Dr. Adams' Alabama Headache Blog

Balance is defined as a state of equilibrium or parity characterized by the cancellation of all forces by equal opposing factors. This is the act of maintaining an upright posture (static balance) or in locomotion (dynamic balance or gait). This system depends on vestibular function, vision, and proprioception to maintain posture, to navigate one's surroundings, to coordinate motion of body parts, to modulate fine motor control, and to initiate the vestibuloculomotor reflexes. These parts of the vestibular system provide our brains with information about changes in the head movement with respect to the pull of gravity. Besides the visual, vestibular and skeletal systems, which contribute to balance disorders, the dental (stomatognathic) system may also contribute to balance disorders. It is when all four of these systems are in coordination with one another, that a person will maintain equilibrium and balance, proper gait and posture.

A recent abstract discussed the limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups 1 to 3 were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm2, 60 J/cm2, and 105 J/cm2, respectively. Pain scores were assessed just before, then immdeiately after the fourth application, immediately after the eighth application, at 15 days and at one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of the LILT suggests it is a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

A recent investigation of the relative importance of systemic and local inflammatory mediator (serotonin; 5-HT; tumore necrosis factor, soluble interleukin-1 receptor II: IL-1sRII) in the modulation of the temporomandibular joint (TMJ) pressure pain in the threshold in patients with seropositive or seronegative rheumatoid arthritis (RA) and to investigate to what extent TMJ pressure pain threshold is related to other TMJ pain parameters. Statistical analyses indicated that TMJ pressure pain threshold was only correlated to systemic factors. TMJ movement pain was in turn mainly correlated to systemic mediators in the seropositive patients but to local mediators in the seronegative patients where synovial fluid IL-1sRIIwas positively correlated to TMJ pain on mouth opening. Seropositive patients had a higher systemic inflammatory activity but lower TMJ movement pain intensities than seronegative patients. The results indicate that TMJ pressure pain threshold is modulated by systemic rathar than local inflammatory mediators and suggest that it is unrelated or only weakly related to other TMJ pain entities RA patients. A rheumatoid factor-dependent systemic modulation, in combination with local factors, seems to account for TMJ pain in RA patients.

A recent discussion to determine the short-term effectiveness of a stabilization appliance with a prefabricated occlusal appliance in myofascial pain patients in a randomized controlled trial. The main treatment outcome in the groups tested was a positive improvement in overall symptoms without any statistically significant differences between the groups at either 6 to 10 weeks. At the 6 week follow-up, 72% of all the patients reported a 50% reduction of the worst pain, whereas at the 10 week follow-up, the percentages were 69% and 61%, respectively. According to the verbal scale, 85% of all patients reported themselves to be "better", "much better", or "symptom-free"at the 6 week follow-up, and 83% reported this at the 10 week follow-up. The effectiveness of the prefabricated occlusal appliance seemed to be the same as that of the stabilization appliance. The prefabricated appliance can therefore be recommended as a short-term therapy in adult patients with myofascial pain.

A recent discussion in regards to the comparison of the prevalence of psychologic, dental, and temporomandibular disorder signs and symptoms between young women suffering from chronic eating disorders and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the eating disorder group. Women with eating disorder showed a significantly higher sensitivity to muscle palpation and higher levels of depression, somatization, and anxiety, as well as a higher prevalence of intensive gum chewing, dental erosions and attrition, than the healthy controls. Vomitting patients showed higher muscle sensitivity to palpation than nonvomitting patients and greater emotional and psychologic distress. Women with chronic eating disorders suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.

A recent discussion in regards to the testing for an association between rhythmic masticatory muscle activity during sleep, as assessed according to polysomnographic criteria for sleep bruxism, and myofascial pain, as well as the chance of occurrence of myofascial pain in patients with sleep bruxism. Most myofascial pain patients reporter mild or moderate pain (46.67% and 43.33%, respectively), and only 3 (10%) reported severe pain. Pain duration ranged from 2 to 120 months (mean 34.67+/- 36.96 months). Significant associations between daytime clenching and myofascial pain. Sleep bruxism is significantly associated with myofascial pain; although sleep bruxism represents a risk factor for myofascial pain, this risk is low; and daytime clenching probably contstitutes a stronger risk factor for myofascial pain than sleep bruxism.

A recent abstract discussing The Jolt Syndrome, The Muscle Dysfunction Following Low-Velocity Impact. Pain Manag, Nov/Dec 1990.

Despite involving forces insufficient to cause tissue injury, many low velocity collisions and occupational accidents result in pain and sometimes disability. This article proposes that the underlying mechanism in this dysfunctional state is an unusual sustained positive feedback loop, flowing from the proprioceptor in the muscle spindle and joint capsules to this neuologic circuit, an increase in muscle tension and an imbalance in the motor position of the jolted muscles.

This study used a three pronged approach. The office archives were carefully evaluated for appropriate cases. A review of the literature was conducted. Consultation with a varied group of basic and chemical scientists and back care providers was also included. The premise of this study was that there can be pain without specific injury. Myofascial structures can be made painful without injury when stretched into the supra-physiologic stretch reaction or suddenly reflexly contracted.

Muscle spindles are encapsulated muscle fibers connected to or ensheathed in windings of sensory fibers and innervated by small efferents. There are twelve of these in each muscle. The tension of the intrafusal muscle fibers is set by the gamma efferent and it is this tension that determines the sensitivity of the local extrafusal muscle fibers to stretch. Experiments with cats have indicated that gamma efferents may be highly responsive to very small disturbances as rapid stretching of partially contracted muscles occurs. Work with muscles of cats demonstrates a powerful synaptic activity among interneurons associated with ascending tracts, as well as spinal reflex pathways. This indicates that a flurry of afferent discharge from the spindles may reflexly generate exaggerated sensitivity to stretching. Evidently, the more structurally compromised a tissue, the less force necessary to cause systematic disruption.

Despite involving forces insufficient to cause tissue injury, many low velocity collisions and occupational accidents result in pain and sometimes disability. The mechanism proposed is a positive feedback loop, flowing from the proprietory in muscle spindles and joint capsules. The effects of this neurologic circuit are an increase in muscle tension and an imbalance in the motor patterns of the jolted muscles. Treatment should focus on reestablishing dynamically efficient motor patterns via properly selected exercises and posture training.

A recent abstract discussing The Whiplash and TMJ Dysfunction. The Spine Research Institute of San Diego.

TM injuries occur during motor vehicle accidents. This abstracts several articles to describe the forces involved to the TM joint during rear-end motor vehicle accidents. It also challenges the article by Howard et. al, that used a poorly designed model-without considering other works contrary to their methodology-which oversimplified the working of the cervical spine.

There is good supporting evidence that the TMJ receives injury during the initial acceleration phase during whiplash injuries. Stretching and tearing of the posterior attachments, as well as the discal attachments of the medial and lateral parts of the condyle, may occur. In the second phase (the deceleration phase), the head and neck are snapped forward into flexion. The exact sequela of events in this phase are yet undetermined. Enough evidence is presently available to refute Howard's criticism of TM whiplash injuries. Enough evidence also exists to substantiate that major injuries occur to the TM joint apparatus during whiplash related injuries.

The TM joint and related structure can receive sumstantial injuries during cervical whiplash related accidents.

If you suspect you may or may have had a whiplash injury due to an auto accident or experience headaches as a result of an auto accident, please see your Neuromuscular/TMD Dentist.