Orofacial Pain is often the First Sign of Cardiac Disorders and Myocardial Infarction

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Patients with orofacial pain most commonly have myofascial pain but it is always important to remember that orofacial pain is the most frequent first symptom of Cardiac pain.

This has been published in numerous locations including:
Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction. Conference Paper · July 2010 (Abstract below)
Conference: IADR General Session 2010 (Additional references below).

Differential Diagnosis is the key to treatment of orofacial pain but it is also important to note that the most common cause of Orofacial is referred myofascial pain. In the orofacial region this is common due to repetitive strain injuries to the masicatory muslces and related postural muscles of the head and neck.

The most common treatment for myofascial pain is the use of occlusal oral appliances to address the myofascial pain. A neuromuscular appliance may be the most successful occlusal appliance partially due to occlusal scheme and partially do to ULF-TENS muscle relaxation utilized in neuromuscular dentistry. The Myomonitor is the original ULF-TENS that is very efficient at relaxing all of the masticatory and facial muscles and has an added advantage of being a Sphenopalatine Ganglion Stimulator.

Many patients with TMD and Orofacial Pain have a high Axis
Two component which involves the Hypothalamus-Pituitary-Adrenal complex. The SPG stimulation tends to act as a reset to these important autonomic structures.

Internal Derangements of the TMJoints may or may not be present in patients with TMD. Internal derangements are the source of clicking, popping and locking commonly associated with TMJ disorders.

Many dentists and physicians fail to make the proper diagnosis if clicking anf popping of the joint is not present because they don’t understand the complex nature of these disorders.

This has been published in numerous locations including:
Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction. Conference Paper · July 2010 (Abstract below)
Conference: IADR General Session 2010

Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case
Iran Endod J. 2015 Fall; 10(4): 274–280.

Craniofacial Pain of Cardiac Marcelo Kreiner Origin
An Interdisciplinary Study
Umeå University Medical Dissertations
Full Test at: http://www.iesta.edu.uy/wp-content/uploads/2014/05/Craniofacial-Pain-of-Cardiac-Origin.pdf

Craniofacial Pain as Sole Prodromal Symptom of Acute Myocardial Infarction.
OBJECTIVES: Recently, we revealed that craniofacial pain can be the sole symptom of an acute myocardial infarction. We hypothesized that this finding is also true for pre-infarction angina. METHODS: A total of 326 consecutive patients with verified cardiac ischemia comprised the study material. Those 150 patients, who experienced two or more acute cardiac ischemic episodes were selected and the latter two episodes were included in an intra-individual variability analysis. Acute myocardial infarction was experienced by 120 patients and was classified as having an abrupt onset or acute myocardial infarction with prodromal angina. Ischemia symptoms experienced within three months prior to the occurrence of an infarction were regarded as prodromal. Data was collected on demographic details, pain characteristics and risk factors. The McNemar’s and the Marginal Homogeneity tests were used to assess the differences in pain characteristics between intra-individual episodes. A multivariate logistic regression model was used to assess possible associations between risk factors, age, gender and the presence of craniofacial prodromal pain. Ethical approval was obtained and informed consent was obtained from each patient. RESULTS: Pain in craniofacial areas constituted the sole prodromal symptom of an acute myocardial infarction in 5% of patients. Women were more likely than men to experience craniofacial pain during their two ischemic episodes (p=0.004). The pain quality descriptors used, i.e. mainly pressure or burning, did not differ significantly between the two episodes (p=0.26). CONCLUSIONS: Craniofacial pain can be the only prodromal symptom of an acute myocardial infarction and thus easily misinterpreted, with the risk of fatal outcome. These data suggest a need of education of the general public and clinicians regarding craniofacial prodromal symptoms indicating myocardial infarction. ACKNOWLEDGMENTS: Funded by the Universidad de la Repblica, Uruguay, the Medical Faculty, Ume University, Sweden and the Swedish Dental Society.…

Wrong Treatment Given For Most Emergency Room Visits For Migraine

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The wrong treatment for migraines can actually increase future risk for increased severity and frequency of migraine.

Physiologic dentistry can decrease the severity and frequency of future migraines in many patients. The first step is a complete evaluation and the use of a diagnostic physiologic orthotic to evaluate treatment.

A recent study in Cephalalgia. 2014 Jun 19 showed that over half of patients seeking emergency care for migraine are given opiods in spite of recommendations to the contrary. The use of meperidine has declined but the use of hydromorphone has increased.

Trigger point deactivation, Sphenopalatine ganglion blocks, occipital nerve block can often give immediate relief without narcotics to patients with severe pain.

Neuromuscular Dentistry, Trigger Point Injections and Sphenopalatine Ganglion Blocks are all useful in the differential diagnosis of Orofacial Pain.…

TMJ Diagnosis

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How TMJ is diagnosed by a dentist


TMJ is a type of complex disorder that frequently goes undiagnosed or worse misdiagnosed. Patients feel that they can handle the popping they hear in their jaws when eating and ignore the headaches that the condition causes. The physiologic approach to treatment that Dr. Shapira uses gives his patients relief from their headaches, muscle pain, back pain, shoulder pain and all the other symptoms of TMJ.

A large number of patients suffering from the condition develop problems sleeping and with chronic pain. The trigeminal nerve is one of 12 sets of cranial nerves that go directly from the brain to the body without passing through the spinal column.  The Trigeminal nerve is at the heart of the physiologic system controlling the jaws, teeth jaw muscles, jaw joints, and controls blood flow to 2/3 of the brain thru the meninges.  The trigeminal  nerve that controls  the flow of blood to the brain and  can cause headaches, migraines and other types of pain when impaired, and disruption of normal function of that nerve can lead to TMJ.

Diagnosing TMJ through patient history and examination

Your TMJ diagnosis requires a detailed history and interview prior to performing an examination.  I usually like when my patients have pain to start by eliminating all or most of their pain.  I then understand their problem better and can discuss what the cause of the pain and decide the best way to eliminate your problems.  A patient history, also known as a medical history, lets you inform me of any symptoms you experienced in the past that might relate to the pain you feel.  The check list nature of the history and exam insure an approach that does not miss important information.  You also need to explain to me any medical conditions you currently have, any medications you take and any surgeries you had in the past.

Depending on your specific history I will chose a  long or short examination that looks at your mouth, jaw, neck and other areas of your body. If a doctor previously diagnosed you with the condition, or you received a different diagnosis in the past, arrange for your former doctor to deliver your test results to your current dentist. After the examination, the dentist will determine if you need any further testing.  If a shorter exam is chosen to save the patient time and money it is possible a more thorough exam may later be required.

Tests used in your TMJ diagnosis

Physiologic Dentistry uses sophisticated computerized scan that show how the jaw functions in real time.  When utilized with ultra-low frequency TENS it is possible to evaluate the physiologic health of the bite.  This is often used in conjunction with surface EMG that allows the TMJ Dentist to evaluate muscle health, function and most important symmetry.  Sonography is used to measure joint vibrations to give functional information about joint status.  These test are more specific for treating TMJ dysfunction and eliminating pain and dysfunction.

tmj-k7-2Dentists typically use several types of imaging as well, when looking for TMJ problems.  A screening panoramic radiograph is usually the best study to evaluate the entire dental system including the jaw joints and to screen for other problems.  An MRI scan is specifically used for evaluating the soft tissue in the joint including the disc and is usually used prior to surgery or following a motor vehicle accident .  The MRI is ideal when evaluating soft tissue growths, saliva gland, lymph nodes and other areas where organic disease may exist. CT scans are used to evaluate bony structures.  There is always a balance between radiographic exposure to x-rays and the information obtained and CT scans expose patients to more addition.  Cone beam CT’s are becoming more popular with dentists and patients due to lower exposure than medical CT scans  These tests get an inside look at your the soft tissues, bony structures and the  muscular system, which helps the doctor get an idea about the cause of your problem.

Other common tests include an EEG or a Pet scan. Doctors often use these exams when searching for the cause of your headache, and potential diagnoses can include cluster headaches or migraine headaches.

If you also have problems sleeping, pain in your neck, shoulders or back and pain in your jaw or mouth, the doctor might diagnose TMJ disorder. Though many people think that the condition involves popping or locking of the jaw, some patients never experience any of those symptoms. A large number of patients seek treatment for their headaches and later find that they suffer from TMJ.

Finding relief from TMJ

Finding relief from your TMJ is easier than you might think.  The majority of patients see 50-80 % improvement within a couple of visits and many patients have almost miraculous relief after only one treatment visit with their diagnostic orthotic.

I had one patient who had a continuous headache for over 50 years that went away after one visit. Headaches, migraines and jaw pain (TMJ) are the most common symptoms.  Some  other common symptoms of the condition include difficulty sleeping, problems opening your jaw,ear pain and stuffiness, tinnitus or ringing in the ears, issues eating or chewing and poor speech skills. TMJ can affect people of all ages, and left untreated, the symptoms can worsen. The longer that you leave your condition untreated, the worse your problems can become in the future.

It is important that you talk to a TMJ doctor or specialist as soon as possible about your TMJ and the type of treatments that are available to you. Your doctor will take your medical history, talk to you about your symptoms and perform the necessary tests before diagnosing you.  Frequently, Dr Shapira will temporarily eliminate the pain during the consultation appointment to help understand the root causes of the pain.

Today is the day that you talk to a TMJ specialist and finally find relief for your medical condition. To learn more about how doctors diagnose you with this medical problem, the types of treatments available to patients and what you can do to find relief, download a copy of my e-book.