Do you or someone you know suffer from chronic headaches or Migraines? Usually these people have seen a variety of different doctors, with little if any relief. Their symptoms are being treated, but the cause of the problem still persists. Ever thought about seeing your dentist for a migraine? Well that is just one of the conditions that Neuromuscular dentistry is being used to treat. Neuromuscular dentistry is one of the new technologies available in dentistry today. It is different from regular dentistry in that it focuses on the muscles of the jaw and neck and how they are related to the teeth. (Fig 1.) Neuromuscular dentistry recognizes that the muscles that move the jaw must be in a comfortable, relaxed position in order to not be in conflict with the teeth and jaw joint i.e. we must have " happy muscles."
Some of the symptoms that occur when we do not have these" happy muscles" include: Headaches, Loose teeth, Clenching or grinding, root abfractions, Pain or clicking and popping in the jaw joints, Shoulder, neck, and back pain, Numbness in arms and fingers, non-specific Facial pain, problems swallowing , hot or cold sensitive teeth ,Crowded teeth , Receding gums , Ringing or congestion in the ears. A person could experience Migraine headaches and no other symptoms for example, yet be suffering from a neuromuscular dental problem.
There are a number of different types of equipment used in Neuromuscular dentistry to help us get a person to a position of "Happy Muscles". First, we must find a position at rest that is most comfortable for the patient. . This is position where the muscles are relaxed, regardless of where the teeth line up.A device known as the Myo-monitor (Fig. 2) is used to help relax the patient's muscles. It is a low frequency T.E.N.S. (Transcutaneous Electrical Neural Stimulation) unit. The Myo-monitor stimulates the Trigeminal Nerve and The Facial nerve using a very mild electrical impulse.

Figure 3 shows how the TENS is set up. This TENSing accomplishes 3 things. First, It pumps waste metabolites and lactic acid away from the stressed muscles. Second, it increases the blood flow to the muscle, which increases the oxygen, glucose, and energy to the muscle itself. Finally, it allows the jaw to relax into its ideal position.  Tensing usually takes 45- 60 minutes depending on how bad a patients symptom are and how tight their muscles are. Sometimes we will use an EMG machine to measure the level of tightness in the different muscles.

Figure 4 shows on the left how active the muscles are before the use of the TENS. On the right, after TENSing there is much less activity and the muscle are much "happier". After TENSing and finding the ideal position of the jaw where the muscles are happy, we make an appliance called an orthotic to keep the muscles in this position.  Keeping the muscles in this position is very important because it allows them to

Wearing the orthotic allows the muscles to heal, pain to dissipate and/or disaapear and the jaw joint to heal. The orthotic is usually worn for 1-3 months to make sure the bite is correct and that the symptoms disappear. Once the patient has become symptom free, we make a decision about Phase 2 of treatment. The patient may decide to wear the orthotic indefinitely, have orthodontic treatment done to move teeth into the correct position, have the teeth restored or adjust the teeth to their ideal bite.

The following three patient cases recently came to me for migraine treatment.

Alan is a 68 year old male with a history of migraine headaches 6-10 times per month for the past 25 years. "I had seen every imaginable type of doctor in the country, including the Mayo clinic. Nothing would stop the headaches, just control the pain with drugs. It got to the point where I had to carry narcotics with me everywhere I went." Alan was treated using neuromuscular dentistry and is now virtually headache free. "I am so happy with the results of my treatment. I am practically headache free and don't have to take any headache medications anymore. What a relief after all these years."

Barbara is a 43 year old mom of three with a history of headaches and stiff neck for the past 7 years. She had seen numerous physicians, specialists, chiropractors and acupuncturists over the years. "Nobody was able to stop the headaches and I haven't been able to move my neck completely for 1 and ½ years. I had to miss my 10 year old's birthday party because of a migraine." When Barbara came to our office, she had a severe headache and a knot the size of a golf ball in the muscles of her neck. We used the TENS unit on her for 1 hr. "I couldn't believe it. My headache had disappeared, the knot in my neck was gone, and I could move my neck from side to side for the first time in a year and a half." Barbara has been virtually pain free for the last 3 months, and is extremely happy with the results of her orthotic use. "I can't wait to have my mouth restored."

Deaun had occasional migraines until two years ago. "I was at a comedy club with my husband and I felt a migraine coming on. We left the club, went home and I went to bed. Ever since then, the migraines have been pretty much all the time for the last two years." Deaun had been to numerous doctors with no resolution. "They kept telling me that all they could do was give me pain medication. Then I heard about Dr. Cohen. My husband didn't think anything would work, but I really wanted to try neuromuscular dentistry. I am so glad that I did. My headaches have been reduced to about 1 every 6 weeks, and even my husband, the skeptic, is amazed at the improvement. I am religious about wearing my orthotic and feel great."