Headaches and Pain

One of the more perplexing problems in life has got to be Headaches! Most people get them from time to time. Some are particularly plagued with them and they can become quite disabling. Common types of head and neck pain include: chronic tension headaches, facial pain, jaw joint problems and even Migraines. These problems are usually related to the bite – or how the teeth fit together. In fact, new research into migraines (click to see TIME Magazine, 7 Oct, 2002 for simple explanation) is showing that disturbances in the volume of upstream nerve traffic from the nerves and muscles of the face and jaws, is a primary cause of many migraine or migraine-like headaches.

This is exciting news for pain sufferers – because it offers a solution in the explanation of the cause. When the jaw joint (TMJ) and the bite are treated properly, nearby muscles begin to relax. When the lower jaw finds a comfortable position to rest at (called “physiologic rest” – usually a down and forward position), muscle spasm is decreased, teeth grinding stops, and headaches go away.

Neuromuscular dentistry is an emerging discipline that concerns itself with fixing the bite so that muscles are relaxed and comfortable. Like gears meshing together, there is only one way for the teeth to relate to each other for chewing, swallowing and bracing together. If this jaw posture position or the way the bite comes together, is not comfortable for the muscles, the muscles will be in spasm or tension. This imbalance or tug-of-war is what generally causes the jaw problems and headaches. All the physical therapy, massage, chiropractic, aspirin, and prescription drugs in the world won’t help or solve the root cause, if there is a bite discrepancy and it isn’t remedied. While it may require other health disciplines to help, only a properly trained dentist can solve this problem – if indeed the muscles are in spasm from an improper bite relationship – because teeth are involved in the equation.

Modern technology lets us precisely find a position where the muscles can be relaxed. We utilize the most sophisticated and modern computer program to collect and analyze key muscle function and jaw movement / tracking information. It is impossible to gather this quality of data which shows the true status of muscles, without proper computer and electronic instrumentation. That is why we have made the investment in this state-of-the-art technology.

When drugs don’t work for you.

Unfortunately, most physicians, chiropractors and other health professionals are unaware of these new advances in Neuromuscular dentistry, or the close relationship that muscle tension and occlusion have with headaches. And even when they do identify the relationship, they are unable to do anything to properly correct the bite, and hence they and their patients go around in circles treating symptoms that are secondary to the primary problem.

Because of a mis-alignment of teeth or a condition where the jaw is not positioned right, other health problems can be created that often go untreated or are mistreated due to ignorance or in-attention. If a person has a bite problem it can cause or aggravate: compromised airway, sleep apnea, snoring, ear aches and/or congestion, vertigo, tinnitis (ringing ear), sinus pain, headaches, migraines, neck and back problems, jaw popping and pain, altered skin sensation on the backs of hands and forearms, difficulty chewing, insomnia, bells palsy, neuralgias, tooth grinding and tooth wear, and depression, among others. Subtle but important, a rearward positioned lower jaw narrowing the airway, with tense or spastic muscles compressing nerves and altering the jaw joint, is an important consideration. Throwing drugs at these problems or massaging them away for the moment will usually not be adequate in the long run because teeth don’t move! Tooth wear and gum line notching are significant proofs of evidence that you have an occlusion problem.

Chronic sufferers often bounce from one doctor to another, who being unaware of new information, focus on treating symptoms because they are unable to properly correct the occlusion. Because of their limitations in training, they offer potent drugs, counseling, surgery and other extraordinary but less effective “treatments”, all of which ultimately fail to bring relief. Often these cases go unrecognized by many health professionals (including dentists) whose standard training has not equipped them to understand the relationship between the proper alignment of teeth and jawbones, and how the muscles react to those teeth and bone relationships. Many are unaware of how closely this is linked to a person’s general health and sense of well-being.

Toward a better understanding – How your bite works

The upper teeth are fixed solid in the upper jaw which is attached to the base of the skull. They don’t move. The lower jaw is an “L” shaped bone on each side of the face, which crosses the midline in front. The lower teeth are positioned on top of this lower jaw. The lower jaw is held or suspended in place beneath your skull by an intricate system of chewing muscles, tendons and ligaments. As the jaw muscles contract they raise the lower teeth upward until they strike closed against the upper immobile teeth. The way your teeth fit together (your bite) is called “occlusion.” We call this action “chewing.” It is also necessary for swallowing, (+/- 2,000 times per day). It is also common to close our teeth together during physical exertion, and of course, during night grinding and clenching.

Because there is only one position which the jaw/teeth can assume in order to function together, the muscles are subservient or obedient to the teeth. Just like gears fitting together, the teeth fit together in only one position and dictate the position of the jaws as they relate to each other in space. Problems can arise when muscles are in tension in order to achieve and maintain this closed position. Consider walking around all week with your shoulder raised in a shrug position, or with your head or back tilted sideways. These posture muscles will soon become painful and fatigue. Of course with your shoulder you can just relax your shoulder. However, you can’t just quit using your jaw, stop swallowing or eating, or otherwise set your jaw aside. Even at night the muscles will be in tension and can cause clenching or night grinding of teeth. All this hyper-activity leaves the muscles fatigued and in spasm. They never relax.

At the back end of this lower jawbone and immediately in front of each ear, is the jaw joints. This is actually called the temporomandibular joint (“TMJ” for short). These joints are perhaps the most complex in the body. Contrary to popular belief, they don’t actually hinge, like other joints can. They allow the jaw to move through six planes of space: forward-backward, up-down, side-side, and pitch, yaw and roll (like airplanes). There is a delicate disc of tissue interposed between the head of the condyle (top of lower jaw) and the glenoid fossa (base of skull) which prevents bone on bone contact and facilitates movement of the jaw as it opens and closes. If this disc becomes damaged, stretched, or injured, it can be very problematic.

When the teeth don’t fit together properly the jaw automatically shifts to a new or accommodated position in an attempt to compensate for this misalignment. This can be caused by a deep bite, a cross bite, under-developed jaw bones, allergies and airway problems, genetics, and dental problems. Misaligned jaws and joints can affect blood vessels, nerves and muscles, and can cause severe headache (including migraines), and jaw, face, teeth and ear pain. Up and down the postural chain (head to foot) nature attempts to compensate and accommodate for problems. Pain, spasm and disease are typical results as other joints and musculoskeletal structures become involved.

Structural and accommodative stresses from bad occlusion is one of the worst kind of physical and psychological stresses because there is no possible way the body can find relief for itself. An injured limb can be rested and favored, but it is impossible to leave the jaws and jaw joints inactive. Every time teeth touch in an incorrect bite position, there is stress to the muscles. To make up for this we try to relax – to hold a tense unnatural accommodated position – but it is to no avail.

Diagnosing the problem

It is critical to achieve a proper and definitive diagnosis of your headache, TMJ and occlusion problems. It should be noted that headaches are caused by other factors than a “bad bite.” True migraines are linked to hormonal, chemical and biochemical factors, as well as stress. Tumors, trauma, and other unknown or hidden reasons can prove positive for headaches and jaw pain. Ascending postural problems originating primarily in the neck, spine, pelvis, knees or feet, must be ruled out, or be dealt with by the appropriate health professional.

Before prescribing treatment we must determine the degree to which your muscles and occlusion are at war with each other, and if this is significant enough to cause your varied problems. In addition to a detailed medical/dental history and a thorough hands-on exam, a computerized diagnostic procedure is used to evaluate the status of your muscles at rest and during function. Your jaw position is also tracked in its “envelope of motion” and this is correlated with muscle activity. Sophisticated x-rays may be needed to study the condition of the jaw joints and the disc space between the bones.

How we can help

Dr. Ostler understands the delicate relationship between the teeth and the musculoskeletal and orthopedic balance of the head, neck and jaws. He has had and continues his ongoing and extensive training in this area of Neuromuscular dentistry, occlusion , and CranioMandibular therapy. This field is rapidly moving forward. He studies (and has taught) at the prestigious Las Vegas Institute for Advanced Dental Studies (see www.lvilive.com and www.lvidentist.com). He is a member of the International College of CranioMandibular Orthopedics, an organization of physicians and dentists dedicated to the study, prevention and treatment of head and face pain, jaw joint problems and pathology, and the latest developments in TMJ, headache, and occlusion research and treatment.

After a proper diagnosis, the appropriate treatments and management strategy can be recommended. Elimination of pain and muscle spasm are primary goals initially, with stabilization and rehabilitation to follow which will allow a normal and pain free existence.

Back to Top | Read Special Report