Author Archives: Dr. Prabu Raman

Can the lancinating pain of Trigeminal Neuralgia (TN) really be ‘cured’ by correcting jaw alignment?

Isn’t TN only managed with medications or resort to (irreversible and risky) neuro-surgery? That is exactly what someone suffering with these symptoms would hear from their physicians – Primary care, neurologists or neurosurgeons.

It may sound far-fetched but it is true. Disabling, lancinating (stabbing) facial pain, commonly diagnosed as TN could be resolved in most cases, by precisely correcting jaw alignment through Physiological Neuromuscular Dentistry (PNMD).

Is it just a coincidence or is it the treatment paradigm that is making the difference? Is the real difference, our paradigm, our understanding of the origin of these symptoms? Is it nerve injury or increased input in to the Trigeminal nerve from structural discrepancy that causes these stabbing, shocking facial pain symptoms?

These three cases of physician diagnosed TN were completely resolved of TN symptoms in a matter of days through PNMD. Each case is slightly different but the common denominator is the PNMD approach of diagnosing the discrepancy.

Mary Beth https://youtu.be/V8RaZ65pxO4
Pansy https://youtu.be/nQLQDOLnOl0

 

Angie Symptoms https://youtu.be/EtZ68pDJYx0  Angie Solution  https://youtu.be/BGvvAzSJRfQ

 

What exactly  is TN? Trigeminal neuralgia is a disorder that causes debilitating nerve pain in the jaw area that can feel like a lighting strike. The accepted medical explanation is that it is due to damage to the Trigeminal nerve’s myelin sheath. As such, TN symptoms can only be managed with medications for life or when that fails resort to irreversible and risky neurosurgical procedures including nerve surgery or brain surgery.

I have copied and pasted authoritative information from the National Institutes of Health that describes the medical paradigm of this condition. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet  Underlines were added for emphasis. My comments are italicized...

Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve……

Another synonym is suicide disease. If there is no end in sight for this debilitating pain, it is understandable that some sufferers would choose to end their lives instead.

TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours. The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.
TN can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes the wearing away or damage to the protective coating around the nerve (the myelin sheath).

This is a widely accepted ‘theory’ similar to many other theories in medicine about migraine, fibromyalgia etc. But if this theory is correct, then everyone that gets Micro Vascular Decompression surgery to place a protective cover over the nerve would get better. That is not the case. Or the surgeon would find the sheath damaged by a vessel each time. That is not the case either. Or if the myelin sheath of this nerve is missing as seen on MRI, then that patient would have symptoms. That is not true either. So, this is a theory with many holes in it.

Pain varies, depending on the type of TN, and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping.

As listed above, some additional stimulation of the Trigeminal nerve usually triggers pain. During sleep, most people are relaxed and slack jawed resulting in less stimulation of the Trigeminal nerve. So, this points to any solution that could LESSEN the stimulation of the Trigeminal nerve as a viable treatment. Does it not?

TN diagnosis is based primarily on the person’s history and description of symptoms, along with results from physical and neurological examinations. Other disorders that cause facial pain should be ruled out before TN is diagnosed.

This is very similar to the other “diagnoses of exclusion (DOE)” such as Migraine, Fibromyalgia etc. Diagnosis is based primarily on what the patient subjectively reports. All the medical tests are done to ‘rule out’ another cause for the symptom – that they know of – and hence confirm their initial diagnosis. Because most physicians including specialists are simply unaware of the Physiologic Neuro Muscular Dental approach (PNMD), poor jaw / neck alignment is NOT ruled out as a cause of the symptoms. Dentists are trained to repair teeth and gums. They usually look at where the teeth fit together (occlusion) but not the physiologic alignment of the jaws as a dentist trained in PNMD does. So simply consulting with any dentist ‘to rule out jaw alignment problems’ will not be helpful either.

A diagnosis of classic trigeminal neuralgia may be supported by an individual’s positive response to a short course of an antiseizure medication. Diagnosis of TN2 is more complex and difficult but tends to be supported by a positive response to low doses of tricyclic antidepressant medications (such as amitriptyline and nortriptyline), similar to other neuropathic pain diagnoses.

Drugs that reduce ALL nervous system activity is similar to a dimmer switch on the entire house. They do reduce the Trigeminal input in to the brain as well. But do so indiscriminately, with side effects and only for a few hours. So, if the symptoms get reduced with these drugs, how does THAT PROVE that the myelin sheath damage is the real cause of the symptoms? Is that logical to come to that conclusion and give no end in sight for patients besides taking drugs for the rest of their lives?

Eventually, if medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, then surgical treatment may be indicated. Since TN is a progressive disorder that often becomes resistant to medication over time, individuals often seek surgical treatment. ………
Some degree of facial numbness is expected after many of these procedures, and TN will often return even if the procedure is initially successful. Depending on the procedure, other surgical risks include hearing loss, balance problems, leaking of the cerebrospinal fluid (the fluid that bathes the brain and spinal cord), infection, anesthesia dolorosa (a combination of surface numbness and deep burning pain), and stroke, although the latter is rare.

So when the drugs are not enough, do invasive, irreversible and risky surgeries that do not work all the time is the only option left? Why not even consider a non-invasive and completely reversible treatment that actually lessens the input in to the Trigeminal nerve by correcting the structural discrepancy of the jaw / neck alignment that is necessitating constant over-work of this nerve to compensate for that structural discrepancy? THAT in a nutshell, is PNMD. THAT can only be described as a CURE as evidenced by many cases including the three examples given earlier.

Climbing Mount Everest and Full Mouth Reconstruction

When I started teaching dentists from around the world as a clinical instructor for Full Mouth Reconstruction (FMR) courses in 2002, I saw my role as a Mount Everest guide. I have often shared that analogy with those doctors, experts all, to be taking that course in the first place, to emphasize the dangers on their path to the summit of successfully completing FMR. In dentistry, preparing all of the teeth at one time – 28 or even 32 teeth at times – while precisely maintaining the jaw alignment through the provisional stage and in the bonded porcelain restorations is the equivalent of an Everest climb. There are so many things that can go wrong and the path to successful completion is quite narrow. The doctors will still have to do the climb. My role when teaching FMR is to keep them in that narrow predictable path to success for the patient and the treating dentist just as an expert guide would on Mount Everest.
As I provide this FMR option to my own TMD / CCMD patients as a phase 2 solution, the financial cost is a barrier for many. It is even beyond the reach of many. That is why I never recommend any treatment option. My role is always to educate the patients on the options and their consequences first. Then once they choose an option, competently delivering that treatment option is also my role.
What does FMR has to do with Mount Everest, besides my comparing them to my students? The dangers of cutting corners.
“Deliverance from 27,000 Feet” on NY Times from yesterday is a superbly written and illustrated article by John Branch. It chronicled the death of three climbers from India who perished on the mount. He shined the spotlight on one aspect. https://nyti.ms/2kG615e    “Climbing Everest is an expensive endeavor……. Some spend $100,000 to ensure the best guides, service and safety.” Speaking of those that perished, Branch writes, “These four climbers measured monthly salaries in the hundreds of dollars. ..….They cut costs and corners, because otherwise Everest was completely out of reach.”

In the end three of the four suffered a horrible death on the mountain. The fourth one only survived because of the kindness of a self-sacrificing stranger who gave up his own climb to save that woman.
The lesson? Don’t cut corners and opt for a cheaper way to get Full Mouth Reconstruction. Risking your health and quality of life when things go awry is only slightly better than the fate of these climbers.

Normal values for electromyography of jaw, neck muscles at rest – K7 Scan 9

Surface electromyography is very useful in the evaluation and treatment of TMD patients.  Hypertonicity of masticatory muscles at rest is indicative of TMD.  To determine hypertonicity, we need to know the normative data.  “Normal” values, in microvolts, for each muscle group comes from the work of Dr. Jeffrey Cram Ph.D. who did the research and published the normative data in his book “Clinical EMG for Surface Recordings: Volume 2” Aspen Publication 1998.  These values are:

Anterior Temporalis   (TA)          2.8 uV

Masseter                 (MM)            2.0 uV

Digastric                    (DA)            1.7 uV

Posterior Temporalis (TP)          2.2 uV

Sternocleidomastoid   (SM)        1.5 uV

Some have misinterpreted how these EMG norms are used by a clinician.  They are, in themselves, not diagnostic of TMD.  After all the clinician is the one who diagnoses the patient’s condition using many different metrics including EMG data.

It needs to be understood by the clinician that these normal values are similar to other physiologic metrics such as the ‘normal’ blood pressure of 80/120 mm of Hg.  Of course this blood pressure value is not applicable for all humans.  Many physically fit people have much lower ‘normal’ blood pressure and there are healthy individuals with a slightly higher normal blood pressure.

On K7 scan 9, resting electromyography of muscle Groups A & G, or A & B, the normal values are shown on the left and actual values on the right.  In this example below, LSM is hypertonic.  Even though the RTA value is within the norm, it seems to be hypertonic compared to LTA.

 In the example below, both TA’s are hypertonic, with the LTA clearly more so.  Even though RSM value is only slightly over the norm of 1.5  uV, it is nearly twice that of the LSM and so would be considered hypertonic.

Is there a cure for life long migraine when medications and Botox have failed?

Can Migraine even be ‘cured’? What would be a better word to describe the following result?
A patient that has been suffering with neurologist diagnosed migraine fails to get relief from various oral medications and fails to get relief from Botox. Even with medications, she is at such a constant severe pain level, that she needs intravenous medications every other week to reduce the pain level. The migraine is so disabling, she had to get a medical leave of absence from Medical school! Yet with Physiologic Neuromuscular orthotic, her pain resolves within days and she got off all her migraine medications. She continues to be pain free after 6 months so that she is able to rejoin medical school and continue to pursue her dream of becoming an ophthalmologist.
Yes. Cure is probably the best word to describe it.

Can a TMJ that has been locking for 20 years be corrected without surgery? Yes, we can!!

Jaw locks seldom get better on their own. Without treatment, they normally get worse, get more frequent and lead to more damage to the TM Joints. Jaw locks can be closed locks or open locks. This case history is that of a “closed lock” -meaning the jaw is locked when the mouth is closed and the disc is out of place preventing the jaw from opening normally.

This is a medical doctor who figured out how to manipulate the jaw to unlock. But since the jaw alignment was poor, the jaw locks recurred until the jaw would lock every time he closed his mouth. He had tried a mouth guard from one ‘TMJ expert’ for 2 years. He then went through 2 years of orthodontics hoping to resolve the TMJ locks. The teeth were straighter, but the jaw locks never improved. He was unwilling to have jaw surgery since he was managing OK.

When he learned about Physiologic Neuromuscular Dentistry, he looked into that for a solution. He realized that Dr Raman is a recognized TMD expert in his profession. After the optimal jaw alignment was diagnosed through Physiologic Neuromuscular Dentistry protocols, he chose to have Phase 1 PNMD orthotic treatment done. IMMEDIATELY after the orthotic was placed, the jaw locks were resolved! After 20 years of jaw locks, which was not corrected with splint therapy and orthodontic braces, PNMD orthotic corrected the jaw alignment problem and resolved the jaw locks! Headaches and neck pain also resolved.

TM Joint replacement surgery avoided

TMJ Joint replacement surgery avoided through Physiologic Neuromuscular Full Mouth Reconstruction

Vicki started having right side jaw pain in December of 2011. She could not open her mouth, chew or yawn without being in pain. She also suffered with neck pain, inconsistent bite, hip pain, arm pain and a shoulder impingement. She decided to see her dentist about the jaw pain who then referred her to an orthodontist. The orthodontist did some tests on her but determined that he could not help her and referred her to an oral surgeon in Arkansas.

Vicki consulted with the oral surgeon who read her MRI report and informed her that her discs were gone. He told her that the only option was to have surgery and to give her titanium jaw joints for both sides. She was not well informed about what all the surgery entailed and how it would impact her life. Her dentist told her NOT to do TMJ surgery. She did her own research about jaw joint surgery and realized that she did not want to do it. Her dentist found Dr Raman to help Vicki.

Vicki drove over two hours from Carthage MO to see Dr Raman in Kansas City. At her first visit Dr Raman evaluated her and determined that there is a jaw alignment problem and he felt confident that he could help her. Vicki chose to go through a series of Physiologic Neuromuscular Dentistry diagnostic testing to determine the optimal jaw neck alignment. After a detailed consultation, Vicki and her husband chose to move forward with phase 1 Fixed orthotic treatment.

Vicki admitted that she was skeptical at first prior to starting the treatment. She was fitted with a fixed neuromuscular orthotic for 90 days. During this time period Vicki said that her jaw stopped hurting, she could open her mouth wider and had better neck range of motion. She actually had surgery scheduled for her right shoulder due to the impingement but Dr Raman asked her to wait and see if the pain subsides with the orthotic treatment. Vicki cancelled her surgery and no longer has shoulder pain.

Vicki then chose to move forward with phase II of the treatment. She chose the option of Neuromuscular functional orthodontics in combination with full mouth reconstruction. She is certain that she made the right decision. She feels better and looks better and is happy with the results. Vicki said that it was a lot of money and a lot of driving but she would do it all over again.

Disabling Vertigo, severe ear pain, Migraines resolved through Physiologic Neuromuscular Fixed Orthotic

Angela and her family live in Kenai peninsula, Alaska and have traveled to Kansas City to seek help from Dr Raman. She has been suffering with severe vertigo for about 8 months and more recently extreme ear pain and Migraine.

Initially Angela went to her dentist to have a filling done and left the office that day in extreme pain. It was then determined that this tooth could not be saved and would need to be removed. Angela decided to have both of her lower wisdom teeth removed at the same time along with the lower right molar.

Angela was put under with IV sedation and had all three teeth removed. She was unable to bring her teeth together for about 8 days due to the amount of swelling. Three days later she had a migraine and the severe vertigo started. Angela went to the hospital and was told that she had an anxiety attack. She then decided to see an ENT who ruled out BPPV (Benign Paroxysmal Positional Vertigo). They also did an MRI, CT scan and hearing tests. All of these tests came out negative. The ENT specialist told her that her symptoms had NOTHING to do with TMJ or her teeth loss.

At this point a family friend who is also a dentist was the first one to mention that it could have something to do with her TMJ and recommended that she see a massage therapist. She also had lower back adjustments done by a chiropractor and her symptoms just got worse. Angela then made the decision to see a TMJ doctor in Anchorage who made her a lower acrylic guard to be worn at all times except when eating. The vertigo was so bad that she could barely walk out of his office.

At this point Angela felt stuck. She was unable to eat and could not even get in a car for 3 weeks. She has 2 young children ages 6 and 3 and couldn’t even drive her son to school because of the vertigo. Her anxiety level has been very high trying to deal with all of this and she did not want to spend her life this way. Her husband Jeremy then found Dr Raman on the internet. Once Angela realized that the more she moved her jaw around the worse the vertigo got, Dr Raman’s Physiologic Neuromuscular dentistry approach made a lot of sense.

Once Dr Raman determined that there is a jaw alignment issue, Angela went through a series of diagnostic testing. A detailed consultation was done with Angela and Jeremy and they made the decision to proceed with the phase I treatment option. She was then fitted with a fixed neuromuscular orthotic. Just five days after the orthotic was delivered Angela was doing really good. She said that she had one of the best days that she had in the past 8 months.

Angela said that her vertigo did not spike and she was able to drive. She was enjoying spending time with her family and is excited to keep moving forward.

Does Physiologic Neuromuscular Dentistry seem ‘just too simple’ to resolve debilitating Migraines?

Does Physiologic Neuromuscular Dentistry (PNMD) seem ‘just too simple’ to resolve debilitating Migraines? Is it too hard to believe that neck pain (after an injury) and back pain (after disc herniation surgery) could ALSO resolve through PNMD? Dana thought that there is no way a ‘dentist’ could help her with Neurologist diagnosed Migraine that was barely controlled with Zomig. Even after a friend that had her Mayo Clinic diagnosed Fibromyalgia resolved through PNMD referred her, it was just too hard to believe! Until she checked it out herself as a ‘last resort’!

Dana suffered with debilitating migraines and severe neck pain for 14 years. At times the pain would get so bad that she would have to go to the hospital and gets shots. She felt as if she had so many lost days in her life. Dana was on several medications to try and control the pain that were prescribed to her by a neurologist and her general practitioner. These medications consisted of Naproxen, Zomig and Phenergan for nausea.

Dana heard about Dr Raman through a friend who had also suffered with TMJ symptoms and was already in treatment with him. She was skeptical at first because she has tried so many other things. At this point she started to feel very depressed and sick almost every day. She thought that she was going to have to live with the pain for the rest of her life and felt like this was her last try at getting help.

Dana came to see Dr Raman initially for a consultation and then went through a series of neuromuscular diagnostic testing. Once the correct jaw alignment was determined she was then fitted with a fixed Physiologic neuromuscular orthotic for 90 days. She first felt the biggest difference in her neck pain and range of motion. She said that she has improved immensely and has no more back spasms, sleeps better, headaches much improved and no more lower back pain.

Dana is now in the Physiologic neuromuscular functional orthodontics phase of her treatment. She now has a lot more energy and even her family sees a difference in her. She is very excited. The best part of this is how it impacted her daughter’s wedding. Dana felt so well that she made all the table decorations and made all the hors d’oeuvres at home by herself over several days. She could not have even imagined being able to do all of that prior to her treatment. That made the wedding very special for the whole family. THAT is the power of PNMD and its impact on families as well as on the guests we help.

Vertigo resolved through Physiologic Neuromuscular Dentistry

Isn’t Vertigo, a medical condition? How can a dentist possibly help vertigo? One of the symptoms of a poor jaw alignment is vertigo. In such cases, PNMD can definitely help.

Unrelenting Vertigo resolved through Physiologic Neuromuscular Fixed Orthotic when medications did not help. AO chiropractic adjustments helped for short periods. Previous Neuromuscular removable or fixed orthotics worsened the vertigo.

Veronica lives in Dubai, United Arab Emirates and traveled to Kansas City to seek treatment from Dr Raman. She has been suffering with severe vertigo as well as neck pain, headaches and shoulder pain for the past 5 yrs. She would always feel off balance. Even raising her arm and picking up light weights would bring on vertigo. Her symptoms first began after having 20 Lumineers done in Lebanon for cosmetic purposes. She had her first “violent vertigo attack” immediately following that.

Veronica sought help from several different doctors including 3 neurologists who were very thorough, had MRI, MRA and CT scans done of her brain and spine. No cause of her vertigo was diagnosed. She then consulted with 5 ENT specialists who ruled out Meniere’s and Benign Positional Vertigo. When medications did not help, she was told by all of these doctors that she would just have to learn to live with it. She then decided to see a Physical therapist, a Chiropractor and an Osteopath. Those treatments actually worsened her symptoms. Her symptoms slightly improved with the Atlas Orthogonist Chiropractor at least for short periods. He is the only one who mentioned that her symptoms may be related to her jaw alignment. Poor jaw alignment affects the AO alignment. So his AO cervical adjustments would not ‘hold’. Much credit should go to this AO chiropractor since he alone pointed Veronica in the right direction when all the medical specialists were telling her that is due to “stress” and “just have to learn to live with vertigo”. So she saw a neuromuscular dentist near her and was treated for 8 months .

Veronica was first given a removable orthotic that she wore at night time only. She was then fitted with a bonded orthotic. The bonded orthotic made her “violently ill” for the 10 days that she had it in her mouth. They decided to discontinue treatment and had the orthotic removed. Several people that Veronica knew kept telling her to go to America for treatment. She did a lot of research on the internet and found Dr. Raman as well as a doctor in California and one in Nevada. After much checking she decided that her best chances for getting better is to be treated by Dr. Raman in Kansas City, Missouri. She saw more examples of difficult cases that he had treated than the other doctors. The only thing he could promise was that he would do his very best to help her.

Veronica was seen on a Wednesday for examination and diagnostic tests. Two days later, her Physiologic Neuromuscular Fixed orthotic was delivered on Friday afternoon. No adjustments were made. Her jaw and rest of the body needed to adjust to the alignment correction of the orthotic.

At her First follow up visit on Monday morning, 2 days post orthotic delivery, Veronica said that she had absolutely no vertigo, no neck/shoulder tightness and has been able to eat just fine. She said that she feels quite relaxed. She was vertigo and shoulder pain free after suffering for 5 years.

It is hard to measure the life impact of this treatment in this woman’s life compared to how it would have been in her family life, social life and general happiness if the unrelenting vertigo had continued. After all neurologists told her to “accept it” and live with. No wonder Veronica believes that it was worth the cost & travel time it took for her PNMD treatment.

Voice problems and pain when singing resolved through Physiologic Neuromuscular Fixed Orthotic

Can difficulty with singing, inability in holding a note with power and facial pain after singing be related a poor jaw alignment even if the “bite” looks great?

For more information http://www.MidwestHeadaches.com

David is in college majoring in singing. He had previously had braces and has nice looking bite. No one diagnosed him as a TMJ patient but he has seen many doctors for pain. They diagnosed him as over stressed, stress disorder and having allergies then gave him allergy medication. The last 3-4 years his jaw has locked many times. He also has tingling in his fingers, pressure on his back teeth, migraines and tension in his shoulders, neck and back. Pain pills do not work well. He had his wisdom teeth removed about 2 years ago and the oral surgeon told him that his jaw kept locking while he was working on him.

His main reason for coming to Dr Raman is that he was having a lot of pain and tension in his jaws when singing. As a singer it is very important to try and relax. After hours of practice each week it would become so painful for him and he would develop extreme headaches. David felt as if he was just trying to survive through it and singing was no longer a source of joy for him.

David started to think that maybe there was something mentally wrong with him because he just did not understand what was going on with his jaw. His vocal teacher noticed the extra effort that it took for him to try and relax. He then suggested that David have his jaw joints checked out by a TMJ specialist. David did further research to find a specialist and that’s when he found Dr Raman.

David initially saw Dr Raman for a consultation to determine if he had poor jaw alignment even though his bite looked good and if his symptoms were due to that misalignment. He then proceeded with a series of diagnostic tests to determine the correct jaw and neck alignment. David was then fitted with a fixed Physiologic neuromuscular orthotic for 90 days. He said that this treatment has been life changing and even his vocal teacher noticed the difference right away. He can now hit notes he could not before, has more duration and holds a note with power. David feels hopeful that he can pursue his music passion and that there isn’t something mentally wrong with him.