Spreading the Word

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.

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.

Ear pain, tinnitus, jaw pain resolved through Physiologic Neuromuscular Dentistry

10% of all patients that go to an ENT specialist for ear pain, ear congestion etc. have NOTHING wrong with their ears at all, according to ENT specialists. Their pain is from TMD / TMJ disorder.

Unrelenting Ear pain, ringing in ear called tinnitus, jaw pain resolved through Physiologic Neuromuscular Dentistry. Physiologic Neuromuscular Fixed Orthotic resolved these symptoms when pain medications did not help.

Stan was having ear pain and dull jaw pain about a year ago. He went to his primary care doctor who told him that his jaw and face was constantly hurting. The doctor thought it was from clenching. Stan then went to his general dentist who also confirmed that his pain was coming from clenching. A couple of months later he started having ringing and sharp pain in his ear. He decided to see an ENT who examined his ear & throat which were normal. He told him to take over the counter Aleve for 2 weeks but it made no difference in the pain and then he was referred to Dr Raman.

Stan owns a construction company and always felt very fatigued. He also noticed that he could not lift heavy items as easily but just blamed these things on his job and age. Once Dr Raman evaluated Stan and determined that his symptoms were stemming from his poor jaw alignment he was then fitted with a fixed neuromuscular orthotic for 90 days. Within this 90 day period Stan saw an 80% overall improvement with his symptoms.

Stan said that he feels a lot better, not fatigued and that most of his pain has calmed down quite a bit. He can also lift more than he used to and feels more balanced.

If ear pain, ear congestion and ringing in the ear called tinnitus is affecting your life but the ear examination is normal, Physiologic Neuromuscular dentistry may help resolve those problems once and for all. It may also improve your overall balance and lessen fatigue.

Who needs a seat belt? Part 2

It is common for the chronic TMD sufferers to have over stretched the ligaments of the TMJ.  This results in the joints being too loose.  When sleeping, the jaw often falls back and interfers with breathing.  There are studies that link bruxism ( clenching and grinding) to Sleep Disordered Breathing. 

Gilles Lavigne, a researcher in the Faculties of Dentistry and Medicine at Université de Montréal, explains that “the development of neurobiology has enabled us to better understand the structure of sleep in clenchers and to define bruxism clearly as one of many cyclic phenomena that are characteristic of sleep.” The researcher and his team at Sacré-Cœur hospital in Montréal have now gained international recognition for establishing criteria to identify nocturnal bruxism.

Many medications that are classified as Selective Serotonin Reuptake Inhibitors (SSRI) have been shown to induce clenching especially during sleep. 

Drugs in this class include (trade names in parentheses): (source: Wikipedia)

  • citalopram (Celexa, Cipramil, Dalsan, Recital, Emocal, Sepram, Seropram)
  • dapoxetine (no trade name yet; not yet approved by the FDA)
  • escitalopram (Lexapro, Cipralex, Esertia)
  • fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR), Fluox (NZ), Depress (UZB))
  • fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
  • paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)
  • sertraline (Zoloft, Lustral, Serlain)
  • zimelidine (Zelmid, Normud)

These medicines are used so commonly for a long list of indications, this is definitely something to be aware of.

When I wear my seat belt before driving my car on the street, it does not show a lack of confidence in my driving ability.  There are other drivers on the road that may be impaired or inattentive.  There may be a mechanical problem such as a blown tire from a nail on the street.  So wearing a seat belt is a sensible thing to do.

If we prescribe a sleep appliance such as Somnomed MAS after finishing a Neuromuscular Reconstruction, it shows prudence.  Not a lack of belief in our ability.  Just like wearing a seat belt.

Who needs a seat belt? – Part 1

Neuromuscular dentistry is based on these fundamentals: 

  • measured, objective data is fact; while all else is just opinion
  • start with unstrained jaw and neck muscles that move the mandible
  • allow the lower jaw to move through a trajectory which is determined by the simultaneous contraction of all of these unstrained muscles and optimal TM Joint conditions
  • freedom of entry in to and exit from, a stable bite position
  • address ascending posture factors with co-treatment from physical therpists and AO (Atlas Orthogonal) chiropractors

 

 

With this level of attention to muscles, posture and joints as well as micro occlusion of the bite, most of the usual reasons for breakage of restorations (crowns, veneers etc.) are successfully addressed.  As such the usual cause of breakage, interferences when chewing and bruxism is resolved to a great extent.

Should a NM dentist then prescribe a “seat belt” for his restored patients? If he or she gives a sleep appliance or night guard, after NM full mouth resotrative treatment, does it exhibit a lack of confidence in the priciples of Neuromuscular dentistry?

Let us look at this more closely in the next post!

Locating Prabu Point ….safely!

There have been some instances that the myotrode has been incorrectly placed right over the SCM at the level of Carotid sinus. This is potentially dangerous.

When I looked into it, this occurence is related to HOW the Prabu Point.

One way to locate SCM is to have the patient turn the head to the side. But if the Prabu Point is located when the head is turned, when the patient turns the head straight, the SCM rolls…as it should..and roll under the previously located point. This turned out to be culprit.

The proper way, as I had described in my ICCMO Masterhip thesis….is to have the patient continue to look straight. But offer resistance to the head to turn against. This makes the SCM stand up…even in heavy people…but once the Prabu Point is located…in the middle 1/3 of the Posterior Cervical triangle.. the SCM does not change location.

I have attached a Power Point to illustrate this here.

Download locating_prabu_point.ppt

Dental health affects fertility

The connection between dental health and overall health….the “Oral systemic link” is widely recognized. Most of the studies related to periodontal ( gum support) disease and heart disease, stroke, diabetes and low birth weight babies. It makes sense to expect that infection in one area of the body is bound to affect other areas. But this new study has an interesting twist.

Male infertility is often connected to connected to chronic bacterial infection of the epididymis. This is the structure that “stores” semen. This study from Germany showed a direct connection between male sterility and dental infections. An abstract with the references is below.

They only studied those that were resistant to antiobiotic therapy. I wonder if the results would be even better if all of the sterile subjects were included in the study.

One more reason to make dental health and its maintenance a high priority!

1: Andrologia. 1993 May-Jun;25(3):159-62. Links
Bacterial foci in the teeth, oral cavity, and jaw–secondary effects (remote action) of bacterial colonies with respect to bacteriospermia and subfertility in males.
Bieniek KW, Riedel HH.
Department of Obstetrics and Gynecology, University of Halle-Wittenberg, Germany.

Bacteriospermia requiring medical treatment were diagnosed in more than 70% of the subfertile patients who had since 1988 attended the gynecological clinic at the RWTH hospital in Aachen. In 23% of all cases specific treatment with antibiotics did not reduce the concentrations of bacteria in sperma. Thirty-six patients with bacteriospermia resistant to antibiotic therapy were then subjected to dental examination. A high incidence of potential dental foci was found in all patients. In a test group of 18 patients these sources of potential infection were eliminated. Between dental operations and therapy swabs were taken to determine bacterial levels and bacteriological composition. It could be demonstrated that the bacterial spectrum of the intraoral samples was almost identical with the spermiograms. Six months following completion of dental treatment a further spermiogram analysis was carried out. In the test group about two thirds of the spermiograms proved sterile. Spermatological parameters, such as motility, density and morphology, had also clearly improved. In the control group the findings of the spermiogram remained poor. This study indicates that a direct causal relationship exists between bacterial colonies (dental foci) and therapy-resistant bacteriospermia which probably leads to subfertility.

Upcoming Speaking Engagements

Speaking engagements:

November 8, 2007 : Scottsdale, Arizona

ACEsthetics Occlusion Symposium

Academy of Comprehensive Esthetics has convened a symposium on Occlusion and Esthetics from November 7 – 10. The educational objectives of this symposium include “an understanding of the differences between CR and NM occlusal philosophies and the clinical implications associated with those differences”.

Well known experts in CR and NM occlusal philosophies have been invited to give presentations allowing the audience an opportunity to learn through comparing and contrasting.

I was invited to present about how I treat my TMD patients using NMD protocols. The title of my presentation is “A Neuro Muscular dental practice in the “Show me” state”.

If you are interested in attending a meeting dedicated to understanding both CR and NMD, check out www.ACEsthetics.com to register.

Upcoming Speaking Engagments

November 16-18, 2007:

Vincenza, Italy

14th International Congress of The Internation College of Cranio Mandibular Orthopedics

This is a meeting of the International Congress that is held every 2 years. I was invited to give a presentation on “Neurally mediated ULF-TENS to relax cervical and upper thoracic musculature as an aid to obtaining improved cervical posture and Mandibular posture”.

About a year ago, I had proposed a new way of stimulating the cervical muscles. This new technique and the particular point of stimulation have since been named “Prabu Point” by Dr. Dan Jones of Chino, California.

Since I will be presenting to doctors from around the world, there will be live translations in to Italian, German and Japanese.

For more information go to www.ICCMO.org