Dr. Shapira's Chicago Headache Blog

Chronic pain is frequently multifactorial in nature. Neuromuscular dentistry has been very successful in treating TMD, Migrines, Tension Type headaches and other disorders. Frequently it is not a total cure but 50-80% reduction in pain is usually attained within several visits. There are many disorders and symptoms associated with TMD including:
Ear Aches or Otalgia
Sinus Pain
TM Joint Clicking and Popping
Ear Stuffiness or Eustacian Tube Dysfunction
Dizziness
Vertigo
Temporal Pain
Occipital Headaches
Morning Headaches
Sleep Apnea
Snoring
Sore Throats
Neck pain or stiffness
Feelings of a foriegn object in the throat
Pain in or behind the eyes
Scalp pain or feeling like your hair hurts

Most of these symptoms are mediated by the Trigeminal nerve and the Trigeminovaqscular system. These Nerves also connect to facial nerves, occipital nerves, glossopharyngeal nerves and to the autonomic nervous system. What happens in these nerves cause biochemical changes in the brain. Recent stuies shown the neural plasticity can create permanent changes in the brain. If chronic pain is the stimulus it can lead to central sensitization.

Changes inthe brain can be reversed over time but the exact amount of recovery will vary with individual patients genotypes, how long the pain has been present , other comorbidities that the patient carries. Some patients experience immediate3 and almost miraculous pain relief while others have a slower longer version of recovery. I always tell my patients to work for 50 - 80% improvement in pain. That is then our new starting point and we again seek 50 - *0 % reduction in pain.

There is "no cure" for long term chronic pain because lives have been changed due to living with pain. A cure would require a do-over of the years you had pain. There are no do-overs therefore we look to improve your future quality of life to the maximum. Some patients still have to do exercises or watch diet or even continue different medications. Other patients have remarkably and incredible improvements as described by Dr Barry Cooper in Cranio where he talked about "overwhelming success". This is why we use a diagnostic orthotic as the first step of treatment. We try to avoid permanent changes until the patient feels substantially improved. This is not a judgement that any doctor can make for the patient. It is a subjective evaluation by the patient themselves. Only the patient knows how well or poorly they are doing. We may have objective data showing physical improvement but the final test is have we improved or dramatically improved the patients quality of life. If the answer is yes we can talk about long term stabilization. The diagnostic orthotic is the first phase of treatment for those patients.

If the patient has improvement, whether it is only 25-30% or if they are at 80-90% the decision that the diagnostic orthotic treatment is successful remains the patient's. If they do not feel sufficiently improved they should not feel pressured into continuing treatment or making permanent changes. You should treat the diagnostic orthotic like a CAT SCAN or MRI but instead of images we have improvement in the quality of life. If improvement is not sufficient then a diagnostic approach should continue.

While NEUROMUSCULAR DENTISTRY IS REMARKABLY EFFECTIVE AT TREATING MANY CONDITIONS THERE ARE OTHER CONDITIONS THAT ARE NOT RELATED TO THE TRIGEMINAL NERVOUS SYSTEM, MYOFASCIAL PAIN OR JAW JOINTS.

TMJ disorders are frequently called The Great Imposter ("SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER" IS A MUST READ FOR ANY PATIENTS WITH MIGRAINES OR TMD http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor) but we must remember that other disorders can also masquerade or more frequently coexist with these problems. Many times a diagnostic orthotic relieves many of the symptoms but the remaining symptoms have a different cause. The expression that "you can't see the forest for the trees" applies. When the majority of symptoms are relieved you now find that you can identify a particular problem that was lost in a long and winding maze of symptoms. As NMD unravels the maze a specific problem can now be identified and treated.

Labels: chronic daily headaches, diagnostic orthotic, facial pain TMJ, Migraines, neuromuscular dentistry, neuromuscular dentistry tmd, neuromuscular orthotic, quality of life, TMJD

Patients with morning headaches usually have either TMJ disorders or Sleep Apnea. Sleep Apnea can be treated with CPAP or an Oral Appliance. Patients who have TM Joint clicking and are undergoing treatment for headaches or TMD can benefit in several ways from having a night-time apnea appliance and a daytime neuromuscular orthotic.

A problem that is sometimes encountered with oral appliances for sleep apnea are undesired bite changes. These changes can actually be helpful when treating TMJ clicking and popping and headaches. The bite changes that occur are actuallly the healing of the TM Joint. The jaw usually postures forward unloadding the retrodiscal lamina of the TM Joint that is compressed in patients with clicking. The retrodiscal lamina rehydrates and does not let the condyle go into retrusive pathology which serves to stabilize the disk.

The Daytime appliance allows this position to stabilize and heal. In patients who are not undergoing treatment exercises are done to prevent this healing from occuring. The joints will frequently heal if placed in a healthy position. A recent paper showed no damage to the joints with sleep appliances.

The American Academy of Sleep Medicine recommends that dentists fitting patients with oral appliances for sleep apnea be well versed in treating TMJ disorders. There are many good reasons for this recomendation. Dentists who do not uderstand how bite changes affect the joints and the muscles as well as head posture can create difficult problems they do not have the expertise to treat. Please check my I HATE CPAP website (http://www.ihatecpap.com) for more information about the dangers of sleep apnea and on how oral appliances are used in treating sleep apnea.

Labels: AASM, American Academy of Sleep Medicine, bite Changes, cluster headaches, headaches, neck pain, SLEEP APNEA, TMD, TMJ, TMJ clicking, TMJ pain, TMJ popping, TMJD

When you see a doctor for the first time for a TMJ disorder you should expect to have to give lengthy and detailed history. There are usually forms to fill out. What is important is that this history should be reviewed with the patient and how the history relates to the current problem should be explored. The initial consult is usually at least 45 minutes but can last for several hours.

In most cases the doctor can provide instant relief of some of the painful conditions by deactivating muscular trigger points. This is usually done by use of a technique called Spray and Stretch that utilizes a vapocoolant spray. These techniques were developed by President Kennedy's personal physician Dr Janet Travell. In most patients it is possible to connect their symptoms to their history in an understandable fashion.

If there is a acute close-lock of the TM Joint time is of the essence and immediate reduction is best if possible. Prescribing anti-inflamatories should never take the place of attempting to reduce an acute disc dislocation.

Permanent and/or irreversible treatment should rarely be the initial treatment. Adjusting the teeth or doing equilibration of the back teeth should be avoided when there s acute muscle spasm. The exception is if a recently placed restoration is in hyperocclusion and percipitated the problem. It should be carefully evaluated because acute spasm can change the bite.

A thorough examination of the muscles and joints is usually performed before initiating treatment. A Neuromuscular Dentist will usually take impressions and a bite utilizing TENS (transcutaneous electrical neuro stimulation) as well as EMG and computerized mandibular scans. This information helps the dentist understand all aspects of the problem before initiating treatment.

Many insurance companies deny coverage of TMJ disorders and Neuromuscular diagnostic work-ups. This is done to "save money" but in reality it has a heavy toll in the quality of patients lives and their future health and welfare. Insurance companies are not in the business of caring for patients. Insurance companies are in business to make money for their shareholders. The larger the premiums they collect and the less they pay in benefits the better the bottom line. A healthy bottom line is the primary concern of insurance companies. These companies are in business to creat profit and shareholder value. The executive of insurance companies make millions of dollars in bonuses for increasing profitability. Unfortunately for patients increasing profitability usally is done by denying patients medical benefits. The more effective an insurance company is in reducing payments for care the more profitable they become.

The insurance companies often use terms such as reasonable and customary to explain why patients are not given the coverage they were promised. I have been treating sleep apnea with oral appliances for close to 30 years. In the early years I was the only dentist in the state of Illinois doing this type of treatment. I would still receive letters telling me my fees were more than "usual and customary" even though I was the only doctor doing these treatments.

Labels: insuranceTMJ treatment, TMD, TMJ, TMJ Specialist, TMJD