Dr. Shapira's Chicago Headache Blog

Saturday, April 3, 2010

TMJ and Sleep Apnea

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

posted by Dr Shapira at 8:17 PM

Monday, March 1, 2010

EAR PAIN: What to do when the ENT says there is no infection and does not have a treatment to relieve ear pain.

When chronic or acute ear pain occurs an evaluation by an otolaryngologist or ENT is a good way to begin treatment. The exception to this rule is when movements of the lower jaw cause the ear pain or the motion of the lower jaw is limited. This is a sign of a TMJ disorder. If it happens suddenly it may be the sign of an acute close-lock of the TM Joint and a dentist with experience in treating temporomandibular disorders is a must. Neuromuscular Dentistry is extremely effective in treating chronic haeadaches, migraines, Tension Headaches and TMD but when an acute close lock occurs time is of the essence to prevent permanent damage.

Many neuromuscular dentists know how to manage the chronic pain aspect of TMD but are less sure of handling an acute disk dislocation.

The wrong treatment is to not attempt to reduce the dislocation, taking anti-inflamatories or pain meds without attempting to reduce the dislocation. The longer the disk is out the more likely there will be permanent damage or internal derangement of the TMJ.

A trip to the emergency room is usually non-productive or may even create additional damage if they try to force the jaw open.

A simple method to reduce a close-lock it to stimulate a strong gag reflex which will sometimes reduce the dislocation. It is then necessary to stabilize the joint with an orthotic.

Labels: atypical migraine, ear pain, facial pain TMJ, migraine neuromuscular dentistry, neuromuscular dentistry, otalgia, temporomandibular joint, TM Joint, TMD Migraine

posted by Dr Shapira at 7:36 PM

Thursday, February 4, 2010

New Technique to Treat TM Joint Dislocation

A new study in Anaesthesia Progress reported on a new method to treat dislocation of the Temporomandibular Joint (TMJ or TM Joint). The technique is to do a deep temporal nerve block with lidocaine to reduce muscle spasm The entire study "Use of Masserteric and Deep Temporoal Nerve Blocks for Reduction of Mandibular Dislocation" is available at www.anaesthesiaprogress.org.

An alternative method that I frequently use for patients is to induce instantaneous muscle relaxation of elevator muscles via a gag reflex. This will frequently cause an immediate reduction of an acute close lock dislocation.

Labels: dislocation, temporomandibular joint, TM Joint, TMD, TMJ

posted by Dr Shapira at 9:44 AM

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