DNA® & RNA® APPLIANCES by VIVOS: EPIGENETIC ORTHODONTICS, ORTHOPEDICS AND PNEUMOPEDICS: PATIENT TESTIMONIALS: VIVOS : The Breathe New Life Advantage.

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DNA and RNA Appliance are used to Treat a wide variety of issues including TMJ disorders, Headaches, Migraines, Snoring and Sleep Apnea.  Postural disorders to impaired breathing can be related to chronic head and neck pain and spread  postural issues throughout the body.

It is vitally important for dentistry and medicine to address the development of airway issues that last a lifetime.  I primarily work with older children, adolescents and adults in my practice.  Children, even very young children receive the biggest benefit from expansion of airways.  The DNA/RNA Appliance gives an important second chance to patients who did not properly develop as children.  Adults can now be treated without orthognathic surgery, tongue reduction and other invasive procedures.

The DNA Appliances are changing the field or dental orthodontics from cosmetic shifting of teeth in available bone into the field of Epigenetic Orthopedics correcting problems that conventional orthodontics never addressed.

Orthodontics utilizing braces and brackets or plastic aligners as used by Invisalign, Smile Direct and other systems is about moving the teeth in the available bone to create a prettier smile and straighter teeth.   Phased orthodontics in children has to a small extent embraced expansion of bone to create more space to straighten the teeth.  Airway has only been minimally addressed by most of orthodontics.

There are many orthodontists who still practice “Contraction Orthodontics” also known as “Four on the Floor” or Bicuspid Extraction cases.  The thought process is the you “Amputate” the teeth to make room in the mouth for all of the remaining teeth.  This Contraction Orthodontics” makes the teeeth fit but crowds the tongue and impairs breathing.

Unfortunately, until recently the question of airway and ideal development of the jaws has not been addressed.  There have been major changes in the last few hundred years to patterns of orofacial and cranial bone growth.  These are negative epigenetic changes due to environmental issues including pollution, changes in how babies are fed and nurtured as new borns ant throughout their early lives.  This has led to a massive problem of underdeveloped maxillas, mandiibles and airways.

I became involved in the early 1980’s in managing airway in adults by treating sleep apnea and snoring.  I saw my son Billy had issues but when he was ready to start Kindergarten he was evaluated and I was told he had ADD, ADHD, could not start Kindergarten and needed to be on
Ritalin for life.  You worry about your child’s when they cannot start kindergarten and I refused the diagnosis and took Billy to Rush Medical School for a sleep study.  He had severe sleep apnea and we proceeded to have tonsils and adenoids removed and at 5 orthopedic expansion of hist maxilla.  He had a tongue and lip tie corrected as well.  He became a straight “A” student, went from 50% growth curve to 90% growth curve, slept well and mood was vastly improved.  He graduated college double major, double minor Magna Cum Laude,  His drug of choice was Oxygen not Ritalin.  I became a Visiting Assistant Professor at Rush Medical School Sleep Center in 1985 and did research into similarities in jaw position in sleep apnea patients and TMJ patients.

Breast feeding is a major factor in the development of proper facial form.  “Form follows function” is a truth in medicine and the changes in how babies are fed and nurtured has changed,  which changes their development.  These changes in growth and development  affect airway and sleep, intelligence and learning and most importantly brain development and function and can lead to learning and behavioral disorders including ADD, ADHD and ODD.  Many of these disorders are related to sleep disordered breathing including snoring, increased upper airway resistance syndrome (UARS), Respiratory effort related arousals (RERA) Hypopnea, Sleep Apnea.

The  underdevelopment of the nasal  oropharyngeal airway is the single biggest culprit and creates problems not just in infants, children and adolescents but also problems that last a lifetime.  Sleep Apnea can cause issues with insulin resistance, memory loss and dementia, they cause a 300-600% increase in heart attacks and strokes as well as motor vehicle accidents, are implicated in hypertension,  metabolic syndrome and obesity.  Ideally a narrow airway is corrected before 8 years of age and it was thought expansion was limited if not impossible in adolescents and adults.  The DNA Appliance has changed all that and expansion is possible throughout your life.

The DNA Appliance  is an FDA approved orthodontic device that can often correct all of these issues.  The RNA version of the
DNA Appliance is an FDA approved Sleep Apnea Appliance.  Both the DNA and RNA Appliance utilize Epigenetic Orthopedics to grow larger airways and offer the possibility of curing sleep disordered breathing in all forms.  The process of growing a larger airway has been called Pneumopedics by Dr David Singh who invented the DNA Appliance.

I will present several video testimonials of patients who have utilized the DNA/RNA Appliances.  The first one is a patient experiencing major improvement in nasal breathing after just a few months of treatment.  When the maxilla is expanded the roof of the mouth widens and high palates correct themselves flattening out.  The hard palate is the roof of the mouth  but that same bone is also the floor of the nose.  With epigenetic expansion the cross section of the nose dramatically increases in both height and width.  The expansion of the mouth makes more room for the tongue.

Nasal breathing increase the amount of Nitric Oxide the body produces which is the single most powerful antioxidant known.  A Nobel prize has been given for work on Nitric oxide.

Sleep Apnea is a serious medical issue for millions of Americans.  There are many treatments available to treat Sleep Apnea, the best known treatment is CPAP or Continuous Positive Airway Pressure which uses a compressor to deliver pressurized air through the nose and/or mouth through a mask.  CPAP is extremely effective when it is used by patients but only about one in four patients prescribed CPAP actually use it on a regular basis.  The 25% of patients who utilize CPAP is dwarfed in number by the 60% of patients who reject or fail CPAP completely.  Approximately 15% try to manage CPAP but do poorly.  Success is not the norm with CPAP in spite of the fact that it is extremely effective when used and is considered the “Gold Standard” of treatment.

The primary reason patients don’t use CPAP is that they “Hate CPAP”.   Oral Appliances are also extremely successful at treating Sleep Apnea and are considered a first line approach for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea.  They are under prescribed primarily due ignorance in the medical community about effectiveness.  CPAP is a billion dollar industry that has tremendous monetary power and thee makers of CPAP machines also make much of the diagnostic instrumentation for sleep.

The website https://www.IHATECPAP.com is an excellent resource to learn more about Sleep Apnea diagnosis and treatment.  The name of the website is from patients who when asked why the wanted an oral appliance would commonly reply “I HATE CPAP!”

The following is a video of a physician describing his experience with an oral appliance to treat sleep apnea.  Many physicians choose not to utilize CPAP but rather a comfortable oral appliance.  Oral Appliances are excellent for managing Sleep Apnea but the DNA/RNA Appliances offer a “CURE”!  Patients with sleep apnea must have their sleep apnea treated but it can be managed for a lifetime without negative consequences.

The following video is a physician whose life was affected by her sleep apnea and who chose to seek a cure for her apnea rather than just a treatment.  She has not completed treatment at the time this video was made.  Prior to treatment she was living in a state of exhaustion.  The RNA Appliance is acting as both a sleep appliance and is growing her airway orthopedically.  When the DNA/RNA Appliance is used to cure sleep apnea it actually results in a 24/7 improvement in airway not just a correction during sleep.  This patient discusses oral Myofunctional Therapy which can aid in expansion and ideally should be utilized in every single orthodontic treatment.  More important pediatric dentists and physicians should learn to be aware of these developmental issues and address them as soon as possible to prevent future issues.  In retrospect, my son would have been far better off having his airway issues treated far earlier.  Brain development is changed by sleep apnea even in infants and very young children.

TMJ Disorders, Chronic Headaches and Migraines and other types of Orofacial pain are often associated with airway issues.  The National Heart Lung and Blood Institute published a report “The cardiovascular and sleep related consequences of TMJ disorders”  The NHLBI of the NIH  considers Sleep Apnea to be a TMJ disorder.  The DNA Appliance is often utilized as a second phase of treatment for patients with TMD.  The following is a patient who has lived her entire life with an underdeveloped maxilla and is using the DNA/RNA appliance to pneumopedically grow a larger airway and orthopedically grow her maxilla in order to treat her TMJ disorder.  While she is still early in treatment she feels that her TMJ disorder has been cured.  Her lower jaw (mandible) was locked in a posterior position and maxillary expansion has given it freedom to move forward and relieve abnormal pressure in the TM Joints

The next video is a patient who has lived with chronic head and neck pain for many years and initially was treated with a neuromuscular dental  orthotic and is  now utilizing the DNA Appliance to complete her treatment (Phase 2 ).  She describes a wide variety of improvements after wearing the DNA Appliance for a couple of months.  When you breathe better and correct airway issues it has positive effects throughout the entire body.

The next video is a patient who has had a lifetime of sinus issues and TMJ issues.  While here TMJ issues were dealt with her small airway would create a less stable result and relapse.  The DNA Appliance is being utilized to increase her airway and led to dramatic improvements in he sinus issues.  Listen as she discusses how improved breathing is improving all aspects of her life.

Shimshak et al published a paper in Cranio Journal in  1998 looking at medical expenses in patients with TMJ disorders and found that there was a 300% increase in medical expenses in every single field of medicine.  We now know that sleep and airway are very closely related and that the increase in medical expenses has many causes but treatment with the DNA Appliance addresses a wide spectrum of these issues.  I wrote an article for Cranio Journal in 2013.  The full ediitorial can be found at https://www.tandfonline.com/doi/pdf/10.1179/crn.2013.001?needAccess=true.  I was asked to write this editorial by Riley Lunn tthe editor of
Cranio Journal because I had been treating sleep and airway issues since 1982 long before most of medicine or dentistry ever looked at airway and sleep apnea.

TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep

The next patient is much  younger and his parents who are both Chiropractors brought him in to address airway issues that were leading to forward head posture and was affecting his posture in his entire body.  Chiropractors are very aware of how head and jaw position affect the entire body.

The DNA Appliance is giving three dimensional expansion and there is a cascade of positive outcomes that occur as airway improves.

The next video is of Lewis who is now utilizing his RNA Appliance instead of CPAP while he is growing a larger airway.  He appreciates being able to go camping with his appliance, something he could not do with CPAP.His teeeth have straightened out and he has a bigger better lower jaw.

 

The DNA and RNA Appliance utilize Epigenetic Orthodontics which is the single most exciting advancement in dentistry today.  While  it is called epigenetic orthodontics a more accurate name would be epigenetic orthopedics because it actually grows and reshapes and idealizes the bone rather than just move the teeth.  This is far different than typical orthodontics.

This  technological advances of the Vivos System allows us to comfortably create (grow) big wide healthy looking smiles even in patients with narrow arches. Patients with weak chins and poor profiles can see improvements often even early in treatment. In an ideal world every patient would naturally have developed big wide healthy arches with resultant large airways and enough room for their lower jaw to grow ideally.

One very special aspect of utilizing the DNA Appliance and Epigenetic Orthodontics is that the appliances are only worn for 14-16 hours per day.  This is very different that standard orthodontics with brackets and wire or Invisalign®.  Most of the wear can be done in your sleep, watching TV or commuting.  During the day at work or with friends you can be free of the appliance.  This is one of the special features patients love about the DNA Appliance, the convenient fit into your lifestyle.

The time when the appliances are out the teeth move to ideal position as nature and/or genes intended.

Typical orthodontics is a four-step process designed to move teeth through the bone.  The first step is FORCE that creates PRESSURE (1) that compresses the periodontal ligament and puts pressure on the bone.  The second step is INFLAMATION (2) which is associated with pain and discomfort. The third step which is RESORBTION (3)  which is breaking down the bone by osteoclasts to create space.  The fourth step is CONSOLIDATION (4) where new bone is formed.  The process is then repeated after every orthodontic visit when braces are tightened or with each new Invisalign® tray.

Epigenetic Orthodontics is very different because it is a two step process.  The forces are very light and movement is limited to 250 microns approximately every four days.  The light forces are applied and growth and movement occur without inflammation which makes the entire process practically pain free.  If there is any discomfort the adjustments are spaced out further.

Relapse is frequently a problem with orthodontics after orthodontists have used fixed braces to straighten crooked teeth.  Relapse is the teeth moving back to their original position and relapse is why orthodontists make retainers.  The reason for relapse is complex and not well understood.  The hours when the appliance is out let the teeth follow natural eruption processes with far lower risks of relapse.

According to Dr. Dave Singh the Founder of the field of pneumopedics and craniofacial epigenetics which includes epigenetic orthodontics “there is a natural way for the body to remodel the upper airway, reshape bone and move teeth into their correct positions painlessly without the use of surgery, drugs or injections.”

Professor G. Dave Singh DDSc, PhD, BDS states on his website: “However, the entire human genome has now been sequenced, and we now know that certain genes are involved in moving teeth. Teeth are naturally-designed to move, for example, tooth eruption in a normally-growing child. In addition, the teeth in some people erupt in a specific arrangement, producing a beautiful smile. Dr Singh believes that the specific arrangement of teeth is due to certain genes. In fact, a natural process called ‘temporo-spatial patterning’ is at work. This process is the blueprint or body plan that is encoded by genes. In other words, the right and left sides of the body, the top and bottom of the body as well as the front and back of the entire body is under the control of a genetic body plan, including the teeth. Sometimes, however, the plan gets disturbed, producing crooked teeth and improper orthopedics.”:

Getting Older or Getting Better™. THE CHOICE IS YOURS! Come in and find out what is possible.

The Vivos DNA Appliance allows us to grow and develop a more ideal facial structure and a healthier airway.

Dr. Shapira has long had a special interest in developmental processes because of his work with sleep apnea in children and adults. Dr Shapira also has over 38 years experience in treating difficult TMJ Disorders, Migraines, headaches and other Chronic Pain.  When these processes go are disturbed it changes how people breathe and swallow.  Young children are frequently put in expanders to expand their maxilla or upper jaw.  This is needed because of negative epigenetic changes caused by environmental allergies, food allergies or disturbed growth from insufficient breast feeding and bottle feeding.

Dr. Shapira, has taught classes to hundreds of dentists and their teams on how to treat sleep apnea with oral appliance therapy.  It is one of Dr. Shapira’s students Dr .Martha Cortes who first introduced him to Dr Singh and to this exciting new field.

Dr Shapira has studied this field extensively and in 2014 gave a lecture in Buenos Aires,  Argentina on the “Common Developmental Pathways of TMJ Disorders and Sleep Apnea.”  These pathways are an example of negative environmental effects on development that can be reversed in adults who were not expanded as children.  Prior to the DNA Appliance only extensive orthognathic surgery was available to widen or move bone.

Faces are different and each and every one of us is unique.  Our appearance and physiology is determined by our DNA or genes.  Genes determine our physiology and everything else about us.  This is a description of Genetics

What many people are not aware of is that the environment and other factors can change how our genes express themselves.  These types of changes are called Epigenetic changes.

Each person has a unique Genotype, these are the genes we inherited from our parents that when combined created a unique and special person.  Identical  twins  actually share a identical DNA .

The Phenotype is how are Genes are expressed, the effects of the environment on us.  These are the epigenetic changes that can be positive or negative in nature.  This can be the difference between a big wide smile that shows all the teeth

What makes the DNA Appliance special is that it uses the patient’s own genes to modify and change not just the position of the teeth but the size, shape and position of the bone that holds the teeth as well as Pneumopedically change the size and shape of the airway.  This 3-D spatial reconfiguring of the teeth and bone can make amazing changes not just in the teeth but in the face as well.  The changes the DNA Appliance stimulates mimic the natural developmental process that occur in an ideal world.  Biomimetic is the term used to describe what the DNA Appliance accomplishes, it mimics through biologic means what an ideal environment would have developed.

Oral appliances are frequently worn as a comfortable alternative to CPAP to manage snoring and obstructive sleep apnea.  These appliances often protrude the lower jaw and are needed for life.  Pneumopedics® is a term coined by Dr Singh to describe non-surgical upper airway remodeling is a different approach because instead of merely repositioning the lower jaw during sleep it gently allows allows the body to gently and gradually orthopedically increase the size of the upper jaw and increase the nasal airway.  This has been shown in some clinical cases to create a cure for sleep apnea and snoring.  The FDA-registered Daytime-Nighttime Appliance® system (or DNA appliance®) is worn during the evening and night for a total of 14-16 hours/day

Patients who are CPAP intolerant can utilize the FDA-cleared, patented mandibular Repositioning-Nighttime Appliance® (or mRNA appliance®) which works to maintain an open airway in the fashion of sleep apnea oral while gently re-developing the upper airway and moving the mandible or lower jaw and the teeth into a more natural position.

The DNA appliance® and mRNA appliance® protocols can effectively address TMD issues and headaches in both adults and children.  Dr Shapira is a leader in the use of the DNA Appliance to finish phase two treatment in TMD patients.

Sinus Headache, Sinusitis, Sinus Pain and TMJ Disorders

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Chronic Sinus Headache and other Sinus Pains are closely related to TMJ Disorders. The connections between these problems is multifacted.

The Trigeminal Nerve also called the Dentist’s Nerve is the underlying common source of all of these problems.

Dentists are the experts on the Trigeminal Nerrve Disorders and in particular neuromuscular dentists who optimize eliminating noxious input to the trigeminal system. The term “TMJ: The Great Imposter” was coinded because patients with TMJ disorders frequently report symptoms not specifically related to the joints.

Dentists who practice TMD and Neuromuscular Dentistry are well versed in Myofascial Pain and Dysfunction or MPD as it relates to upper body, head neck and facial pain referred from active myofascial trigger points.

The Sphenopalatine Ganglion (SPG), the largest parasympathetic ganglion in the head is on the maxillary division of the trigeminal nerve. I have taught hundreds of neuromuscular dentists both from the USA and from across the world how to utilize SPG Blocks as part of Neuromuscular Treatment.

The Sphenopalatine Ganglion also contains Sympathetic fibers of superior cervical change responsible for “Fight or Flight” reflex and when not controlled create a wide variety of stress, pain and emotional issues.

The Myomonitor utilized by Neuromuscular Dentistry effectively neuromodulates the sympathetic and parasympathetic autonnomic input from the Trigeminal Nervous System.

The majority of sinus pain and sinus headache are NOT primary issues or infections within the sinuses. Antibiotics may actually create new sinus issues related to fungal infections.

Sinus pain and Headaches can be relieved with SPG Blocks very quickly.

Long term sinus improvements are related to function and structure.  The following is a video of a patient who has experienced a cure of her lifetime sinus issues with DNA Appliance.  Neuromuscular Dentistry treated her TMJ disorders and the DNA is used for long term stabilization and to increase the size of her airway.

There are over 150 additional videos on treatment of TMJ Disorders, Headaches, Migraines, MPD, Fibromyalgia, Sinus pain, Sleep Apnea and snoring mat this link:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

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Acute Migraine: Sphenopalatine Ganglion Blocks (SPGB) Safe and Effective. Self Administration is a Patient Friendly Approach

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A new article published in 208 discusses utilization of Sphenopalatine Ganglion Blocks for treatment of Severe Migraine.  Because it is published byty.the US National Library of Medicine of the National Institute of Health I can reprint it here.

I will make my personal comments in ALL CAPITAL LETTERS.  I ALSO FIND THAT SPG BLOCKS  CAN TREAT MANY OTHER DISORDERS INCLUDING FIBROMYALGIA, NECK, BACK, TMJ DISORDERS, TMD AND SHOULDER PAINS.

SELF-ADMINISTRATION OF SPG BLOCKS SHOULD BE CONSIDERED BY ALL PATIENTS WITH CHRONIC HEAD AND NECK PAIN, CLUSTER HEADACHES, ACUTE MIGRAINES, SINUS PAIN, SINUS HEADACHE AND EYE PAIN.  THIS DOES NOT MEAN THAT NEW PAIN SHOULD NOT BE EVALUATED BY APPROPRIATE PHYSICIANS AND SPECIALISTS.

INTRESTING NEW STUDIES HAVE SHOWN SPG BLOCKS ELIMINATING ESSENTIAL HYPERTENSION IN ONE THIRD OF PATIENTS.

. 2018; 2018: 2516953.
 Published online 2018 May 7.
Sphenopalatine Ganglion Block for the Treatment of Acute Migraine Headache

Abstract

Transnasal sphenopalatine ganglion (THE SPHENOPALATINE GANGLION IS ALSO KNOWN AS THE PTERYGOPALATINE GANGLION, MECKEL’S GANGLIO, THE NASAL GANGLION AND SLUDER’S GANGLION) block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions.  We assessed the efficacy and safety of this treatment using the Sphenocath® device. 55 patients with acute migraine headaches underwent this procedure, receiving 2 ml of 2% lidocaine in each nostril. (2% LIDOCAINE HAS ANTIINFLAMATORY PROPERTIES AND HAS VERY FAVORABLE SAFETY PROFILE)  Pain numeric rating scale (baseline, 15 minutes, 2 hours, and 24 hours) and patient global impression of change (2 hours and 24 hours after treatment) were recorded. The majority of patients became headache-free at 15 minutes, 2 hours, and 24 hours after procedure (70.9%, 78.2%, and 70.4%, resp.). The rate of headache relief (50% or more reduction in headache intensity) was 27.3% at 15 minutes, 20% at 2 hours, and 22.2% at 24 hours. The mean pain numeric rating scale decreased significantly at 15 minutes, 2 hours, and 24 hours, respectively. Most patients rated the results as very good or good. The procedure was well-tolerated with few adverse events. This treatment is emerging as an effective and safe option for management of acute migraine attacks.  THE EXCELLENT AND RAPID RESPONSE IS EXTREMELY FAVORABLE HOWEVER PATIENTS MUST GO TO THE EMERGENCY DE3PARTMENT OR PHYSICIANS OFFICE TO BE TREATED.  A BETTER APPROACH IS TO TREAT THE PATIENTS TO SELF ADMINISTER THE BLOCKS TO STOP THE MIGRAINE EARLY OR PREVENT IT COMPLETELY IF THE BLOCK IS DONE DURING PRODROME.

THE SPHENOPALATINE GANGLION BLOCK WAS ORIGINALLY DESCRIBED BY SLUDER IN 1908.  DR GREENFELD SLUDER WROTE A TEXTBOOK NASAL NEUROLOGY AND BECAME CHAIR OF OTOLARYNGOLOGY AT WASHINGTON UNIVERSITY MEDICAL SCHOOL IN ST LOUIS.A   A 930 ARTICLE IN THE ANNALS OF INTERNAL MEDICINE BY HIRAM BYRD MD REPORTED ON 10,000 BLOCKS ON 2000 SEPERATE PATIENTS WITH VIRTUALLY NO ADVERSE EFFECTS.  UNFORTUNATELY, THE SPHENOPALATINE GANGLION BLOCK BECAME A VICTIM OF FORGOTTEN MEDICINE WHEN DRUG COMPANIES CREATED A STORM OF PHARMACEUTICALS.  THE SAFETY PROFILE OF THESE DRUGS DO NOT APPROACH THAT OF SPG BLOCKS WITH 2% LIDOCAINE.  A 1986 BOOK ‘MIRACLES ON PARK AVENUE” WAS PROBABLY RESPONSIBLE FOR THE GRADUAL RESURGENCE OF THIS EXCELLENT TECHNIQUE.  THE BOOK DESCRIBED THE NYC PAIN PRACTICE OF DR MILTON REDER AND ENT WHO UTILIZED ONLY SPG BLOCKS TO TREAT A WIDE VARIETY OF PAINFUL CONDITIONS REGARDLESS OF UNDERLYING DIAGNOSIS.

1. Introduction

Migraine is a common primary headache disorder, causing significant disability and personal, societal, and financial burden (SELF ADMINISTRATION OF SPG BLOCKS CAN SIGNIFICANTLY REDUCE COSTS IN TERMS OF EXPENSES, LOST WORK AND SUFFERING) []. It is a highly prevalent condition, affecting 11% of adult population worldwide, including people of all ages, races, geographical areas, and income levels []. Although there are currently many options for acute migraine treatment, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), triptans, combinations analgesics, and antiemetics [], these treatment options are often (MORE OFTEN THAN NOT)  suboptimal, with inadequate efficacy and significant side effects []. In addition, several studies [] have shown that migraine patients with poor response to acute treatment are at increased risk for transformation to chronic migraine (CM) (SPG BLOCKS ARE ALSO EFFECTIVE AT TREATING CHRONIC MIGRAINE BUT EARLY INTERVENTION IS STILL THE BEST ROUTE) , with roughly 2.5-3.5-fold greater odds of developing CM []; patients with a moderate or better acute treatment efficacy did not have a significant increased risk. Therefore, there is a continuous need for new treatment modalities to address the therapeutic needs of migraine sufferers, especially those with frequent and disabling attacks [].

Sphenopalatine ganglion (SPG) block has gained interest as an effective treatment modality for migraine and other headache and facial pain syndromes []. SPG, also known as the pterygopalatine ganglion (PPG), is a large extracranial parasympathetic ganglion (THE SPG IS THE LARGEST PARASYMPATHETIC GANGLION OF THE HEAD)with multiple neural connections (Figure 1), including autonomic, motor, and sensory []. This complex neural structure is located deeply in the pterygopalatine fossa (PPF) posterior to the middle turbinate and maxillary sinus [], on each side of the face. The parasympathetic preganglionic cell bodies originate in the superior salivatory nucleus in the pons, and the parasympathetic fibers run in the nervus intermedius (a branch from the facial nerve) through the geniculate ganglion, forming the greater petrosal nerve (GPN). The sympathetic fibers originate in the superior cervical ganglion (THE SYMPATHETIC FIBERS OF THE SUPERIOR CERVICAL SYMPATHETIC CHAIN ARE VERY IMPORTANT IN THE ABILITY OF THESE BLOCKS TO TURN OFF THE “FIGHT OR FLIGHT” REFLEX) around the internal carotid artery and give rise to the deep petrosal nerve, which joins the GPN to form the Vidian nerve, which enters the SPG. The sensory input to the SPG is via branches from the maxillary nerve, carrying sensations from the palate, buccal cavity, gingival, and tonsils [].

An external file that holds a picture, illustration, etc. Object name is PRT2018-2516953.001.jpg

Saggital view of the nasopharynx, showing the sphenopalatine ganglion and its neural connections. Reproduced with permission from Robbins et al. (2016) [under the Creative Commons Attribution License number 4318850197898 (Wiley).

The parasympathetic fibers synapse in the SPG and second-order neurons provide secretomotor function to the mucous membranes of nose, mouth, pharynx, and lacrimal glands, as well as branches to the meningeal and cerebral blood vessels []. The sympathetic fibers pass through the SPG without synapsing and provide innervations to the palate, nasal cavity, and pharynx.

As acute migraine attacks, as well as other primary headache disorders like cluster headache, are often associated with signs of parasympathetic activation, including lacrimation, nasal congestion, and conjunctival injection, blocking the SPG, which is the major parasympathetic outflow to the cranial and facial structures, is a reasonable target to help relief pain and autonomic features seen in these disorders []. It is proposed that various migraine triggers activate brain areas related to superior salivatory nucleus, leading to stimulation of the trigemino-autonomic reflex. This results in increased parasympathetic outflow from the SPG, causing vasodilatation of cranial blood vessels that happens during migraine [], with the release of inflammatory mediators from blood vessels and activation of meningeal nociceptors, causing migraine pain []. Another possible effect of SPG block is modulation of sensory processes in the trigeminal nucleus caudalis via the afferent sensory fibers, which may change pain processing center and reduce central sensitization to pain that is commonly seen in migraine [].

SPG blocks have been used for the treatment of headache since a long time []. In 1908, Sluder described the use of transnasal SPG block using a long needle to inject cocaine, treating what was called Sluder’s neuralgia []. The technique was further developed by Simon Ruskin [], and in 1925 he used it to treat trigeminal neuralgia. Since then, the indications for SPG block have expanded to include cluster headache, migraine, trigeminal neuralgia, and many more [].

SPG blocks have been achieved with various techniques, including the use of lidocaine-soaked cotton tip applicator through the nose, transorally, transnasal endoscopic, infratemporal approach, and more recently using various noninvasive transnasal devices to inject anesthetics into the SPG [].

The objective of this study is to assess the efficacy of SPG block, using the Sphenocath device, for the treatment of acute migraine headaches in the outpatient setting. We also report the safety of this novel technique for migraine treatment.

2. Methods

2.1. Study Design and Setting

We conducted an open, uncontrolled, retrospective study in the neurology clinic at a university medical center. The patients were treated between March 2017 and September 2017. The study was approved by the institutional review board of University Medical Center at King Abdullah Medical City.

2.2. Study Population

The patients were recruited to the study if they were between 18 and 60 years of age, have been diagnosed with migraine headache according to International Classification of Headache Disorders-3 Beta [] since at least one year, and present with moderate to severe headache lasting between 4 and 72 hours not responding to abortive medications. Patients with medication overuse headache, bleeding disorders, abnormal neurological examination, and history of allergy to local anesthetics were not included in the study. All patients gave an informed written consent.

2.3. Methods of Measurement

Pain was assessed using numeric rating scale (NRS), where 0 is no pain and 10 is worst pain imaginable; this was recorded at baseline, 15 minutes, 2 hours, and 24 hours after the procedure. We also recorded patient global impression of change (PGIC; very poor, poor, no change, good, and very good) at 2 hours and 24 hours after procedure.

2.4. Outcome Measures

The primary efficacy measure was the percentage of patients free of headache at 15 minutes, 2 hours, and 24 hours after the procedure. Secondary endpoints were

  1. headache relief rate, defined as percentage of patients with 50% or more reduction in headache intensity at 15 minutes, 2 hours, and 24 hours;
  2. change in NRS from baseline to 15 minutes, 2 hours, and 24 hours after treatment;
  3. PGIC (effects on headache and its associated symptoms and tolerability) at 2 hours and 24 hours;
  4. all adverse events up to 24 hours after procedure.

Statistical analysis was done using SPSS Statistics Version 23.

3. Procedure

Prior to procedure, the nose was inspected for any obstruction, and xylometazoline 0.05% nasal drops( AFRIN NASAL SPRAY, OXYMETAZOLINE SPRAY IS EXTREMELY EFFECTIVE IN SHRINKING NASAL MUCOSAL TISSUES) ) (one drop in each nostril) were used to help open the nasal passages. Face temperature was recorded using temperature sensor skin probes put on both cheeks. A small amount of 2% lidocaine jelly was installed in each nostril for patients’ comfort, using a needless syringe. (AN ALTERNATIVE IS TO USE 2% LIDOCAINE IN A SPRAY FORM ONE MINUTE BEFORE PLACEMENT) Each patient received a single treatment of transnasal SPG block with 2 cc of 2% lidocaine in each nostril in the supine position with head extension, delivered using the Sphenocath device.  (I UTILIZE PRIMARILY A COTTON-TIPPED NASAL CATHETER THAT ALLOWS CONTINUAL CAPILLARY FEED OF LIDOCAINE FOR MOST PATIENTS.  I ALSO UTILIZE THE SPHENOCATH AND THE TX360 DEVICES IN MY OFFICE.  THE ALLEVIO DEVICE IS SIMILAR TO THE SPHENOCATH DEVICE) This is a small flexible sheath with a curved tip (Figure 2). It is inserted through the anterior nasal passage parallel to nasal septum and above the middle turbinate. Once in place, the inner catheter is advanced to administer 2 cc of 2% lidocaine. It is then removed and the procedure is repeated on the other side. Typically after the block, there is an increase in face temperature by 1 to 2 degrees Celsius and/or tearing []. The patient is instructed to remain in the same position for 10 minutes.  GENERALLY THERE IS LESS DISCOMFORT WITH THE COTTON TIPPED CATHETER BUT IN SOME PATIENTS WITH DIFFICULT ACCESS I UTILIZE DEVICE DELIVERY.

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ATERAL APPLICATIONThe Sphenocath device. Image provided courtesy of Dolor Technologies.

4. Results

55 patients received treatment with bilateral transnasal SPG blocks. 72.7% were females. The age range of patients was 19 to 58 years, with a mean age of 37.9 years. The baseline NRS range was 4 to 10, with a mean of 6.8. For the primary end point (headache freedom at 15 minutes, 2 hours, and 24 hours), the percentages were 70.9%, 78.2%, and 70.4%, respectively (Figure 3). Among the secondary efficacy measures, 27.3%, 20%, and 22.2% of patients reported headache relief at 15 minutes, 2 hours, and 24 hours after the procedure, respectively (Figure 3).  THE RAPID RELIEF IS TYPICAL OF PATIENTS RECEIVING SPG BLOCKS REGARDLESS OF THE METHOD OF DELIVERY.  THE COSTS OF THE DEVICES ARE HIGH APPROXIMATELY $75.00.  I PREFER THE COTTON-TIPPED NASAL CATHETERS WHICH COST LESS THAN $1.00 PER BILATERAL APPLICATION.  MORE IMPORTANT THEY ARE VERY EASY FOR MOST PATIENTS TO UTILIZE FOR SELF ADMINISTRATION AT HOME.

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The percentage of patients reaching headache freedom (pain numeric rating scale 0) and patients with headache relief (50% or more reduction in headache intensity), at 15 minutes, 2 hours, and 24 hours.

The mean NRS scores decreased significantly from a baseline of 6.8 to 0.9, 0.6, and 0.8 at 15 minutes, 2 hours, and 24 hours after procedure, respectively (Figure 4).

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The mean pain numeric rating scale at baseline and 15 minutes, 2 hours, and 24 hours after treatment, showing significant and sustained reduction in pain intensity.

Regarding PGIC, the majority of patients (98.1% at 2 hours, 98.1% at 24 hours) reported feeling very good or good (Figure 5). Only one patient reported “no change” in PGIC scale at 2 hours, but “very good” at 24 hours, and another patient rated her PGIC as “good” at 2 hours and “poor” at 24 hours due to return of headache which was slightly worse than before.

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Patient global impression of change after the procedure at 2 hours and 24 hours. The majority of patients rated the treatment result as very good or good.  PATIENTS SIMILARLY RATE RELIEF FROM TRANS-NASAL COTTON-TIPPED CATHETERS VERY HIGH.

Overall, the procedure was well-tolerated. Adverse events reported by the study population were mild (Figure 6), including transient throat numbness (100%), nausea (10.9%), dizziness (10.9%), vomiting (1.8%), nasal discomfort (18.2%), and worsening of preexisting headache (1.8%). These adverse events were transient and lasted less than 24 hours.  I RARELY SEE ADVERSE REACTIONS THOUGH THERE IS LIMITED COMPLAINTS ABOUT TASTE AND THROAT NUMBNESS BUT BECAUSE OF THE SLOWER DELIVERY THIS IS LESS OF A PROBLEM.  CHIEF COMPLAINT IS NASAL DISCOMFORT THAT CAN USUALLY BE ELIMINATED WITH AFRIN NASAL SPRAY AND LIDOCAINE SPRAY. THOSE SPRAYS.

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Adverse events recorded in the first 24 hours after the procedure.

5. Discussion

This retrospective case series demonstrated that transnasal SPG block with 2% lidocaine, using the Sphenocath device, is an effective and safe treatment for acute migraine headaches. There was a rapid relief of headaches observed at 15 minutes and 2 hours, and treatment effect was sustained at 24 hours after procedure in most patients. 70.9%, 78.2%, and 70.9% of patients were completely headache-free at 15 minutes, 2 hours, and 24 hours, respectively, while further 27%, 20%, and 27% achieved 50% or more headache relief at 15 minutes, 2 hours, and 24 hours, respectively. The majority of study population reported either very good or good response on PGIC at 2 hours and 24 hours.

A number of studies were published over the years regarding SPG blockade in acute migraine, with variable results []. Kudrow et al. [] conducted a noncontrolled study in migraine patients using 4% intranasal lidocaine and showed that 12 out of 23 patients achieved complete headache relief, and the effect was sustained at 24 hours. Maizels and Geiger [] evaluated the efficacy of 4% intranasal lidocaine as a treatment for acute migraine attacks, which was administered by the patient at home, in a double-blind, randomized controlled study. There was a significant reduction in headache severity at 15 minutes compared to placebo, but there was headache recurrence in 21% of patients receiving lidocaine.

Another placebo-controlled study compared outcomes for acute treatment of chronic migraine patients with intranasal 0.5% bupivacaine (n = 26) or saline (n = 12) using the Tx 360® device to block the SPG []. The injection was given twice a week for 6 weeks. The trial revealed significant reduction in pain numeric rating scores in the bupivacaine group at 15 minutes, 30 minutes, and 24 hours after each treatment. A randomized, double-blind, placebo-controlled study using intranasal bupivacaine or saline injections in patients presenting to the emergency department with acute frontal-based headache [specific classification was not required] demonstrated no significant difference in the proportion of patients achieving 50% or more headache relief at 15 minutes [].

Other studies used different agents for SPG blockade. For example, Bratbak et al. used onabotulinum toxin A injections into the SPG in 10 patients with intractable chronic migraine in an open, uncontrolled study []. This was done through a percutaneous infrazygomatic approach with a novel injection device. A statistically significant reduction of moderate and severe headaches was observed at 2 months after treatment; there were a total of 25 adverse events, mostly local discomfort, but none were classified as severe.

The SPG unique position in the PPF, as well as its multiple neural connections to sensory and autonomic systems involved in pain generation and propagation and the associated autonomic manifestations seen in many primary headache and facial pain syndromes, makes it a promising target for the treatment of these conditions. Inhibition of parasympathetic outflow from the SPG causes reduced activation of perivascular pain receptors in the cranial and meningeal blood vessels, with resultant reduction in the release of neuroinflammatory mediators (acetylcholine, nitric oxide, vasoactive intestinal peptide, substance P, and calcitonin gene-related peptide) from sensory fibers supplying the cranial and meningeal vasculature. This, in turn, reduces pain intensity and intracranial hypersensitivity observed in migraine [].

In our study, SPG blockade produced a rapid relief of headache at 15 minutes, with a significant treatment effect observed at 24 hours and high patient satisfaction. In general, the treatment was well-tolerated. We recorded few adverse events, which were mild and transient, similar to those seen in previous studies [].

The main limitation of our study included the lack of a placebo group, as subjective pain response might have a significant placebo component []. However, the high treatment response and satisfaction rates in this study were both encouraging and clinically meaningful for our patients. We did not assess the use of analgesics after two hours of receiving the SPG block, which might have influenced the headache relief percentage at 24 hours. However, this is allowed in acute headache trials guidelines [].

6. Conclusion

Transnasal SPG blockade is emerging as an effective and safe option for the treatment of several disabling headache and facial pain conditions such as migraine, cluster headache, and trigeminal neuralgia. Its ease of administration using noninvasive devices, safety profile, and quick pain relief makes it an attractive treatment option for these conditions. More well-designed studies are needed to further explore the efficacy of this treatment modality and its use as part of a comprehensive headache management program.

Conflicts of Interest

The authors report no conflicts of interest related to this paper.

References

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6. Lipton R. B., Fanning K. M., Serrano D., Reed M. L., Cady R., Buse D. C. Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. 2015;84(7):688–695. doi: 10.1212/WNL.0000000000001256.[PMC free article] [PubMed] [Cross Ref]
7. Lipton R. B., Silberstein S. D. Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention. 2015;55:103–122. doi: 10.1111/head.12505_2. [PubMed] [Cross Ref]
8. Rizzoli P. B. Acute and preventive treatment of migraine. 2012;18(4):764–782. doi: 10.1212/01.CON.0000418641.45522.3b. [PubMed] [Cross Ref]
9. Khan S., Schoenen J., Ashina M. Sphenopalatine ganglion neuromodulation in migraine: What is the rationale? 2014;34(5):382–391. doi: 10.1177/0333102413512032. [PubMed] [Cross Ref]
10. Robbins M. S., Robertson C. E., Kaplan E., et al. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. 2016;56(2):240–258. doi: 10.1111/head.12729. [PubMed] [Cross Ref]
11. Piagkou M. N., Demesticha T., Troupis T., et al. The Pterygopalatine Ganglion and its Role in Various Pain Syndromes: From Anatomy to Clinical Practice. 2012;12(5):399–412. doi: 10.1111/j.1533-2500.2011.00507.x. [PubMed][Cross Ref]
12. Láinez M. J. A., Puche M., Garcia A., Gascón F. Sphenopalatine ganglion stimulation for the treatment of cluster headache. 2014;7(3):162–168. doi: 10.1177/1756285613510961. [PMC free article] [PubMed] [Cross Ref]
13. Suzuki N., Hardebo J. E. The cerebrovascular parasympathetic innervation. 1993;5(1):33–46. [PubMed]
14. Yarnitsky D., Goor-Aryeh I., Bajwa Z. H., et al. 2003 Wolff award: possible parasympathetic contributions to peripheral and central sensitization during migraine. 2003;43(7):704–714. doi: 10.1046/j.1526-4610.2003.03127.x. [PubMed][Cross Ref]
15. Sluder G. The role of the sphenopalatine ganglion in nasal headaches. 1908;27:8–13.
16. Waldman S. D. Sphenopalatine ganglion block-80 years later. 1993;18(5):274–276. [PubMed]
17. Coven I., Dayısoylu E. H. Evaluation of sphenopalatine ganglion blockade via intra oral route for the management of atypical trigeminal neuralgia. 2016;5(1, article no. 906):1–5. doi: 10.1186/s40064-016-2612-8. [PMC free article][PubMed] [Cross Ref]
18. Miller S., Matharu M. Trigeminal autonomic cephalalgias: Beyond the conventional treatments. 2014;18(8, article no. 438) doi: 10.1007/s11916-014-0438-z. [PMC free article] [PubMed] [Cross Ref]
19. Candido K. D., Massey S. T., Sauer R., Darabad R. R., Knezevic N. N. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. 2013;16(6):E769–E778. [PubMed]
20. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders. 2013;33(9):629–808. doi: 10.1177/0333102413485658. 3rd edition. [PubMed] [Cross Ref]
21. Wasserman RA., Schack T., Moser SE., Brummett CM., Cooper W. Facial temperature changes following intranasal sphenopalatine ganglion nerve block. 2017;3(5):p. e354.
22. Kudrow L., Kudrow D. B., Sandweiss J. H. Rapid and Sustained Relief of Migraine Attacks With Intranasal Lidocaine: Preliminary Findings. 1995;35(2):79–82. doi: 10.1111/j.1526-4610.1995.hed3502079.x. [PubMed][Cross Ref]
23. Maizels M., Geiger A. M. Intranasal lidocaine for migraine: A randomized trial and open-label follow-up. 1999;39(8):543–551. doi: 10.1046/j.1526-4610.1999.3908543.x. [PubMed] [Cross Ref]
24. Cady R., Saper J., Dexter K., Manley H. R. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with Tx360® as acute treatment for chronic migraine. 2015;55(1):101–116. doi: 10.1111/head.12458. [PMC free article] [PubMed] [Cross Ref]
25. Schaffer J. T., Hunter B. R., Ball K. M., Weaver C. S. Noninvasive Sphenopalatine Ganglion Block for Acute Headache in the Emergency Department: A Randomized Placebo-Controlled Trial. 2015;65(5):503–510. doi: 10.1016/j.annemergmed.2014.12.012. [PubMed] [Cross Ref]
26. Bratbak D. F., Nordgård S., Stovner L. J., et al. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache. 2015;36(6):503–509. doi: 10.1177/0333102415597891.[PMC free article] [PubMed] [Cross Ref]
27. Diener H. C., Schorn C. F., Bingel U., Dodick D. W. The importance of placebo in headache research. 2008;28(10):1003–1011. doi: 10.1111/j.1468-2982.2008.01660.x. [PubMed] [Cross Ref]
28. Tfelt-Hansen P., Pascual J., Ramadan N., et al. Guidelines for controlled trials of drugs in migraine: Third edition. A guide for investigators. 2011;32(1):6–38. doi: 10.1177/0333102411417901. [PubMed] [Cross Ref]

Dr Shapira Awarded Diplomate Status with American Board of Sleep and Breathing. Currently in Boston Learning Advance Pain Management at Harvard Medical School.

Dr. Shapira Blog, Lake Forest, Sleep, TMJ 1 Comment

I am pleased to announce that I am now a new Diplomate of the American Board of Sleep and Breathing. I am a long term Diplomate of the American Board of Dental Sleep Medicine, Credentialed by the Sleep Disorder Dental Society (SDDS) and a Founding member of both the SDDS (Now AADSM) and Dosa , the Dental Organization for Sleep Apnea.

I did research into jaw position and sleep apnea as a visiting Assistant Professor at Rush Medical School from 1985 until 1991 and returned as an Assistant Professor from 1998 until 2001.  I had the pleasure of  working with Dr Rosalind Cartwright who was responsible for the growth of Dental Sleep Medicine.

I am currently in day two of my Harvard Medical School course on Advanced Pain Management. I am spending all of this week in Boston to improve on my skills in pain management.

The program is on Advanced Pain Management continuing Education with Academy of Integrative Pain Management and Harvard Medical School’s Top Pain Doctors.

Updates and Practice Recommendations to
Optimize the Assessment and Treatment of Pain
Headache, Fibromyalgia, Neuropathic, Myofascial, Cancer, Abdominal, Pelvic, Musculoskeletal, Spinal Pain.

https://americansleepandbreathingacademy.com/

Management of Orofacial Pain with Sphenopalatine Ganglion Blocks

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Rapid treatment of Orofacial pain is very important because of the deleterious effects on your quality of life. According to an article in Cranio (abstract below) Journal SPG Blocks are “Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.”

Orofacial pain is often related to the autonomic nervous system. The lack of homeostasis or balance between the sympathetic division and the autonomic division division of the autonomic system often leads to problems with anxiety, stress overload, panic attacks and other Axis 2 events involving the limbic system.

The Limbic system is where we feel both good and bad emotions as well as pain. Pain is an emotional response secondary to nociceptive input to the brain.

Sympathetic overload is a common element of all orofacial pain patients. Many patients in chronic stress end up in a constant state of reflex “fight or Flight”

SPG Blocks or Sphenopalatine Ganglion Blocks are often rapidly effective in decreasing Orofacial Pain conditions. Utilization of a diagnostic neuromuscular orthotic often gives almost immediate relief. though some groups object to occlusal changes even when they dramatically improve patients quality of life.

Combination of these two treatments can give rapid dramatic improvement. Self-Administration of SPG Blocks is especially important in orofacial pain patients due to strong emotional effects of this type of pain.

Over 100 video orofacial pain testimonials: https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

Shimshak showed in his lanfmark study that orofacial pain patients who carry TMJ diagnosis have a three fold increase in utilization of medical services in all fields of medicine. Side effects and costs of orofacial pain are enormous as is their effect on Quality of Life.

Sphenopalatine Ganglion Blocks
Cranio. 1995 Jul;13(3):177-81.
Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.
Peterson JN1, Schames J, Schames M, King E.
Author information
Abstract
The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.…

Orofacial Pain and TMJ Disorders: Specialty?

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There is currently no specialty in Orofacial Pain and the American Dental Association does not believe one is needed. That does not mean that orofacial pain is not a problem, it is.

Most orofacial pain is actually well treated by the dental community. The most common causes of orofacial pain are related to teeth, gums dental abscesses, pulpitis and other disorders routinely treated by general dentistry. Sometimes non-dental pain is mistakenly treated as dental pain. The most common example is referred pain from muscles mistakenly treated as pulpitis pain and patients having root canal treatment preformed but the pain continues or moves to another tooth. I have seen patients with very healthy mouths with multiple teeth having had root canal treatment due to this type of misdiagnosis,

The second most common cause of orofacial pain is TMJ disorders which include Myofascial Pain, TM Joint internal derangements, capsulitis and tendonitis. These are commonly related to the bite, stress and parafunction, particularly night-time bruxism.

The majority of these problems are handled by a simple night-time bruxism appliance.

The more complicated TMJ disorders usually include multiple facets and affect not just the the oral structures but all of the muscles and nerve connections of the head and neck as well as the postural chain. They are not limited to the nerves of the somatosensory nervous system but are also firmly rooted to the sympathetic and parasympathetic divisions.

Typically dentists with advanced training in the treatment of TMJ disorders are very good at the differential diagnosis of orofaxial pain, particularly neuromuscular dentists.

Most of the chronic pain related to TMJ disorders is Myofascial Pain as described by Janet Travell in her landmark book; “MYOFASCIAL PAIN AND DYSFUNCTION: A TRIGGER POINT MANUAL” This ptype of pain is relatively easy to treat once it is understood that the problem is basically a repetitive strain injury.

Treatment of this Myofascial Pain and associated TM Joint pain usually involves utilization of a diagnost neuromuscular orthotic as part of the diagnostic process.

There are many other more infrequent and obscure conditions that fall under the umbrella of orofacial pain. Most of these are best treated by neurologists, ENT’s and Opthamologists. The push for an orofacial pain specialty is from a small group of doctors who think they are better equipped than the current medical specialties in doing differential diagnosis and treatment.

Differential diagnosis is the key to successful treatment. Dentists treating TMJ disorders need to understand this concept.
This link is to Chronic TMJ and Orofacial Pain Patients discussing treatment:
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/playlists

There are groups in dentistry that are currently suing state boards to try to create a specialty denied by the American Dental Association, these are self appointed specialists.…

SPG Block for Headaches and Migraines: Sphenopalatine Ganglion Blocks help Orofacial Pain Treatment and Differential Diagnosis

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SPG Block for frequent Migraines Or Headaches

spg-block-headaches-migraines-chicagoIf you’re someone who suffers from frequent headaches or migraines then you know how debilitating this can be. Sometimes the pain can be so intense that it makes it hard for you to perform your everyday activities, making it so that you’re always looking for the best cure or treatment that will help alleviate the pain. The majority of people who suffer from frequent headaches and/or migraines don’t tend to look for a solution until they feel one coming on, and by then it’s usually too late.

Now there’s a remedy available when it comes to the effective treatment of headaches and migraines. Its official name is Sphenopalatine Ganglion Block, or SPG for short, and it is uses a simple numbing agent but can give astounding results. that’s been proven to block the intense autonomic pain that often comes with a cluster headache or migraine. 

Stop Headaches Before They Start:  A simple way to stop pain early.

Now the option to stop the pain associated with headaches and migraines is available. The SPG Block is a minimally invasive procedure that requires a local anesthetic on a cotton tipped applicatoer (no needles) be used in order to stop the headaches and migraines before they can start. This is considered to the one of the best treatments that are available today that can help you avoid those headaches and migraines that can prove to be so debilitating.

The cotton-tipped applicator technique is taught to my patients for self-administration, There is also an intraoral approach injection approach and a external approach for injections.

How The SPG Block Works:

The SPG Block works when a local anesthetic and medication is used that helps to block the underlying causes of the intense pain that’s caused by a headache or migraine. The entire process only takes about 5 minutes to complete, and requires a specially designed cotton tipped catheter to be gently inserted inside your nose so that you can be given a local anesthetic that will help to block the pain. The relief is often instant and lasts for many hours or even days.

Because the SPG Block works so well, those who have already undergone the procedure tend to come back to have it done again. There are even some people who are able to learn how to use an SPG Block on their own, this includes those who are looking to avoid any more painful migraines or headaches altogether.

Learn more about SPG Blocks on www.SphenopalatineGanglionBlocks.com

Find Out If It Could Help You

Patient Testimonials with SPG Blocks:  https://www.youtube.com/playlist?list=PL5ERlVdJLdtllxAN1QwD7JU7Qo_ISoqvt

If you’re interested in learning more about how the highly effective SPG Block can work for you, we invite you to contact us today. We can help you determine if this particular treatment is going to be a good choice for you.  

TMJ and MPD: Trigger Point Injections Trigger Points Are A Frequent Underlying Cause Of Tension Headaches

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Trigger Point Injections and rapid relief of pain

The majority of pain that most patients experience is Myofascial Pain.  This is pain from the muscles and the connected fascia.  There are many patterns of referred pain from muscles to various area of the upper back, neck , head, shoulders and jaws.  Dr Shapira is an expert in these referral patterns and understands how to deactivate trigger points for instant relief. SPRAY AND STRETCH FOR MYOFASCIAL PAIN The use of vapocoolant spray and stretch can deactivate or eliminate trigger points that are the actual cause of your pain.  Dr Shapira will frequently use these techniques during your first consultation appointment.  Relieving your pain allows him to better understand your specific problems and how to achieve the most rapid improvement.  The majority of patients can be made temporarily pain free in the first visit.  The goal of physiologic dental treatment is to make this temporary relief permanent This is an excellent predictor of the pain relief patients can expect.  Dr Shapira is one of the few doctors who actually teaches his patients and their significant how to use this instant relief method of muscle pain relief.  Patients are amazed when a severe headache can often be relieved in seconds.  More importantly it gives patients personal control over their condition.  Another amazing technology  Dr Shapira teaches his patients is how to do SPG or Sphenopalatine Ganglion Blocks with cotton tipped applicators.  This is the exact technique used by Dr Reder  that was described in the famous book “MIRACLES ON PARK AVE” by Albert B Gerber that gave techniques for treating arthritis and other chronic pain. The use of trigger point injections is one of the most effective methods to eliminate tension headaches and referred muscle pain.  Dr Shapira has been utilizing Trigger Point Injections in combination with Physiologic Dentistry to eliminate chronic pain for years in Gurnee and is excited to be offering trigger point injections in Highland Park. The use of trigger point injections is often essential in differential diagnosis of orofacial pain.  Combined with Sphenopalatine Ganglion Blocks and Physiologic Orthotics trigger point injections are the missing piece in your treatment regimen. TRIGGER POINT INJECTIONS ARE A MORE AGGRESSIVE TREATMENT THAT CAN PERMANENTLY RELIEVE TRIGGER POINT PAIN.  Many patients want to speed up their treatment of neck shoulder and back pain along with their headaches and TMJ problems.  For treating referred pain from trigger points nothing is as effective as injecting the trigger point.  A area that has caused problems for years can be fixed with a single set of injections. Dr Shapira utilizes the diagnostic physiologic orthotic as the first line treatment for TMJ disorders.  The Physiologic Othotic is an orthopedic Appliance that eliminates the causes of muscle pain, primarily over use or inappropriate use of muscles.

Trigger point deactivation with spray and stretch and injections is both treatment and part of the diagnostic process for orofacial pain disorders.…

TMJ Symptoms

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The many faces of TMJ

TMJ is often called THE GREAT IMPOSTER

tmj-symptoms-chicagoTMJ symptoms can be wide ranging, complex and difficult to understand.  Frequently patients go from doctor to doctor looking for answers to these problems only to be frustrated again and again.  This is why the name  The Great Imposter is so accurate.  Patients are treated for symptoms not underlying causes.

If you experiencing any of the following common symptoms:

  • facial pain and soreness
  • Tension headaches or tmj and/or muscle headaches
  • migraines and other vascular headaches
  • ear pain …otalgia
  • ear ringing
  • sinus pain or pressure
  • ear stuffiness or pressure
  • distorted hearing
  • eye pain
  • pain behind the eye..retro-orbital pain
  • eye sensitivity
  • neck pain
  • back pain
  • tender jaw muscles
  • muscle tightness
  • MPD or Myofascial Pain and Dysfunction
  • Fibromyalgia
  • Sleep Disordrs
  • Morning Headaches
  • muscle pain
  • pain when biting, chewing or yawning
  • difficulties closing and opening the mouth
  • popping or clicking sounds when opening the mouth
  • sensitive teeth
  • excessive tooth wear
  • numbness in the fingers, hands & arms

and you can’t seem  to find a way to resolve them, they could be caused by a dental problem known as Temporomandibular Joint Disorder or Dysfunction (TMD).

TMJ is often ignored by the medical community.

If you’ve sought medical treatment with no results, the next logical step to finding out what is at the root cause of your pain or discomfort is to seek a consultation with a dentist trained in physiologic dentistry.  Dr. Shapira has over 30 years experience in physiologic dentistry and pain treatment.

How could your TMJ be the cause of your unexplained chronic pain?

The Trigeminal Nerve Connection

Often, unresolved chronic pain or discomfort is associated with the temporomandibular (TMJ) joint. You use this important joint to eat, chew, talk or yawn. The successful working of these joints depends on the smooth interaction of ligaments, muscles, bones and discs that make up the TMJ.

The largest input to our brain is the Trigeminal nerve, it is amplified by the reticular activating system which gives it incredible influence on all head and neck pain or disorders. Differential diagnosis of orofacial pains is crucial in treating all TMJ patients.

Computers users are familiar with the phrase “Garbage in…Garbage out”   Our brain is our computer and if it is flooded with painful (Nociceptive) input from the Trigeminal Nerve the Garbage out is perceived as PAIN!

If there is any misalignment in your bite painful or uncomfortable symptoms can result, as:

  • the components of your TMJ encounter friction spots
  • the jaw muscles become overworked sometimes radiating pain to other body parts or
  • the underlying nerves become compressed sending pain signals to your brain.
  • Excessive muscle contraction increases friction in the TMJ’s

 

Balance your jaw and ease your TMJ symptoms

tmj-treatment3If your jaw disorder symptoms are caused by a misaligned bite, you have a good chance of easing or even eliminating them with TMJ dental treatment. A dentist trained in physiologic dentistry can diagnosis TMD to determine an effective course of treatment to realign your bite.

  1. The dentist will first check your medical history to ensure that there is nothing else that could be causing your unexplained symptoms.
  2. The next step is to assess the misalignment of your bite that can cause so many uncomfortable symptoms.  A complete examination includes muslce palpation and takes close to an hour or more
  3. If misalignment is detected, the dentist will measure your jaw function and relax your jaw muscles by massaging them with a TENS machine – an extremely low frequency electrical stimulator, which activates blood flow.  Physiologic Dentistry utilizes sophisticated diagnostics that track jaw movement and function and can evaluate muscle function and muscle symetrr
  4. When the tension in your muscles has been relieved, the best position for your bite will be found. This is then kept in the right place by positioning a non invasive orthotic device over your teeth. If successful, longer term stabilization can be achieved by dental restorations or othodontics.
  5. The first step is the Diagnostic Physiologic Orthotic.  The orthotic is an integral part of the diagnostic process.  It is our trial appliance that determines a three dimensional not stressed position of the mandible.  It is adjusted to reflect changes in posture that occur during treatment.  These changes are the result of healing and take time to occur and stabilize.
  6. Miraculous instant relief and slower relief are difernet versions of that healing process.  There are many factors that affect the pathways of healing.

Once your bite is in a healthier more comfortable position, you should find your pain fading away.  These results with the diagnostic orthotic are used as a blue print for long term treatment.

Patient Testimonials: TMJ, Orofacial Pain and Sleep Disorders

Video Testimonials

There are over 140 additional YouTube testimonial videos on my YouTube channel.

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

Neuromuscular Dentistry TMJ Testimonials on Reddit:

https://www.reddit.com/search?q=neuromusculardent


Dear Dr. Shapira,
I wanted to thank you for taking my sense of fatigue seriously and trying to help me overcome it. You noticed things that sent me to a surgeon to stop my snoring and fashioned a mouth guard for me. This is in addition to other tips you have given me.

I appreciate you asking for my recent blood tests and analyzing them. You even went a step further and contacted my internist. She suggested, as did you, I see an endocrinologist. I have an appointment next month and will request you receive a copy of the results.

Again, thank you for caring.

– Bonnie S.


Dr. Shapira, or as I like to call him, Ira, is an angel in every sense of the word; blessed with a great brain and a greater heart and his hands work pretty good, too. His top qualities are that he provides great results, he’s an expert, and he is creative. I will never forget his devotion to one client he met with for eighteen months, on a weekly basis, at Rush Pres St. Luke’s who still has never received a bill for all services provided. May God bless you and yours always.

– Patrice C.


My longtime acupuncturist recommended Dr. Ira Shapira as an expert on Sleep Apnea when I shared with her my frustrations with my CPAP. Less than three months later, (and a sleep study to prove it), I am cured of my moderate condition of sleep apnea. Dr. Shapira created an oral appliance that is easy to sleep with and maintain. I am so relieved, feeling much better, significantly fewer headaches and more energy I would recommend Dr. Shapira to anyone. His knowledge of dentistry goes well beyond the norm. Anyone that suffers from TMJ and or sleep disorders should have a consult.

– Karen G.


I saw Dr Shapira for TMJ problems and chronic Migraines. I wore a plastic appliance for several months. All of my issues with jaw locking and clicking resolved as did my daily headaches and chronic migraines. I no longer have dark circles under my eyes either.
I could not afford a full mouth reconstruction but have been wearing a permanent appliance for several years on my bottom teeth..Expensive but worth it.
I did have 10 veneers done and now have killer smile, partially because I am no longer in chronic pain.

K.C.

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I have been a patient for over 15 yrs. When I came to Dr. Shapira I was in very bad TMJ pain. He and his staff worked with me for hours and when I left that day the pain was gone. I continued treatment until my bite was fully corrected and not only that but thanks to Dr Shapira’s talent in cosmetic dentistry, my teeth look more beautiful then they ever have. Dr Shapira and the staff continue to gain education on the most innovative ways to help people look and feel good. The staff there are very kind and I always so cared for when I go for my appointments.

Michelle H.

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I received TMJ treatments from Dr. Shapira and I was pleased with the results. I had terrible migraines as well as smaller headaches for as long as I could remember and they dissipated upon receiving treatment. I would recommend Dr. Shapira to anyone with TMJ.I received TMJ treatments from Dr. Shapira and I was pleased with the results. I had terrible migraines as well as smaller headaches for as long as I could remember and they dissipated upon receiving treatment. I would recommend Dr. Shapira to anyone with TMJ.

– Christopher J.


I was referred to Dr. Shapira for TMJ issues almost 30 years ago. Not only did the TMJ treatment plan resolve my issues but, over the years, I’ve also received excellent dental care and had some cosmetic work done, which I am very pleased with. Dr. Shapira has a real passion for what he does, and that passion has brought him vast knowledge and expertise. I trust him completely. Also, Barb has been my hygienist over those 30 years and I am completely pleased and satisfied with her skills and commitment to keeping my teeth and gums in the best condition possible. I’ve had Dr. Amidei a few times over the years when Dr. Shapira was not available and those interactions led me to believe that he is of the same top caliber as the rest of the Delany Dental Care staff.

– MK


Rating: 5.0 5.0 stars,
By: Charlene Bown
On: Google, 05/11/2018
Comment: I cannot imagine my dental work ever being done by any other dentist than Dr. Shapira!! I have been seeing higm for several years to help correct my sleep apnea. I cannot tolerate CPap so Dr. Shapira created an oral device that has literally been saving my life!!! I am a high risk patient and absolutely swear that I might not even be here if it weren’t for this incredible Doctor! He knows more about medicine from all different perspectives than most of my doctors and has exceptional skill in the practice of dentistry!! I truly believe this man is also a philosopher, a practitioner in natural remedies and has become a very special person in my life. Don’t even bother seeing any other dentist cause after you have seen Dr. Shapira you will be horribly disappointed!! I highly recommend Delany Dental for a real experience in what dentistry should be and rarely is!!!

I’ve been seeing Dr Shapira since 1998. In college I developed severe TMJ symptoms where I could no longer open my mouth more than an inch. I saw numerous specialists all over the state, visited top hospitals including the Mayo clinic. My family spent a lot of money and I got no relief from my symptoms. It wasn’t until my mom called the TMJ association in Texas and got Dr Shapira’s name. I was skeptical when I had my first appointment at Delany Dental Care but I was told it’d be a long road to recovery but I’d eventually be pain free. Within the first month of treatment, I noticed the headaches lessened. A few months later I could open my mouth further and within a year I had many days were I was able to forget about TMJ. This practice gave me my life back. While I still have some symptoms a few days a year, I am overall pain free. I was told though once you have TMJ as severe as my case; it would be something that I would have to deal with for the rest of my life but for the most part; most days I will not even know I have it.

– MEK


I am so grateful for Think Better Life and Dr. Shapira. I have been suffering from TMJ for 10+ years and have been to countless dentists who all have told me that I am “fine.” Dr. Shapira was the first dentist to actually listen to my pain, thoroughly examine me, and talk me through my options. My first meeting with him lasted over an hour! Dr. Shapira is not only a great dentist, he is an incredible human being: kind, compassionate, and sincere. After only a month, I am already beginning to feel relief from my chronic headaches and facial pain. It is a feeling I honestly didn’t know was possible. Think Better Life is a warm, caring, and friendly office. Dr. Shapira and his entire staff have are truly competent and hospitable!

Laila N.


When I came to Doctor Shapira I was at the end of my road with severe TMJ pain. I went to many doctors and somehow no one could solve my problem. After many months of research I found Dr. Shapira’s website. I was hesitant to make the appointment due to the distance I would have to drive and feeling hopeless, but after being astonished from watching all the testimonials on his website I thought it was worth a shot.

At the first visit I could instantly tell he had superior knowledge about my issues than other doctors I met with previously. He was open and honest about my condition, the long treatment plan, and the high cost of care. Although this information was intimidating, I finally knew what the saying meant “health is wealth”, life is not worth living in constant pain and discomfort. Therefore, I decided to proceed with his treatment plan.

1 year later I can honestly say that it has been the best money I have ever spent. I am about ~80% better and I will hopefully continue to improve over time. The constant clicking and popping of my jaw is gone, I have normal range of motion again, and most importantly I am mostly pain free.

Not only is Dr. Shapira one of the best and most knowledgeable practitioners I have encountered, he treats you like family and is honestly one of the most interesting people I have ever met. I never leave his office without learning a fun new fact. He truly cares about his patients and work. You can tell he loves what he does. I can’t recommend him enough if you have TMJ pain/issues.

BRITTANY B.


I’ve been seeing Dr Shapira since 1998. In college I developed severe TMJ symptoms where I could no longer open my mouth more than an inch. I saw numerous specialists all over the state, visited top hospitals including the Mayo clinic. My family spent a lot of money and I got no relief from my symptoms. It wasn’t until my mom called the TMJ association in Texas and got Dr Shapira’s name. I was skeptical when I had my first appointment at Delany Dental Care but I was told it’d be a long road to recovery but I’d eventually be pain free. Within the first month of treatment, I noticed the headaches lessened. A few months later I could open my mouth further and within a year I had many days were I was able to forget about TMJ. This practice gave me my life back. While I still have some symptoms a few days a year, I am overall pain free. I was told though once you have TMJ as severe as my case; it would be something that I would have to deal with for the rest of my life but for the most part; most days I will not even know I have it.

– MK


Dr. Shapira has been treating me for TMJ. We started with an oral appliance to relax the jaw and make a better bite. Then we went to a DNA Appliance. I have been pain free since almost day one. Now I can’t wait to see the results of the DNA which will reshape my jaw so I won’t need an appliance in the future. Dr Shapira is a miracle worker. His staff is Awesome as well!

Suzan B.


Very Caring and professional staff! Most definitely the best dentists I have ever been to. After an orthodontic mistake that left me disfigured and with a few less teeth, I was feeling very sad and hopeless. I decided to check out restorative dentistry. They basically pointed out everything and how your jaw can affect your entire body. The doctors were very kind, considering I was in tears. They were completely understanding. They also specialize in sleep dentistry. They did a sleep study on me and I got to choose where I could have it done. They will definitely get my business in the future.

– Marty S


Terrific place for Dental and TMJ healing…I’ve been a patient for 13 years. Not only did they fix my cavities very well, but the incredible relief from my jaw problems was unexpected. My jaw would sometimes lock up on one side, and Dr. Ira discovered that my bite was misaligned. I had the painless TENS treatment, wore a plastic appliance made for my mouth (like a retainer), and then my jaw was fixed, my bite was fixed, and my jaw pain was gone!!
Better still, this treatment apparently also aligned my sinuses, because my life-long sinus congestion disappeared. AND, I no longer require a small shim my right shoe for which I had long ago been diagnosed as having needed “because” one leg was longer than the other — which is no longer the case! Alignment works! This is a great place to get healed for life!!

– Marty S


I have going to this practice for 23 yrs. with Dr. Mark Amidei as my dentist and Dr. Ira Shapira for my Sleep Apnea.
I can not say enough about their staff, friendly and professional.
I enjoy going to the dentist.
A+ all around. Do yourself a favor and look no more, call and make an appointment. You will not be disappointed.
I began working with Dr. Shapira several months ago regarding a case of debilitating TMJ. He uses innovative technology to measure jaw movement, ensuring that his splint treatment is precise. He also works with patients to help them understand and treat the muscular component of TMJ (something not offered by the four previous dentists I had seen for my condition). Dr. Shapira works in conjunction with Dr. Mark Freund of Natural Care Chiropractic for TMJ cases; together they are relentless in finding a solution for their patients. I have been particularly impressed that both doctors continually seek out further education and knowledge in their respective fields. I cannot recommend their work enough!

– DS


I don’t know where my health would be without Dr. Shapira. I have been a TMJ patient for 20 years. I had no idea that TMJ treatment can effect your sinus, sleep, and migraine health as well. Dr. Shapira has been a lifesaver for me more times than I can count. This past January we started DNA treatment which stands for Day and Night Appliance. The improvement I’m already feeling is incredible! I wear this new, comfortable appliance 12 hours a day-basically after dinner and while I sleep. It is expanding my upper and lower jaw which is going to correct my TMJ, open my breathing passages, and greatly improve my allergy and chronic sinus infections. It’s mind-blowing how all of my medical issues are inter-twined with what Dr. Shapira treats. He is always on the cusp of the newest technology and treatments and many of his treatments offer instant relief. Dr. Shapira and his staff treat everyone like family. You couldn’t be in wiser or better hands.

Barbara K


I have been a patient of Dr Shapira and Dr Amidei for the past 24 years. My husband, myself and our three sons are all patients here and I cannot speak highly enough about everyone there! Dr Shapira diagnosed me with TMJ issues about 15 years ago and I have worn a night guard appliance from him ever since. I noticed a remarkable difference within a few nights of starting the appliance and have never had any uncomfortable issues with TMJ since then. Both doctors have seen all three of our sons since they were toddlers. Barb, one of their hygienists, has been treating our entire family these past 24 years and she is the absolute best.
Two years ago, Dr Shapira helped me with the decision to get porcelein veneers and I am thrilled with the results! The level of expertise he has, the wealth of knowledge that both doctors have, the kindness and care that everyone there displays – honestly, there is no place I would rather go and I have recommended many friends to this practice.
You can really tell that at Delany Dental Care, everyone there is treated like they are part of their family. Everyone there makes you feel like you are as important to them as members of their own family. I highly recommend this practice to anyone looking for themselves or their entire family to be treated! You cannot go wrong with choosing Delany Dental!

– DS

100+ VIDEO TESTIMONIALS https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos…