in the Trigeminal Nervous System to treat and eliminate migraines and chronic daily headaches.
The use of drugs to alter neurotransmitters has been shown to be effective but correcting the nociceptive input to the nervous system is a more effective and reliable method of treating trigeminally mediated pain.
Reports of 80-95% effectiveness in treating headaches with a neuromuscular diagnostic orthotic are common and side effects are minimum.
Correcting the problem by altering neural input is the closest to a "cure" for migraines.
Effectiveness has never been the major problem in treating Headaches, Migraines and TMJ disorders with Neuromuscular Dentistry. The problem is that while the treatment is extremely effective it is expensive and insurance companies write contracts that limit coverage. The current cost conscious environment virtually insures that patients will continue to suffer needlessly because lack of coverage puts this extremely effective treatment out of financial viability for any patients.
Patients who suffer from migraines and chronic daily headaches and can affrd neuromuscular dentistry will find it extremely effective.
A downside to neuromuscular dental treatment is that it can be time intensive especially at the start of treatment protocols.
Ending needless pain and suffering is always rewarding to both patients, friends , families and the practitioners.
Cephalalgia. 2011 May 18. [Epub ahead of print]
The L-kynurenine signalling pathway in trigeminal pain processing: A potential therapeutic target in migraine?
Guo S, Vecsei L, Ashina M.
Source
University of Copenhagen, Denmark.
Abstract
Introduction: In recent years the kynurenine family of compounds, metabolites of tryptophan, has become an area of intensive research because of its neuroactive properties. Two metabolites of this family have become of interest in relation to migraine and pain processing. Discussion: Experimental studies have shown that kynurenic acid (KYNA) plays an important role in the transmission of sensory impulses in the trigeminovascular system and that increased levels of KYNA decrease the sensitivity of the cerebral cortex to cortical spreading depression. Furthermore, another metabolite of the kynurenine family, L-kynurenine, exerts vasodilating effects similar to nitric oxide by increasing cyclic guanosine monophosphate. Conclusion: This review summarizes current knowledge of the role of kynurenine signalling in trigeminal and central pain processing, including its therapeutic prospects in migraine treatment.
PMID:
21593189
[PubMed - as supplied by publisher]
The use of drugs to alter neurotransmitters has been shown to be effective but correcting the nociceptive input to the nervous system is a more effective and reliable method of treating trigeminally mediated pain.
Reports of 80-95% effectiveness in treating headaches with a neuromuscular diagnostic orthotic are common and side effects are minimum.
Correcting the problem by altering neural input is the closest to a "cure" for migraines.
Effectiveness has never been the major problem in treating Headaches, Migraines and TMJ disorders with Neuromuscular Dentistry. The problem is that while the treatment is extremely effective it is expensive and insurance companies write contracts that limit coverage. The current cost conscious environment virtually insures that patients will continue to suffer needlessly because lack of coverage puts this extremely effective treatment out of financial viability for any patients.
Patients who suffer from migraines and chronic daily headaches and can affrd neuromuscular dentistry will find it extremely effective.
A downside to neuromuscular dental treatment is that it can be time intensive especially at the start of treatment protocols.
Ending needless pain and suffering is always rewarding to both patients, friends , families and the practitioners.
Cephalalgia. 2011 May 18. [Epub ahead of print]
The L-kynurenine signalling pathway in trigeminal pain processing: A potential therapeutic target in migraine?
Guo S, Vecsei L, Ashina M.
Source
University of Copenhagen, Denmark.
Abstract
Introduction: In recent years the kynurenine family of compounds, metabolites of tryptophan, has become an area of intensive research because of its neuroactive properties. Two metabolites of this family have become of interest in relation to migraine and pain processing. Discussion: Experimental studies have shown that kynurenic acid (KYNA) plays an important role in the transmission of sensory impulses in the trigeminovascular system and that increased levels of KYNA decrease the sensitivity of the cerebral cortex to cortical spreading depression. Furthermore, another metabolite of the kynurenine family, L-kynurenine, exerts vasodilating effects similar to nitric oxide by increasing cyclic guanosine monophosphate. Conclusion: This review summarizes current knowledge of the role of kynurenine signalling in trigeminal and central pain processing, including its therapeutic prospects in migraine treatment.
PMID:
21593189
[PubMed - as supplied by publisher]
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