MIGRAINE  AND  TENSION  HEADACHES  AS  A  RESULT OF JAW  POSTIONING

Millions of people suffer from headaches.  Headaches have many causes; however, the most commonly diagnosed are muscle tension headaches and migraines.  Many diagnosed migraine type headaches by health care practitioners are often treated using a variety of pharmaceutical agents developed to help patients find relief from these symptoms.

There are several distinct types of headache that commonly occur.  

Muscle tension headaches usually occur in the temples or neck and are constant and sometimes throbbing. 

• Migraine type headaches are associated with neurological symptoms and may include light sensitivity, sound intolerance, and dizziness.
• Sinus headaches may give the patient a sense of pressure in the forehead or under the eyes.

If you are under the care of a physician and your headaches are being managed well you are fortunate.  If you are having headaches that have not been professionally diagnosed and finding yourself frustrated by lack of any significant relief, a dentist that has been trained in treating headaches may be able to help.  There are significant neuro-muscular and jaw positioning factors that often contribute to these conditions that many physicians are unaware of because their training did not focus on these newer treatment modalities.  

The headache cases that seem to be non responsive to the conventional pharmaceutical therapies are the headache types that we specialize in treating. We have treated hundreds of patients successfully using a discipline of non invasive appliance therapy and little to no use of pharmaceuticals. Oral appliance therapy has been found to be very effective in many of these situations. 

Headaches

There are a variety of oral appliances that we use. There is no “one size fits all magic bullet”

 that works on every patient.  This is because each patient has unique medical and dental circumstances that vary, so it is critical that the proper design and appliance type be determined to meet the needs of each individual situation. 

A very generic term for an appliance of this type of oral device is called an "oral occlusal orthotic" appliance.  The theory behind many of these designs involves the phenomenon known a "proprioception".  This is the brain's subconscious and intuitive ability to know where your individual body parts are relative to each other.  That is how you can close your eyes and take your index finger and place it on the tip of your nose or even in your ear canal very precisely - when you think in depth about that simple act it is just one very small example of how our subconscious mind functions on a daily basis and can be translated into hundred of actions that take place every waking hour internally and externally in our bodies.   

Here is why that is important regarding migraine and tension headaches and most clenching situations.  Physiologically your upper and lower teeth should contact each other in only two instances:

1). When you chew

2). When you swallow

(Try to swallow with your teeth apart - you can do it but is feels awkward because your jaws need to be braced against your teeth for the swallowing muscles to work efficiently).

When you are not chewing or swallowing your jaw should be relaxed and a space 1/4 inch or so should exist between your upper and lower teeth.  If your teeth are together due to subconscious clenching this is not a normal position. (You do not have to be bearing down with any force - just the fact that your teeth are together means the muscles of mastication are contracting). Teeth chronically together also compresses the TMJ joint and if the meniscus or TMJ cartilage is not in the correct position this closed position will not allow the  joint to function properly or to heal properly if we are attempting to treat the joint.  That is why massage therapy may bring temporary relief but soon the closed clench syndrome returns and the symptoms are back again.

HERE IS THE  INFORMATION YOU NEED TO UNDERSTAND -  When your back teeth (molars) are in contact, that sends the message to your brain that you are in "chewing mode" so the brain sends a message back to the muscles activating the muscles of mastication - primarily the temporalis muscles (over your temples) and the masseter muscles in you cheek area.  If these muscles have been "working" all night or all day in some instances it often results in the migraine like or tension headaches that can be so debilitating.  Sound and light may become unbearable for many patients on top of the screaming pain.

Here is where it gets interesting.  Your back teeth were designed for chewing forces in excess of 20,000 lbs., per square inch (PSI).  Your front teeth were designed for smiling and incising or cutting food at a much lower PSI.   Your brain knows that it you bite down on your front incisors with the same force as it does on the molars it knows that these teeth will break or fracture, so

your brain will not allow the temporalis or masseter muscles to contract at a PSI greater than the incisors were designed to absorb.  So when the brain senses that your incisors are touching it shut down these muscles to protect the teeth.  This natural physiological phenomenon is a built in protective reflex mechanism that we are just now beginning to understand and harness as a way to easily treat the pain syndromes without pharmaceuticals and in a natural non invasive manner.

This appliance is designed so that your front incisors hit the little table that sticks out on the front of the appliance preventing the contact of the molar (chewing) teeth.  This sends the proprioceptive signal to the brain to shut down the contractions of the temporalis and masseter muscles resulting in a cessation of the tension/migraine type headaches.

 That is the science behind this appliance.  A simple test is to place your fingertips over the temple areas in front of and above your ears and then clench your molars together with force. You will feel the temporal muscles "pop" out as the muscle contracts.  Now place your  front incisors together as if taking a bite out of an apple.  Try as you may, you will not be able to force your muscles to bite down as hard when your incisors touch because your brain knows these teeth will eventually break if these muscles are allowed to contract with full force -  to prevent this from happening it sends the neurological signal to these muscles to shut them down.

This is the simple proprioceptive reflex that we now understand and anticipate to stop the chronic subconscious clenching.  The appliance also works to protect the teeth from trauma and the Temporo-Mandibular joint and cartilage. 

The appliance shown is not designed for 24 hour usage and it is not usually designed for chewing food.  Most of our patients wear this at night and also during certain times of the day if they feel that they are subject to higher stress or anxiety levels.

For more information go to:
SCHLEICHER-READ DENTAL

Sensitive Teeth

ARE YOUR TEETH SENSITIVE?

Ouch!!!  Are your teeth overly sensitive?  Current research shows that 30-45% of adults over 40 have overly sensitive teeth to cold, hot, certain foods, or even when touched by a tooth brush bristle or other objects.  The primary reason is the exposure of the tooth root surface when the gum recedes exposing these areas that were previously covered and protected by the gum tissues. This exposed area is called cementum – that’s the root surface that is not protected by the enamel.

It helps to understand the different parts of the tooth.  Every tooth has three main parts –

 1.  Enamel  - that’s the white hard outer surface – the hardest substance in your body and it is not living tissue – just a hard covering.  

2. Cementum is that layer farther down where the enamel stops – it is also known as the root surface and it is made up of dentin – that’s the softer layer under the enamel that has nerve endings  and  thousands of exposes tiny tubules  – this is a the living part of the tooth.

 3. Pulp – the inner most part of the tooth which has blood vessels, nerves and is the vital living center of the tooth.

When you are young (15-35) normal aging has not yet exposed the sensitive cementum area, but when most people get into their 40’s and beyond we often begin to see  gum recession primarily as a simple result of a combination of maturity, aggressive tooth brushing techniques, genetics, gum disease, and  other less significant factors.  It does not have to be much – a tiny exposure of the root can result in major tooth sensitivity.  If you have this you know exactly what I am talking about.  Not a day goes by in our practice without seeing multiple adult patients with varying degrees of hypersensitive teeth wanting relief.

OK -  so now you are forty there is gum recession typical for your age group and your teeth now hurt to the point of distraction. You may even avoid simple brushing because it hurts when you touch that exposed root surface on your teeth. It may just be one tooth or it could be multiple teeth.  What can you do to stop this common problem?

Good News!  Your teeth hurt because there are thousands of dentinal tubules which used to be protected by the gums are now exposed.  If these tubules can be sealed the pain will usually go away completely or be reduced significantly.  There are lots of over the counter tooth pastes that can help, such as “Sensodyne” .  These toothpastes contain a chemical called potassium nitrate.  The potassium nitrate basically “plugs” up the open tubules and over time makes the teeth less sensitive.  The only problem is it may take weeks to work and many times these products simply are not adequate, but it’s the only over the counter product available to patients.

Dental science has developed multiple products specifically created to stop this annoying problem for most people.  It usually involves a simple process of the dentist or hygienist cleaning off the root surface and applying a “desensitizing”  agent that soaks into the cementum plugging up all the dentinal tubules.

Once the tubules are plugged up the area is sealed.  Often patients will find immediate relief.  The treatment may last several years with some areas needing re application every 3-5 years.  It is not uncommon for one treatment to stop the tooth sensitivity permanently.

For severe cases we can make a custom fitting flexible tray that hugs the teeth. The patient fills these form fitting trays with the desensitizing medicine and places the tray over the teeth.  The tray holds the medicine against the teeth allowing it to soak into the dentin.  This technique is a little more expensive but it allows the delivery of a variety of great new products t0 protect  the teeth.

We can put a fluoride gel in the tray to harden the teeth against tooth decay.  We can put a gel that contains a product called amorphous calcium phosphate (ACP) into the tray to put the mineral, calcium back into teeth. 

Today we have a huge epidemic of teeth that have de mineralized from dietary acids so common today from sodas to sports drinks to energy drinks  - you name it -  the current American diet is responsible for many of the problems we see in our dental patients today.  The acids that are found in the typical American diet literally sucks the mineral calcium out of teeth making them sensitive and much more likely to get decay.  The solution is surprisingly, pretty simple – just put back the lost minerals that have been leached out by the dietary acids and armor plate the teeth with these products to prevent tooth decay and sensitivity. 

Ask your dentist about all of the products and treatments now available to desensitize and protect your teeth now – don’t wait until they are damaged any more. You can reverse the process if you start early!

Schleicher-Read Dental Group