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Ramin Mehregan, DMD  
Male, 49
Canton, MA

Interests: neuromuscular dentistry, orthodontics

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Neuromuscular Dentistry and MPD

Mar 27, 2009 - 7 comments
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neuromuscular dentistry

,

TMJ disorders

,

TMD



                                                                                        
NEUROMUSCULAR DENTISTRY
AND
MYOFASCIAL PAIN DYSFUNCTION

When the harmony of the teeth, the facial muscles, and the Temporomandibular joints no longer exist symptoms of
what has been described as TMJ/MPD arises. Some of the clinical symptoms are:
•  Headaches •  Sensitive and sore teeth •  Facial pain
•  Neck and shoulder aches •  Ringing in the ears •  Jaw pain
•  Ear congestion •  Clicking/ popping of the jaw •  Worn down teeth
•  Clenching/ bruxing •  Limited opening of the mouth •  Cervical/ neck problems
•  Loose teeth •  Tingling in the fingertips •  Dizziness/ vertigo

Patients suffering from these symptoms often have to learn to live with pain. They wander from specialist to specialist, depending on the type of pain and problems they experience. When competent clinicians cannot find an organic basis for these symptoms, they often suggest it might be psychogenic. As the wanderers are told and retold that there seems to be no organic basis for their pain, that the cause is psychogenic, their anxiety mounts. When physical findings remain obstinately in abeyance, patients may begin to suspect a brain tumor, turn to drugs to alleviate their symptoms, or on rare occasions, even contemplate suicide.


“Misdiagnosis is rather the rule than the exception with MPD”




What is the cause?  “You can’t catch it”
It is a chronic degenerative disease which often takes years to develop. There are many contributing factors. Every person has a unique personality; this is why we must consider many different aspects of the individual when discussing the cause. The aspects can be divided into three groups:

                                            "STRUCTURAL-EMOTIONAL-BIOCHEMICAL"


All of these components are disturbed to some extent when a person suffers from MPD, but seldom are they affected to an equal extent. Hence, it is important, when diagnosing MPD, to assess the relative impact of each of these components. Many patients may remain oblivious of any symptoms until one day they wake up with, for example, an excruciating headache. It is like filling a cup with water to the rim and one keeps adding droplets until all of the sudden there is a spill over. Similarly, many different lifestyles can combine which could aggravate MPD – such as structural imbalance, stress, fatigue, certain foods and even a simple routine visit with the hygienist for a cleaning. Any one of these is a single drop in the bucket.

Structural
The one aspect that is always present in MPD is structural imbalance. This structural imbalance in the jaw is also termed “mal-occlusion” (“bad bite”), which means that the upper and lower teeth do not close together in the right way. Just as a chair needs four legs in order for one to sit on without falling over, all teeth need to fit firmly together to support the muscles in the face for chewing and swallowing. Teeth are an extension of the skeletal system. It is held to the skull via the Temporomandibular joints (TMJ) and the muscles. Both the position of the TMJ and the muscles are determined by the way upper and lower teeth fit together. When teeth are together they are in occlusion. The occlusion dictates the relation of the jaw to the skull also known as the cranio-mandibular relationship.

Simply stated mal-occlusion is when the skeletal system is in disharmony with the neuromuscular system. This means that the teeth or occlusion is forcing the TMJ’s and muscles into a strained position. Hence, the natural demand to the muscle and nervous system increases beyond their capacity and places them in a spasm cycle. It is just like walking with a pebble inside your shoe. After a few yards the pain becomes annoying and you will twist and torque your hip into all kind of different positions to avoid walking on the pebble. After a mile the pebble feels like a stone and your foot, leg and body hurts. This is the same thing that happens to the muscles of the face and jaw (oro-facial muscles) when they are forced into an unnatural position because of the bite. Eventually the muscles become strained and painful. This strain on the oro-facial muscles causes an alteration in their shape. To compensate for this the other muscles such as the neck, head and back have to compensate for this unnatural position. This in turn places these muscles into strain and spasm. Muscles that are under constant strain can develop “trigger points”, which feel like knots or nodules, and are painful when pressed on them. Trigger points can be the source of referred pain, which means pain is felt in another part of the body other than where it originated.

To correct this, the jaw must be brought back into a neuro-muscularly balanced position.

“Muscles under constant strain are in pain”

Emotional
For a long time it was believed that MPD was a psychosomatic (psych=mind, soma=body) illness, starting in the mind and manifesting itself in the body. Some examples of psychosomatic illnesses are ulcers and hypertension. It is of significance to realize that even though the problem begins in the mind, the physical symptoms themselves are very real.
It is believed, however, that for most part MPD has its origin from a structural imbalance or somatopsychic. The resulting pain in the muscles (soma) causes a feeling of anxiety, tension and stress (psyche). There have been numerous studies on how the impact of being sick affects us mentally and emotionally. For instance emotional reactions when having a headache could include:
• Inability to perform up to ones personal and public expectations
• Anxiety
• Depression
• Frustration
• Anger
• Fear of the unknown
Thus, it is apparent how coping with a chronically painful condition such as MPD can place someone under tremendous amount of emotional stress. Mind and body is a complex interconnected highway, so that even though the problem may stem from a structural imbalance in the jaw, the resulting discomfort will affect the mind as well.

Biochemical
The human body and mind has certain arsenal to its possession. When in pain and in stress it prepares itself for either “fight or flight”. These are short-term positive coping mechanism in the presence of stress. Unfortunately when in pain and under stress at the same time we tend to add to the problems by adopting less favorable habits such as:
• Over-eating
• Drug and alcohol consumption
• Sleeplessness
• Not exercising
Soon the body adapts itself to long term chronic stress. In this second stage, the body’s defense hormones operate in an above-normal rate. In addition to the aforementioned ill-habits, just like your car would eventually run out of fuel, the body will soon be depleted from its natural fuel supply.
At the third stage, exhaustion sets in and the body breaks down. This is where chronic diseases such as MPD will occur.
With MPD the body is placed in constant stress. The extent and severity differs from individual to individual. Some people may have an occasional click in their temporomandibolar joints and some suffer from constant, severe, daily pain. In either case, the body prepares itself to fight against the stressor. Biochemical changes occur to provide the body with energy to compensate and adapt. This energy is limited however, and eventually will be depleted at a faster rate depending on the ill-habits we take on during that time, thereby adding additional stress, pain and discomfort.

“It is important to know the person who has the disease
as to know the disease the person has.”
                                --- Sir William Osler


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by Tammy2009, Mar 27, 2009
Very very true ..... never thought about the three parts and how they all play into one another.  

I have never been truly diagnosed with anything except a bad bite due to the ortho work I had done from age 6-14 (now 21).  I can manage it very well with just a bite guard the dentist made (unforunately with no jaw tracking, just impressions) with almost no pain until midterms/ finals come around.  As soon as I'm stressed I can feel my muscles tightening and if I don't conciously relax them every couple of minutes (which works only until I become very stressed), they become very painful.  

If I can manage the stress, then most of the physical symptoms stay very mild.  However, the problem is how it comes in a circle; stress -> tight muscles -> pain and headache -> can't focus -> more stress and anixety and on and on.  

With changing the basis of the structural factor you could apply this to any disorder/disease.  If your body hurts, your mind and body play up the other hormones and chemicals in your body and can cause stress and anixety which makes the disease worse.  My allergies (cat and dust) also follow this.  Get stressed out -> allergies get worse -> get frustrated and more stressed.  of course they also make my jaw worse because then I have to hold my mouth open because my sinuses and nose are so congested and that stressed the jaw muscle more.  Everything is defintely connected.

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by Ramin Mehregan, DMDBlank, Mar 29, 2009
Thank you Tammy2009
Yes,you are so right. Fortunately the human body can compensate for a lot of what happens to it, what we put in it, how we treat it, etc. etc.
Let me ask you this out of curiosity, when you had ortho work did you have a head gear and or extractions (we call it 4 bicuspid extractions)?

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by Tammy2009, Mar 29, 2009
I had 7 teeth pulled but no head gear.   I had my bottom two eye teeth (baby teeth) pulled before any work was done, thus at about age 5 1/2.  Then later I had all four top molars (baby teeth) pulled and one bottom molar (however this due to it being infected I think, something was wrong with it, also a baby tooth).  

The only teeth that are straight are the ones that had braces on them, thus my 12 year molars sit on a point because the top and bottom are opposite directions.  I do not hold my orthodonist in high regards because I had two sets of braces and then night time retainer and my overbite came back and he wanted to put another set of braces back on, I said no and this is where we sit now (at least, that was a couple of years ago).  

Hopefully at some point I can get my jaw fixed and looked at in regards to the neuromusclar approach I had learned a lot about here, but being in university at the moment, I don't have the down time or money to cover anything and get the work done.  My insurance here in Canada is through a private company and it is lifetime which I have completely maxed out.  I also found out recently that my single mom paid over $5000 out of pocket for the 10 or so years of work, which would be a lot more now and I can't afford that.  But I'm lucky to be able to control it through relaxation and being able to relax the jaw muscles, I have got it done to using less than a dozen OTC pain killers in the past year in regards to this, so at this point I think I'll be fine to leave it for 5 years or so until I'm done school.  

746512_tn?1388811180
by Tammy2009, Mar 29, 2009
... forgot to add, may be relevant may not.  

I also had to have all 4 wisdom teeth pulled they were impacted and trying to pop out sideways, man that hurt!  I believe I would have a serverly messed up mouth if all my teeth were allowed to come in the way they wanted too.  

Avatar_n_tn
by Stevemanto, May 19, 2009
I had a Dystonic reaction to Maxolon about three years ago. It caused every muscle in my body to go into spasm. It went on for three days undiagnosed.

It happened after surgery for a Hernia repair, I was placed on painkillers & Maxolon to stop me been sick. My jaw clenched so tight it felt and sounded like my teeth were breaking. My Jaw was so tight and there was so much pain just beside and below the ear on both sides.

I was unable to move as legs muscles were in spasm as well and the pain was so bad, it was really bad at the sight of Hernia repairs.

I rang the surgeon and was told to harden up, He said your 24 hours post Op what do you expect, Take your meds as prescribed and stop phoning me.

I did this and things got worse to the point I could not move, it took me hours to move a few meters. My jaw would lock shut and I would feel pain in sides of face and jaw area and up from TMJ into skull running up behind the ears.

When jaw was clenched shut it felt like my teeth were breaking or cracking you could here a crashing sound in the ears. After been like this for three days I struggled to the phone and called my sister who told me to get an ambulance and sent my nephew over to be with me. Then for no reason my jaw locked open and I was sitting with mouth wide open.


The ambulance arrived and I was carried out to ambulance and taken To Waikato Hospital in Hamilton New Zealand, While in accident and emergency i was seen by a nurse who suggested I massage the back of my mouth with my fingers which i did and this made mouth or area feel better.

I was told I was having a Dystonic reaction to the maxolon and they would treat it. Following this i put fingers into my still open mouth and Massaged my mouth an  Emergency consultant seen me do this and yelled out get your fingers out of your mouth if your jaw locks closed you will bite your fingers off.

I was given Cogentin and 20 mins latter walked out,

However since then I have had dizzy spells feelings of been spaced out and Vision is blurry and neck back mid and lower really sore, I don’t sleep well like i use to and have tingling  in hands and fingers  when doing things like driving or watching TV I even wake in the night with hands tingling. I have had investigation into a pinched nerve causing this but it came back as normal. My back teeth are also now loose and have had a wisdom tooth lower removed as it became so loose it was getting an infection under it.

Do you think the above could be related to the TMJ joint and Dystoinc reaction?

Is there any medical information to back this up?

I have seen doctors and specialists like Neuro surgeons etc that say its prob Migraines one went as far as saying it was epilepsy I had no symptoms prior to the Dystonic reaction

Can you please give me some feed back on this as at the moment I’m living with all these problems yet no one can help. Then I seen your article and well it gives me a glimmer of hope.

I await your reply


Avatar_n_tn
by Solace261, Aug 01, 2009
Hay Steve MANTO,

Best of luck follow these links -

http://tmj-heal.co.nz/

http://www.painrelief.co.nz/temporomandibulardisorderstmj.html

http://www.tmj.org/

Regards, fellow TMJ/sufferer of 'weird' symptoms - there is relief and understanding out there - its just a matter of piecing together the puzzles of each tmj sufferers individual problems.  

Avatar_m_tn
by roberttaylor, Jul 25, 2011
“Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.”

Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.”

Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary.

“That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.”

Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on Toll Free: 888-419-6855.

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