I just had a patient in the office who we did a spenopaltine block on 1 week ago with major relief of shoulder pain (I was not treating) and reduction of tinnitus and droopy eyelids that we were sleeping. My patients chief complaint is swallowing problems that were better almost immediately after the SPG block
I have seen patients with severe insomnia sleep well without medications, other patients who have had relief from restless leg and other diverse conditions.
I usually do SPG blocks for sinus pain and pressure, migraine prevention or treating cluster headaches. However, when patients have "wierd" symptoms it is nice to have the SPG block as a possible treatment.
The Sphenopalatine ganglion is an autnomic nervous center and if we see only temporary relief frow symptoms it is possible to send patients to a neurologist for a stellate ganglion block for longer lasting relief.
Wednesday, September 29, 2010
Headaches since June, Back of head that last 1 1/2 days and end with throwing up.
Rachel: I have on going headaches since June. They are in the back area of the head and I usually have them for 1 day and half. Most of the time I end up throwing up
Dr Shapira response: Dear Rachel,
I assume that you have visited you physician to discuss your headaches due to the dramatic change. If nothing is found medically occipital headaches are frequently helped by a neuromuscular orthotic. Symptoms that you describe can also be caused by Atlas/Axis problems and you might want to consider seeing an Atlas Orthogonal or NUCCA chiropracter..
If the pain is primarily muscle ait may be easy to relieve utilizing Travell vapocoolant spray and stretch. Does the pain go away immediately after vomiting? When you vomit it causes instant but temporary release of closing jaw muscles.
It is always important to consider organic disease when a new type of headache occurs. Never assume that there is not an undrlying disease process. Neuromuscular Dentistry is probably one of the safest and most effective treatments for chronic headaches and migraines but when a new type of headache occurs it is important to rule out other medical causes.
Objective diagnosis is the key, you do not want to become a drug guinea pig diagnosed by serial drug experiments.
Dr Shapira response: Dear Rachel,
I assume that you have visited you physician to discuss your headaches due to the dramatic change. If nothing is found medically occipital headaches are frequently helped by a neuromuscular orthotic. Symptoms that you describe can also be caused by Atlas/Axis problems and you might want to consider seeing an Atlas Orthogonal or NUCCA chiropracter..
If the pain is primarily muscle ait may be easy to relieve utilizing Travell vapocoolant spray and stretch. Does the pain go away immediately after vomiting? When you vomit it causes instant but temporary release of closing jaw muscles.
It is always important to consider organic disease when a new type of headache occurs. Never assume that there is not an undrlying disease process. Neuromuscular Dentistry is probably one of the safest and most effective treatments for chronic headaches and migraines but when a new type of headache occurs it is important to rule out other medical causes.
Objective diagnosis is the key, you do not want to become a drug guinea pig diagnosed by serial drug experiments.
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]
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]
Monday, September 27, 2010
Chronic daily headaches and meds don't work. What should I do? Neuromuscular Dentistry may be the answer.
Chronic headaches without a cause are frequently related to the Trigeminal nervous system and have no specific diagnosis. When headaches are not helped by routine medical care a neuromuscular dentist may be the best answer.
Question from Tiffany: I have been having headaches everyday now for about a year and 9 months now. Had no accidents or head trama btu i have headaches everyday ..No meds work for me only excedrin for about an hours and the head aches is right back. I really dont know the cause but i would like to find out more or what could be causing this.
Dr Shapira Response.
Tiffany, chronic headaches are usually coming from head and neck musculature, especially those muscle innervated by the Trigeminal Nerve. There may or may not be any joint noise or discomfort. A thorough medical evaluation with your physician to rule out organic disease is alway in order.
I start patients with a consultation appointment and usually can relieve a significant amount of pain during the appointment. Most muscle pains can be allieviated or eliminated temporarily with vapocoolant spray and stretch techniques to confirm muscle problems.
I start treatment with a thorough head and neck exam and a neuromuscular dental work up and than a neuromuscular diagnostic orthotic. Most patients see drastic improvement in just a couple of visits. There are no magic cures and it takes time for a chronic problem to unwind completely.
Question from Tiffany: I have been having headaches everyday now for about a year and 9 months now. Had no accidents or head trama btu i have headaches everyday ..No meds work for me only excedrin for about an hours and the head aches is right back. I really dont know the cause but i would like to find out more or what could be causing this.
Dr Shapira Response.
Tiffany, chronic headaches are usually coming from head and neck musculature, especially those muscle innervated by the Trigeminal Nerve. There may or may not be any joint noise or discomfort. A thorough medical evaluation with your physician to rule out organic disease is alway in order.
I start patients with a consultation appointment and usually can relieve a significant amount of pain during the appointment. Most muscle pains can be allieviated or eliminated temporarily with vapocoolant spray and stretch techniques to confirm muscle problems.
I start treatment with a thorough head and neck exam and a neuromuscular dental work up and than a neuromuscular diagnostic orthotic. Most patients see drastic improvement in just a couple of visits. There are no magic cures and it takes time for a chronic problem to unwind completely.
Sunday, September 26, 2010
IF NEUROMUSCULAR DENTISTRY IS SO EFFECTIVE IN TREATING TENSION TYPE HEADACHES AND MIGRAINES WHY DON'T MORE PHYSICIANS REFER PATIENTS TO DENTISTS.
THE ANSWER TO THIS HAS TO DO WITH HOW PHYSICIANS ARE GENERALLY TRAINED AND THE FACT THEY ARE COMFORTABLE REFERRING TO OTHER PHYSICIANS. DENTISTS ARE USUALLY OUTSIDE THE TYPICAL REFERRAL PATTERNS FOR PHYSICIANS.
A SECOND REASON IS MANAGED CARE. PHYSICIANS ARE FREQUENTLY FINANCIALLY RESPONSIBLE FOR COSTS OF REFERRALS THEY MAKE AND DO NOT WANT TO BE STUCK WITH A LARGE BILL (OR DECREASE IN PAYMENTS).
MANY YEARS AGO I WORKED WITH CHICAGO HMO AND SHOWED THEM I COULD SAVE THEM SUBSTANTIAL AMOUNTS OF MONEY IN TREATING CHRONIC PAIN PATIENTS. AS A RESULT THEY GAVE ME A PREFERRED STATUS WHERE THERE WAS LITTLE OUT OF POCKET COST FOR THE PHYSICIANS WHEN REFERRING PATIENTS FOR TMJ THERAPY. DR TRUBITT WHO WAS THE MEDICAL DIRECTOR OF CHICAGO HMO SAID THAT THE COMPANY SAVED APPROXIMATELY $250.000 IN THE FIRST 6 PATIENTS WE TREATED (TOTAL COST ABOUT $25,000). CHICAGO HMO PAID 100% OF ALL MY TMD TREATMENT COSTS (PHASE 1) FOR SEVERAL YEARS BECAUSE THEY SAVED MONEY ON EVERY PATIENT TREATED. THE PATIENTS GAVE THE INSURANCE COMPANY VERY POSITIVE FEEDBACK. CHICAGO HMO DID NOT COVER PHASE 2 TREATEMNT SO PATIENTS WERE MADE AN APPLIANCE WITH A CAST BASE. PATIENTS DESIRING ORTHODONTICS OR RECONSTRUCTION DID SO AS AN OUT OF POCKET EXPENSE.
I WAS REFERRED PATIENTS FOR MANY YEARS WITH GREAT SUCCESS UNTIL CHICAGO HMO WAS BOUGHT BY ANOTHER COMPANY. THE NEW COMPANY WAS NOT INTERESTED IN LEARNING HOW THEY COULD SAVE MONEY. THEY DID WRITE CONTRACT LANGUAGE SAYING THAT TMJ DISORDERS WERE NOT COVERED.
THE EXPRESSION IS PENNY WISE AND POUND FOOLISH. TWO STUDIES PUBLISHED IN CRANIO BY SHIMSHAK ET AL SHOWED THAT PATIENTS WITH TMJ DISORDERS USE MEDICAL CARE IN ALL FIELDS OF MEDICINE AT 200-300% INCREASES ABOVE NON-TMJD PATIENTS. THE TOTAL MEDICAL SAVINGS DWARF THE COST OF TREATMENT BUT INSURANCE COMPANIES ONLY LOOKED AT THE COSTS NOT THE FUTURE SAVINGS.
QUALITY OF LIFE IS NEVER LOOKED AT BY INSURANCE COMPANIES IN THEIR CALCULATIONS.
THE SAME PROBLEM EXISTS IN TREATMENT OF SLEEP APNEA WHERE PATIENTS ARE ROUTINELY REFERRED FOR CPAP EVEN THOUGH 60% OF PATIENTS ABANDON IT COMPLETELY. ALMOST ALL STUDIES SHOW PATIENTS PREFER ORAL APPLIANCES TO CPAP.
THIS IS ALSO TRUE IN TREATMENT OF GUM DISEASE THAT CREATES CARDIAC PROBLEMS, DIABETES PROBLEMS, INCREASES IN PULMONARY INFECTIONS, PREMATURE BIRTH AND OTHER CONDITIONS BUT MOST PHYSICIANS KNOW LITTLE TO NOTHING ABOUT ORAL HEALTH AND ITS EFFECT ON OVERALL HEALTH. MOST MEDICAL INSURANCE COMPANIES DO NOT COVER THE COST OF TREATING PERIODONTAL DISEASE.
PATIENTS IN CHICAGOLAND AREA CAN CONTACT ME ABOUT TMJ DISORDERS AT 1-800-TM-JOINT AND ABOUT ORAL APPLIANCES FOR TREATING SLEEP APNEA AT 1-8-NO-PAP-MASK.
A SECOND REASON IS MANAGED CARE. PHYSICIANS ARE FREQUENTLY FINANCIALLY RESPONSIBLE FOR COSTS OF REFERRALS THEY MAKE AND DO NOT WANT TO BE STUCK WITH A LARGE BILL (OR DECREASE IN PAYMENTS).
MANY YEARS AGO I WORKED WITH CHICAGO HMO AND SHOWED THEM I COULD SAVE THEM SUBSTANTIAL AMOUNTS OF MONEY IN TREATING CHRONIC PAIN PATIENTS. AS A RESULT THEY GAVE ME A PREFERRED STATUS WHERE THERE WAS LITTLE OUT OF POCKET COST FOR THE PHYSICIANS WHEN REFERRING PATIENTS FOR TMJ THERAPY. DR TRUBITT WHO WAS THE MEDICAL DIRECTOR OF CHICAGO HMO SAID THAT THE COMPANY SAVED APPROXIMATELY $250.000 IN THE FIRST 6 PATIENTS WE TREATED (TOTAL COST ABOUT $25,000). CHICAGO HMO PAID 100% OF ALL MY TMD TREATMENT COSTS (PHASE 1) FOR SEVERAL YEARS BECAUSE THEY SAVED MONEY ON EVERY PATIENT TREATED. THE PATIENTS GAVE THE INSURANCE COMPANY VERY POSITIVE FEEDBACK. CHICAGO HMO DID NOT COVER PHASE 2 TREATEMNT SO PATIENTS WERE MADE AN APPLIANCE WITH A CAST BASE. PATIENTS DESIRING ORTHODONTICS OR RECONSTRUCTION DID SO AS AN OUT OF POCKET EXPENSE.
I WAS REFERRED PATIENTS FOR MANY YEARS WITH GREAT SUCCESS UNTIL CHICAGO HMO WAS BOUGHT BY ANOTHER COMPANY. THE NEW COMPANY WAS NOT INTERESTED IN LEARNING HOW THEY COULD SAVE MONEY. THEY DID WRITE CONTRACT LANGUAGE SAYING THAT TMJ DISORDERS WERE NOT COVERED.
THE EXPRESSION IS PENNY WISE AND POUND FOOLISH. TWO STUDIES PUBLISHED IN CRANIO BY SHIMSHAK ET AL SHOWED THAT PATIENTS WITH TMJ DISORDERS USE MEDICAL CARE IN ALL FIELDS OF MEDICINE AT 200-300% INCREASES ABOVE NON-TMJD PATIENTS. THE TOTAL MEDICAL SAVINGS DWARF THE COST OF TREATMENT BUT INSURANCE COMPANIES ONLY LOOKED AT THE COSTS NOT THE FUTURE SAVINGS.
QUALITY OF LIFE IS NEVER LOOKED AT BY INSURANCE COMPANIES IN THEIR CALCULATIONS.
THE SAME PROBLEM EXISTS IN TREATMENT OF SLEEP APNEA WHERE PATIENTS ARE ROUTINELY REFERRED FOR CPAP EVEN THOUGH 60% OF PATIENTS ABANDON IT COMPLETELY. ALMOST ALL STUDIES SHOW PATIENTS PREFER ORAL APPLIANCES TO CPAP.
THIS IS ALSO TRUE IN TREATMENT OF GUM DISEASE THAT CREATES CARDIAC PROBLEMS, DIABETES PROBLEMS, INCREASES IN PULMONARY INFECTIONS, PREMATURE BIRTH AND OTHER CONDITIONS BUT MOST PHYSICIANS KNOW LITTLE TO NOTHING ABOUT ORAL HEALTH AND ITS EFFECT ON OVERALL HEALTH. MOST MEDICAL INSURANCE COMPANIES DO NOT COVER THE COST OF TREATING PERIODONTAL DISEASE.
PATIENTS IN CHICAGOLAND AREA CAN CONTACT ME ABOUT TMJ DISORDERS AT 1-800-TM-JOINT AND ABOUT ORAL APPLIANCES FOR TREATING SLEEP APNEA AT 1-8-NO-PAP-MASK.
Friday, September 24, 2010
Trigger point injections are an essential part of TMD, Migraine and Headache treatment for many patients
The importance of this study though extremely limited is that it explains why understanding Myofascial Pain and Dysfunction is essential when chronic pain problems including neck pain, headache and TMD disorders. In this study a single injection in the trapezius muscle (shoulder) gave significant reduction in pain in the masseter region along with reduction in EMG values.
There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.
Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.
Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.
Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.
PMID: 8121703 [PubMed - indexed for MEDLINE]
There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.
Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.
Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.
Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.
PMID: 8121703 [PubMed - indexed for MEDLINE]
Mandibular advancement, nasal breathing and swallowing.
Swallowing disorders are frequently associated with TMJ disorders. Abnormal breathing patterns are also associated with both TMJ disorders and Sleep apnea and snoring. This new study "The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex." in the Journal of Oral Rehabilitation (see abstract below) concludes "that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.
This inhibition of movement may be a partial explanation of why anterior positioning appliances help muscle problems. The patients may just be breathing easier in this new position. It is another example of convergence between TMD and Sleep Apnea
J Oral Rehabil. 2010 May 1;37(5):336-45. Epub 2010 Mar 10.
The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex.
Ayuse T, Ayuse T, Ishitobi S, Yoshida H, Nogami T, Kurata S, Hoshino Y, Oi K.
Department of Special Care Dentistry, Nagasaki University Hospital, Nagasaki, Japan.
Abstract
The coordination between nasal breathing and non-nutritive swallowing serves as a protective reflex against potentially asphyxiating material, i.e. saliva and secretions, entering the respiratory tract. Although this protective reflex is influenced by positional changes in the head and body, the effect of mandible position on this reflex is not fully understood. We examined the effect of mandible advancement associated with mouth opening on the coordination between nasal breathing and non-nutritive swallowing induced by continuous infusion of distilled water into the pharyngeal cavity. The combination of mandible advancement and mouth opening increased the duration of swallowing apnoea and submental electromyographic burst duration. When the mandible was advanced with the mouth open, the duration of swallowing apnoea increased significantly compared with the centric position (0.79 +/- 0.23 vs. 0.64 +/- 0.12 s, P < 0.05, n = 12), and the duration of submental electromyographic activity increased significantly (2.11 +/- 0.63 vs. 1.46 +/- 0.25 s, P < 0.05, n = 12). Mandible advancement with mouth opening altered the respiratory phase resetting during swallowing and the timing of swallow in relation to respiratory cycle phase. We conclude that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.
PMID: 20337868 [PubMed - indexed for MEDLINE]
This inhibition of movement may be a partial explanation of why anterior positioning appliances help muscle problems. The patients may just be breathing easier in this new position. It is another example of convergence between TMD and Sleep Apnea
J Oral Rehabil. 2010 May 1;37(5):336-45. Epub 2010 Mar 10.
The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex.
Ayuse T, Ayuse T, Ishitobi S, Yoshida H, Nogami T, Kurata S, Hoshino Y, Oi K.
Department of Special Care Dentistry, Nagasaki University Hospital, Nagasaki, Japan.
Abstract
The coordination between nasal breathing and non-nutritive swallowing serves as a protective reflex against potentially asphyxiating material, i.e. saliva and secretions, entering the respiratory tract. Although this protective reflex is influenced by positional changes in the head and body, the effect of mandible position on this reflex is not fully understood. We examined the effect of mandible advancement associated with mouth opening on the coordination between nasal breathing and non-nutritive swallowing induced by continuous infusion of distilled water into the pharyngeal cavity. The combination of mandible advancement and mouth opening increased the duration of swallowing apnoea and submental electromyographic burst duration. When the mandible was advanced with the mouth open, the duration of swallowing apnoea increased significantly compared with the centric position (0.79 +/- 0.23 vs. 0.64 +/- 0.12 s, P < 0.05, n = 12), and the duration of submental electromyographic activity increased significantly (2.11 +/- 0.63 vs. 1.46 +/- 0.25 s, P < 0.05, n = 12). Mandible advancement with mouth opening altered the respiratory phase resetting during swallowing and the timing of swallow in relation to respiratory cycle phase. We conclude that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.
PMID: 20337868 [PubMed - indexed for MEDLINE]
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