TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep ......Is Dr Shapira's guest editorial in Cranio Journal

Originaly seen in Sleep and Health Journal

Sat, 02/02/2013 - 09:36 — ilshapira

Important information for all patients with Headaches, Chronic Daily Headaches and Migraines:

The relation of Sleep Disorders and/ or TM Joint Disorders (TMD) is presented that is vital to patients with poor sleep or chronic pain, especially Chronic headaches and Migraine

Cranio, The Journal of CranioMandibular Practice is dedicated to the diagnosis and treatment of TMJ, TMD, and related disorders. In a monumental move Riley Lunn the editor is changing the journal to Cramino Mandibular and Sleep Practice. Cranio is the first journal to embract the close ties between TMJ disorders, Chronic Pain and Sleep Disorders.

The entire editorial is available free of charge from Cranio at:
http://cranio.com/volume31/issue1/tmj-alias-great-imposter-has-co-conspi...

This is vital information with all patients who have TMJ disorders, Fibromyalgia, Myofascial Pain & Dysfunction, Sleep Apnea, Snoring, Headaches and/or Migraines. Cranio is leading the way into a new world where these diaparate disorders are all seen as different faces of similar closely related disorders.

The treatment of headaches and migraines and how Neuromuscular Dentistry can drastically improve the life of headache sufferers is discussed at I HATE HEADACHES .... www.ihateheadaches.org

Treatment of Sleep Apnea is primarily with CPAP and Oral Appliances. A side effect of oral appliance therapy is bite changes. Studies have shown that over long term treatment there are rarely TMD problems whether or not their are bite changes. The bite changes seen in treating sleep apnea with an oral appliance are similar to those seen when wearing a diagnostic neuromuscular orthotic. THESE CHANGES ARE ACTUALLY THE PHYSIOLOGIC HEALING THAT OCCURS DURING THE NIGHT WITH ORAL APPLIANCES. The normal advice is to do morning exercises to return the bite to its original pathology (I call this position pathologic because it does not allow for normal breathing the single most important function of the jaw, and tongue)

The use of neuromuscular diagnostic orthotics combined with oral appliances for treating sleep apnea will allow more permanent changes to occur and this healed position may be the ultimate cure for sleep apnea. To better understand Neuromuscular Dentistry I suggest reading.....http://www.sleepandhealth.com/neuromuscular-dentistry

Permanent correction of the bite following the diagnostic phase and dignostic neuromuscuar orthotic can be accomplished with orthodontics, dental reconstruction, long term orthotics and on rare occasions surgery. Patients seeking help with Sleep Apnea should seek out a practitioner trained in treating TMJ disorders, ideally a trained Neuromuscular Dentist.

Migraines, Morning Headaches and nocturnal headaches are usually associated with pathologic jaw positioning that does not maintain a health airway or with nociceptive input into the Trigeminal Nervous System. Neuromuscular Dentistry lets the clinician utilize sophisticated measurements to idealize bite and jaw position to physioogic healthy positions.

Learn more about Neuromuscular Dentistry at http://www.sleepandhealth.com/neuromuscular-dentistry

http://cranio.com/volume31/issue1/tmj-alias-great-imposter-has-co-conspirator-poor-sleep/

Migraines, Chronic Daily Headaches, TMJ, TMD and Neuromuscular Dentistry

Tell us about your headaches...: I have suffered from migraines w/and w/o aura since I was 10. I got a brain tear frontal lobe in the third grade. It's only been about the last several years that I got diagnosed with tmj. In the last 6 months it has got unbearable. I've got a permanent mouth guard for night grinding,but I still have pain and migraines help!
First Name: Lorin
Last Name: M.....

DR Shapira's response:

Lorin in Boston,  Your e-mail was rejected, I hope you find this response helpful

Night Guards work great if you only have pain at night or on awakening.  If you have day and night pain it is usually necessary to utilize a 24/7 appliance. TMJ is not a diagnosis but a Joint, the TemporoMandibular Joint.  TMD is a more correct description because it includes the Myofascial and neurogenic aspects of migraine and chronic daily headaches.  I suggest  a neuromuscular diagnostic orthotic as it allows an ongoing healing process as you adjust it for postural changes.  Spenopalatine ganglion blocks can serve to prevent migraines and you can learn to do them easily at home.  Trigger point injections or spray and stretch techniques are useful for eliminating trigger points.

It is a process to correct a lifetime problem and I like the analogy of ealing an onion, you remove one set of problems to get to the next level.

I would like to tell you that everyone who practices Neuromuscular Dentistry (NMD) can help you but NMD is only one part of a larger puzzle.  It is extremely important component of treatment because it addresses nociceptive input to the Trigeminal Nervous system that is primary in all migraine and non-migraine headaches.  Unlike drug treatment that affect the CNS like a shotgun blast NMD particularly is designed to focus on I/O errors or input/output erros into the Trigemininal nervous system.  In computer lingo the expression GARBAGE IN....GARBAGE OUT describes the effect of unfiltered nociceptive input into the central nervous system.  100% of all physicians, neurologists and pain specialists understand that all headaches and migraines are Trigeminally nerve related.  

Neuromuscular Dentistry addresses this input output error of the human computer...ie the brain.

Physicians often consider TMJ and TMD problems a subset of headaches due to their ignorance of the massive input to the CNS (central nervous system) from the Trigeminal Nervous System)

Te use of Botox to treat headaches and Migraines is directly due to effects on the masticatory system of the trigeminal nervous system...  ie a TMD or TMJ problem addressing not the entire scope of the problem but just the myofascial pain aspects.  Botox is a crutch that can be used while correcting the underlying problems.  Unfortunately there is money to be made in injecting dangerous neurotoxins and where there is money there are always willing participants.  The problem is not the use of Botox but the substitution of Botox for correction of the underlying problems.

Read:  http://www.sleepandhealth.com/neuromuscular-dentistry  for more info on neuromuscular dentistry.

I do see up to two long diatance patients  month in my Gurnee office, the first week I see you twice a day on Monday and Tuesday and half a day wednesday.

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

TREATMENT OF TRIGEMINAL AUTONOMIC CEPHALGIAS: NEUROMUSCULAR DENTISTRY ALTERNATIVE TO IMPLANTED SUPRAORBITAL/SUPRATROCHLEAR NEUROMODULATION

A recent article in neuromodulation is a case study of five patients with implanted neuromodulators. The good news is that there is hope when all other treatments failures but there can be numerous complications as noted in pubmed abstract that follows. The devices must be removed for diagnostic MRI. Some patients required multiple applications but the systems were effective in major pain relief and reduction or elimination of opiod use.

Neuromuscular Dentistry offers a less invasive and frequently extremely effective alternative treatment. A diagnostic neuromuscular orthotic is retained by the lower teeth and alters the input to the trigeminal nervous system. The trigeminal nervous system acts as an input/output for our brain. Approximately 50 % of all brain input comes from the periodontal ligaments and the muscles of the trigeminal nervous system. Neuromuscular dentistry does utilize the use of a nonimplanted neuromuscular stimulator in the form of ULF TENS. This allows relaxation of trigeminally innervated muscles and the autonomic system follows suit. In computer lingo these headaches are I/O errors or input output erros. GARBAGE IN- GARBAGE OUT IS BAD INFO INTO COMPUTER GIVES BAD OUTPUT. Nociceptive inputs are eliminated with the diagnostic orthotic and stabilized. SPG (Sphenopalatine Ganglion blocks) Blocks are frequently used in combination with a neuromuscular orthotic when there is not rapid relief of all symptoms.

The beauty of the SPG Block is that it can be easily performed by patients to prevent episodes and does not require opiods or dangerous neurologic medications but utilizes lidocaine and administered by a hollow cotton swab.

I propose that a neuromuscular diagnostic orthotic should be considered a first linr treatment priot to invasive procedures. A sleep study should be used to rule out obstructive sleep apnea, hypopnea, UARS (upper airway resistance syndrome) and RERAs or respiratory related arousals that are frequently present in these patients and associated with their disorders.

PUBMED ABSTRACT:

Neuromodulation. 2012 May 2. doi: 10.1111/j.1525-1403.2012.00455.x. [Epub ahead of print]

The Treatment of Medically Intractable Trigeminal Autonomic Cephalalgia With Supraorbital/Supratrochlear Stimulation: A Retrospective Case Series.

Vaisman J, Markley H, Ordia J, Deer T.

Source

Pain and Wellness Center, Peabody, MA, USA; New England Regional Headache Center, Worcester, MA, USA; and The Center for Pain Relief, Charleston, WV, USA.

Abstract

Introduction:  This is a retrospective case series of five patients with intractable trigeminal autonomic cephalalgia (TAC) who were implanted with a supraorbital/supratrochlear neuromodulation system. Objectives:  The aim of this Institutional Review Board-approved study was to investigate the percentage of pain relief, treatment response, pain level, work status, medication intake, implantation technique, lead placement, programming information, and device use. Results:  Trial stimulation led to implantation of all five patients. All patients reported improvement in their functional status in regard to activities of daily living. The device was revised in two patients due to skin erosion. It was later reimplanted in both patients due to worsening of symptoms, again with good pain relief. The device was explanted in two other patients because of the need to perform a magnetic resonance imaging or implant an automatic implantable cardioverter defibrillator. The follow-up of the patients ranged between 18 months and 36 months, with a mean of 25.2 months. There was no change in work status. Following the implant, the Visual Analog Scale score was reduced to a mean of 1.6 from an initial mean score of 8.9. Three patients were completely weaned off opioid medications, while two patients continued to take opioid at a lower dosage. All patients experienced a decrease of the adjuvant neuropathic drugs. Conclusion:  Supraorbital/supratrochlear nervestimulation appears to be a promising modality for the treatment of patients with intractable TAC.

© 2012 International Neuromodulation Society.

PMID:

22551506

[PubMed - as supplied by publisher]

Cluster Headache Relief With Sphenopalatine Ganglion Block

A recent article reported on the treatment of cluster headaches with Sphenopalatine Ganglion Blocks. While neuromuscular diagnostic orthotics may relieve or eliminate cluster headaches they may still require treatment on occasion. I frequently teach my patients how to self administer the blocks intranasally with cotton tip applicators. The PubMed abstract is at the end of the blog. J Med Case Rep. 2012 Feb 15;6:64:e23-27 Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.


Another recent article discussed use of sphenopalatine ganglion blocks when doing sinus endoscopic surgery and showed a 50% reduction in time in recovery. What the paper did not mention was that frequently chronic sinus pressure, pain and/or headaches can be treated or eliminated with SPG (sphenoalatine ganglion) Blocks without surgery. J Med Case Rep. 2012 Feb 15;6: Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

Neuromuscular Dentistry as part of a comprehensive treatment of TMJ (TMD) disorder treatment is extremely effective in eliminating chronic daily migraine and tension headaches and chronic sinus and facial pain. It frequently eliminates or r lessens the frequency of episodic pain. SPG blocks are an easily self administered technique that patients accept and that has a very high margin of safety.

J Med Case Rep. 2012 Feb 15;6:64.

Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

Bakbak B, Gedik S, Koktekir BE, Okka M.

Source

Department of Ophthalmology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey. drberkerbakbak@yahoo.com.

Abstract

ABSTRACT:

INTRODUCTION:

The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. CASES

PRESENTATION:

A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased.

CONCLUSION:

Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e23-7.

Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery.

DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine AI.

Source

Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. samuel.demaria@mountsinai.org

Abstract

BACKGROUND:

Endoscopic sinus surgery (ESS) is a common procedure preferably done with an anesthetic technique ensuring effective postoperative analgesia while speeding discharge home. Although anesthesia administered locally in conjunction with vasoconstricting agents is known to minimize intraoperative bleeding, its usefulness in providing postoperative analgesia has not been well characterized. The results supporting the use of regional anesthesia for sinus surgery have also been limited. Using a randomized, double-blinded and placebo-controlled design, we evaluated recovery times, opioid consumption, and nausea and vomiting after ESS when patients were randomized to either general anesthesia (GA) alone or with regional blockade.

METHODS:

Subjects were 70 adults scheduled for sinus surgery. All participants underwent propofol/remifentanil/nitrous oxide anesthesia and similar intraoperative care. Patients received either GA alone or with sphenopalatine ganglion (SPG) blocks in a double-masked study design. Independent observers recorded readiness for discharge, incidence of nausea/vomiting, and pain scores every 15 minutes until discharge. Overall opioid use in the recovery area was also a secondary end point. Twenty-four hours later, patients were called and asked to rate their pain and overall satisfaction with their pain control.

RESULTS:

Block group participants were considered ready for discharge after 45 minutes and discharged from the hospital ∼40 minutes sooner than GA group participants. The block group required less total fentanyl in the recovery room than did the GA group. The incidences of nausea and vomiting did not differ significantly. Data at 24 hours postoperatively did not differ significantly between groups but trended toward increased satisfaction in the block group. No lasting adverse events were observed.

CONCLUSION:

Regional anesthesia using targeted nerve blocks is effective in ESS. The combination of GA and SPG blockade appears to shorten hospital stay and reduce narcotic requirements in the recovery area. No demonstrable benefits were observed after 24 hours regarding pain management.

TMJ, TMD, Headaches and Fibromyalgia: Is Neuromuscular Dentistry a Cure?

A recent article in the Journal of Craniofacial Surgery ties symptoms of TMJ disorders and Fibromyalgia. The article suggests that "the need for an integrated diagnosis and treatment of these patients, which suggest that the FM could be a medium- or long-term risk factor for the development of TMD." What is also known is that Fibromyalgia is frequently related a sleep disorders.

The National Heart Lung and Blood Institue of the NIH published a report that considers Sleep apnea to be a TMJ disorder. The paper "Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders" suggests that fibromyalgia may actuallly be a consequence of TMJ disorders. While Fibromyalgia is often difficult to treat the TMJ and Headache component is usually very responsive to Neuromuscular Dental Treatment. It is not uncommon to see many other fibromyalgia symptoms self correct after treatment of the TMD and Jaw muscular components.

I suggest that all Fibromyalgia patients should be fitted with Diagnostic Neuromuscular Orthotics as an integral part of the diagnostic and treatment sequences. Patients report signifcant and often life changing symptom reduction after reversible treatment with a neuromuscular diagnostic orthotic.

J Craniofac Surg. 2012 Mar;23(2):615-8.

Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients.

Fraga BP, Santos EB, Farias Neto JP, Macieira JC, Quintans LJ Jr, Onofre AS, De Santana JM, Martins-Filho PR, Bonjardim LR.

Source

From the *Health Science, Federal University of Sergipe, Aracaju, Sergipe; †Department of Nursing, University of São Paulo, São Paulo; and Departments of ‡Physical Therapy, §Medicine, and ∥Physiology, Federal University of Sergipe, Aracaju, Sergipe, Brazil.

Abstract

OBJECTIVE:

The objective of this study was to determine the frequency of signs and symptoms of temporomandibular disorder (TMD) in fibromyalgic patients.

METHODS:

Sixty subjects of both sexes (mean age, 49.2 ± 13.8 years) with fibromyalgia (FM) diagnosis were included in this study. All patients were examined by a calibrated investigator to identify the presence of TMD using the Research Diagnostic Criteria for TMD.

RESULTS:

The most common signs (A) and symptoms (B) reported by FM patients were (A) pain in the masticatory muscles (masseter, 80%; posterior digastric, 76.7%), pain in the temporomandibular joint (83.3%), and 33.3% and 28.3%, respectively, presented joint sounds when opening and closing the mouth; (B) headache (97%) and facial pain (81.7%). In regard to the classic triad for the diagnosis of the TMD, it was found that 35% of the FM patients presented, at the same time, pain, joint sounds, and alteration of the mandibular movements. It was verified that myofascial pain without limitation of mouth opening was the most prevalent diagnosis (47%) for the RDC subgroup I. For the subgroup II, the disk displacement with reduction was the most prevalent diagnosis (21.6%). For the subgroup III, 36.7% of the subjects presented osteoarthritis.

CONCLUSIONS:

Thus, there is a high prevalence of signs and symptoms of TMD in FM patients, indicating the need for an integrated diagnosis and treatment of these patients, which suggest that the FM could be a medium- or long-term risk factor for the development of TMD.

Chicago: Headaches, TMJ, TMD, and Neuromuscular Dentistry

Treatment of Chronic Daily Headaches, Tension Headaches, morning headaches and Migraines is frequently is best done thru Neuromuscular Dentistry. All of the disorders mentioned are largely under the influence of the Trigeminal Nervous System.

Neuromuscular Dentists use diagnostics neuromuscular orthotics to allow the Jaw Joints (TMJ, Temporomandibular Joints, TM Joints), the Jaw muscles (stomatognathic muscles), Cervical (NECK) Muscles and nervous system to heal. The use of reversible treatment initially is crucially important to allow correction of the entire postural chain.

Dentists and Physicians do not "heal" their patients but rather remove the impediments to healing. As healing occurs and pain decreases patients experience a feeling of well being. This feeling of well being is as important as the reductions in pain. This feeling of well being is the result of decreases in nociceptive input to the brain. The brain works like a computer and nociceptive input creates negative feedback. In IT language this is an I/O (input/output) error. The expression Garbage In - Garbage Out used to describe I/O errors can also be used to explain how incompatible neuromuscular jaw function creates headaches, migraines, stress, anxiety and sleep disorders.

The Aqualizer Appliance, Neuromuscular Dentistry and Muscle Engrams

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

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

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

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

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

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

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

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

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

Lerman MD.

Source

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

Abstract

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