Posts Tagged ‘craniofacial pain’

Neck Pain of Craniomandibular Origin Unassociated With Trauma

Friday, May 7th, 2010

A complete discussion of the cervical spine and its relationship to the craniomandibular system would require a several day seminar.  The comments to follow will begin to develop the impact of mandibular posture to cervical dysfunction and pain.  The resting relationship of the movable mandible to the fixed maxilla is influenced by many factors.  These include dental occlusion, respiration, TM joint anatomy, muscle function, cervical posture, and tongue position.  Of course determining which is the cause and which is the effect is why a comprehensive diagnosis is necessary prior to proceeding with any treatment for craniofacial pain and dysfunction.

In all humans, mandibular orthopedic relationship to the maxilla is determined by maximum tooth-to-tooth position.  The muscles, TM joints, and cervical spine accommodate to posturally reposition the mandible in order to allow maximum intercuspation of the teeth.  Accommodation to bite discrepancy occurs in the entire upper quadrant, especially the cervical spine and more specifically the upper cervical spine, C-1 and C-2.  Structural relationships within the upper quadrant are extremely complex and so entwined that abnormalities or stress within one area can produce pain and dysfunction in another.  When the individual’s ability to accommodate is exceeded, symptoms occur.

In patients who present with mandibular orthopedic discrepancy as well as cervical discomfort, jaw orthopedics must be evaluated as the primary or secondary stressor for cervical pain and dysfunction.  The proper application of Ultra Low Frequency TENS combined with specific masticatory and cervical muscle response, as revealed through electromyography, provides diagnostic data, which frequently reveals the true source of the patient’s cervical pain.  Any treatment recommended can thereafter be directed properly resulting in efficient, effective and lower cost therapy.

More regarding this complex subject of Trigeminocervical relationships to come.

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Dr. Simmons Speaks to Dental Hygienists

Monday, April 26th, 2010

Saturday was beautiful in Seattle and normally I would be hiking, biking, or working in my garden.  However, on this particular Saturday I was presenting to the Washington State Dental Hygiene Association on the topic “TMJ Facts and Fallacies”.

My presentation offered a primer on current craniofacial pain (CFP) diagnosis and treatment as well as information to assist dental hygienists in developing a CFP screening program in their practices.  Current guidelines and recommendations for CFP screening were also presented.

Dental hygienists are an important part of the dental diagnostic team and patient education is one of their prime prerogatives.  CFP complications often affect the dental hygienist’s ability to achieve treatment objectives.

A local production company professionally recorded the presentation and following the editing process and I hope to offer a CD of this presentation on my website.

I hope I am invited for a return presentation in the future.  Congratulations to the WSDHA for a great conference and Thank You!

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Eye pain and TMD

Wednesday, March 17th, 2010

Retro orbital pain, or pain behind the eye, is a frequently reported symptom by patients who have TMJ/TMD.  This type of pain is often not perceived to be related to TMD by the patient or the doctor.  Patients may have often been convinced that the pain is due to eyestrain or even an undiagnosable or untreatable condition, which only increases their anxiety or depression.  It is well known that retro orbital pain can be referred from a trigger point.  A trigger point is a hyperirritable spot in a muscle that is painful to palpation. It is called a trigger point because it “triggers” a painful response.  A trigger point is more than a tender nodule.  It affects not only the muscle within which the trigger point is located, but also causes “referred pain” to distant and seemingly unrelated sites.  Trigger points are located in a taut band of muscles fibers. The trigger point is the tenderest point in the band.  In the case of eye pain, trigger points are known to be located in at least eight muscles of the head and neck (sternocleidomastiod m., temporalis m., splenius cervicus m., masseter m., suboccipital group, occipitalis m., orbicularis oculi m., and trapezius m.).

The majority of TMD complaints are of muscle dysfunction origin and every patient should be carefully examined of myofascial trigger points, which can be associated with their symptoms.  Of course, these muscles are all paired and therefore the muscle on the affected side will refer the pain.  The majority of TMD complaints are of muscle dysfunction origin and every patient should be carefully examined for myofascial trigger points, which could be associated with some of their symptoms.  Following a comprehensive diagnostic evaluation, if trigger points are identified, these areas should be treated and eliminated prior to any significant surgical or medication intervention.

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TMD Treatment for Headache: a case history

Wednesday, February 17th, 2010

Our experience with headache patients is typified by our patient Beth (the facts of this case are true, only the names have been changed to protect the innocent.)   Beth was referred to me by a neighbor for evaluation of chronic jaw dysfunction including clicking and popping jaw joints, jaw-locking open and closed, and jaw muscle pain.  Other significant complaints included chronic severe migraine headaches, frontal headache, occipital headache, and neck pain.  She was under the care of her physician for migraine headache treatment with daily medication and 1-2 visits weekly to the hospital emergency room for injections.  She was also receiving chiropractic treatment 2-3 times weekly for neck pain.

A complete craniofacial pain diagnostic workup was performed in my office.  The results of these evaluations revealed Beth suffered severe jaw muscle dysfunction, chronic jaw muscle spasm, and moderate destructive bone changes in her jaw joints.  Careful analysis of jaw muscle and temporomandibular joint function using electromyography and computerized jaw motion analysis indicated a removable oral appliance could correct many of the jaw movement problems.  The removable orthotic was delivered and Beth was instructed to wear the orthotic at all times.

Within the first week of wear, she had a dramatic reduction in her headache intensity and frequency.  From the first week, Beth never again needed to go to the emergency room for headache treatment.  Over the following months, her chiropractic adjustments were reduced and she no longer required prescription headache medication.  At approximately 14 months, the orthotic wear was gradually reduced to nighttime wear only.  At her 5-year follow-up evaluation, Beth continued to be virtually headache free.  Her current dominated complaint is continued neck pain, which is controlled by chiropractic treatments 2-3 times monthly.  Beth continues to wear her oral orthotic every night and there has been no further destruction of the jaw joint bone.

Unfortunately, Beth suffered for many years inspite of regular medical, dental, and chiropractic care by good caring doctors doing the best they could to help her.  The problem was they simply were not trained to recognize the signs of jaw dysfunction, which had been present for years.  It was Beth’s neighborhood friend, a chiropractor, who made the connection and as a result changed Beth’s life for the better.

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TMD and Headache

Friday, February 12th, 2010

Headache (cephalgia) is a common complaint among TMD-TMJ patients.  Consulting the literature on the incidence of headache yields widely varying results in study populations.  This is due to the wide variety of craniofacial pain symptoms, including headache, and the various methods used to categorize headache pain.  In spite of this epidemiologic confusion, there are some things we “kind of” know about TMD and headache.  Based upon current studies it seems that between 14% and 26% of all headaches are associated with TMD and over 90% of TMD patients list headache as a primary symptom.  Muscle tension headache appears to be the dominant type of headache and may be mild or debilitating.  Migraine headache is also strongly associated with TMD.  Although published studies offer scarce information on this relationship, clinical observations support the consideration of TMD as a cause of significant numbers of migraine headache.

In my own practice over 80% of TMD patients presenting with migraine type headache achieve significant or total relief.  As with all medical disorders, a very thorough diagnosis with identification of contributing factors is key to effective therapy.  In my experience, deficiency of diagnostic evaluation is the chief cause of treatment failure.

More of this subject later.

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