Dr. Shapira's Chicago Headache Blog

I came across this interesting abstract (below) on the spenopalatine ganglion and how it can cause remote effects. According to the article published in Arch Phys Med Rehabil. 1979 Aug;60(8):353-9 it can be responsible for wide ranging disorders. "Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others." I must disagree that the symptoms are "psychosomatic", I would venture that doctors facing idiopathic conditions sometimes label what they do not understand as psychosomatic. I have not read the original article only the abstract at this time and I am not sure how the authors are using the term psychosomatic.

All of the symptoms are mediated by the autonomic nervous system. The authors point out the connections to the Trigeminal Nerve, facial nerve and to the internal carotid artery plexus of the sympathetic nervous system. these connections could explain how the SPG is ntimately involved in TMD (TMJ) disorders and facial pain, migraines, tension headaches and other problems.

Neuromuscular dentistry will have effects on the trigeminal and facial nerves that travel thru the SPG but use of intranasal spenopalatine blocks will be a valuable tool in treating these autonomic aspects of chronic pain. Neuromuscular Dentists and all physicians and dentists treating chronic pain should be well versed in utilization of intranasal SPG blocks.

The rage reaction may also be affected by the SPG which may explain chemical changes seen in the brains of chronic pain patients. The connections to the pituitary gland could have effects on a wide variety of hormonal conditions.

I have seen remarkable results in some patients while utilizing SPG intranasal blocks while in other patients they seem ineffective. This may actually constitute a diagnostic evaluation for how large an autonomic effect is in a given patient.

Neuromuscular dentistry can evaluate the changes that take place in the masticatory muscles by utilizing EMG measurements of the masticatory muscles before and after SPG blocks. However we will only be able to measure the effects on voluntary muscles but not on visceral muscles or autonomic function. The field of neuromuscular dentistry has tremendous effects on the trigeminal nerve input to the brain. The Trigemnal nerve (fifth cranial nerve) is responsible for over 50% of the total input to the brain. the autonomic components are still not well understood by clinicians treating migraines, tension headaches, TMD, myofascial pain and other disorders. RSD (Reflex sympathetic Dystrophy) or CRPS (complex regional pain syndrome) are autonomic manifestations are some some of the most troubling in clinical treatment of pain.

The authors presents arguments supporting the following hypotheses:" 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered."

I am sometimes amazed at the effectiveness that we achieve utilizing a neuromuscular orthotic while we still do not have a good grasp on the underlying neurology. I believe why we are so successful in eliminating, preventing and treating chronic migraines and headaches is that the correction of the proprioceptive input accomplished by neuromuscular dental orthotics or occlusal corrections is such an emormous reduction in noxious neural input that we accidentally produce vast beneficial effects throughout the trigeminovascular system, the autonomic nervous system, the hormonal systems influenced by the pituitary gland and in the part of the brain (retained) that is involved in rage reflexes found in lower animals.

Arch Phys Med Rehabil. 1979 Aug;60(8):353-9.
Sphenopalatine (nasal) ganglion: remote effects including "psychosomatic" symptoms, rage reaction, pain, and spasm.
Ruskin AP.

Many articles implicate the nasal ganglion in the production of remote symptoms and discuss treatment. Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others. All these symptoms appear to have 2 common denominators. They are mediated by the autonomic nervous system and at least in some instances can be "psychosomatic." The sphenopalatine ganglion (SPG) is a major autonomic ganglion located superficially in the pterygopalatine fossa, with major afferent distribution to the entire nasopharynx and important connections with the trigeminal nerve, facial nerve, internal carotid artery plexus of the sympathetic nervous system and, as shown in the rat, direct connection with the anterior pituitary gland. This paper presents arguments supporting the following hypotheses: 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and "psychosomatic" conditions to the autonomic nervous system and the rage reaction must be considered.20

PMID: 464779 [PubMed - indexed for MEDLINE]

Labels: autonomic nervous system, facial pain, improving quality TMD, migraine treatment SPG, pituitary, Spenopalatine ganglion block headaches, TMJ

All patients with TMJ disorders especially if they get morning headaches or are tired during the day should be evaluated for sleep apnea. Sleep apnea (see www.ihatecpap.com) is a collapse of the airway during sleep.

Patients with clicking or popping TM joints will frequently have resolution of the TM Joint (temporomandibular joint) clicking if they wear a sleep apnea oral appliance.

The appliance stabilizes the condyle of the TMJ forward and if the disc is reduced allows time for the soft tissues to heal and stabilze the disc.

This stabilization will require the use of a daytime neuromuscular (splint) orthotic to maintain joint stability during the day.

Labels: CGRP neuromuscular dentistry, chronic daily headaches, facial pain TMJ, improving quality TMD, morning headache, temporomandibular joint, TMJ clicking, TMJ pain, TMJ popping

IMPROVEMENT IN QUALITY OF LIFE WITH TMD TREATMENT HAS RECENTLY BEEN PUBLISHED. THIS STUDY USED EVIDENCED BASED ARTICLES FROM Medline and Cochrane Library databases. This severely limited the number of studies considered and eliminates publications of exciting clinical work and case reports. This type of search tends toward bias toward drug therapy.

The study showed almost universal improvement in the quality of life with TMD treatment. The twelve papers reviewed showed that the more symptoms and the worse the condition was to begin with the greater the improvement in the quality of life. These results are unmatched in most of medicine where even a 50% improverment is touted. Men and women appeared to improve equally.

The study concluded that: "The reviewed studies convincingly demonstrated that OHRQoL (quality of life) was negatively affected among TMD patients. this coincides with other known materials including Shimshak et al who published in Cranio Journal a 300% increase in medical spending in all medical fields.

An excellent article on how TMD affects the quality of life can be fond in Sleep and Health Journal at:
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor Neuromuscular dentistry has begun to exhibit exponential growth as measured facts are replacing opinions.


AN EXCITING NEW ARTICLE ON IMActa Odontol Scand. 2010 Mar;68(2):80-5.
Temporomandibular disorders and oral health-related quality of life. A systematic review.
Dahlström L, Carlsson GE.

Research Center, Public Dental Service, Clinic of Odontology, Göteborg, Sweden. lars.dahlstrom@vgregion.se
OBJECTIVE: Oral health-related quality of life (OHRQoL) is considered an important aspect of different oral conditions. It has also gained increased attention in temporomandibular disorders (TMDs) in recent years. The purpose of this study was to systematically review the literature on OHRQoL and TMDs. MATERIAL AND METHODS: A systematic search of the dental literature was performed using the Medline and Cochrane Library databases, supplemented by a hand search. Various combinations of search terms related to OHRQoL and TMDs were used. Among numerous titles found in Medline, abstracts and eventually full papers of potential interest were reviewed. Twelve papers fulfilled the inclusion criteria and were included in the review. RESULTS: Most studies used the Oral Health Impact Profile, an instrument with good psychometric properties, for evaluation. All articles described a substantial impact on OHRQoL in TMD patients. Only a small proportion of all patients, a few percent, reported no impact at all. The difference between men and women was small and not significant. The impact appeared to be more pronounced in patients with more signs and symptoms. The perceived impact of pain on OHRQoL seems to be substantial. Two studies found that the impact increased with age among TMD patients. CONCLUSIONS: The reviewed studies convincingly demonstrated that OHRQoL was negatively affected among TMD patients.

PMID: 20141363 [PubMed - in process]

Labels: CGRP neuromuscular dentistry, improving quality of life, improving quality TMD, neuromuscular dentistry tmd, quality of life, TMD neuromuscular dentistry