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Ending the Daily Grind

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Dr. Richard J. Carroccia of Dental Associates in Wilmington specializes in neuromuscular dentistry, which focuses on the nerves and muscles that move the lower jaw. Photograph by Tom NutterDoreen Palucci knew she had a jaw problem, but she didn’t think it was related to the migraine headaches she had begun to experience at the onset of menopause three years ago.

“I thought it was hormonal. So did my doctors,” says Palucci, 49, of Middletown.

While being treated for a toothache, Palucci mentioned the migraines to Dr. Richard J. Carroccia of Dental Associates in North Wilmington.

Rather than doing the standard root canal, Carroccia performed a neuromuscular evaluation. It determined the toothache and migraines were caused by temporomandibular joint dysfunction (TMD), an inflammation of the muscles, tissues and nerve endings of the skull.

Since Palucci was fitted with an orthotic, the problems have almost disappeared.

“I’ll get a headache every so often that’s triggered by a certain food or the weather,” she says, “but it’s not daily, nor is it as intense, which is unbelievable.”

More than 10 million Americans suffer from TMD, and 90 percent of those are women in their childbearing years, according to the National Institute of Dental and Craniofacial Research of the National Institutes of Health.

In addition to severe toothaches, TMD symptoms can include a clicking jaw, shoulder, neck and back pain, earaches, tinnitus, sinus problems and blurred vision.

Neuromuscular dentistry aligns a patient’s bite to relieve the symptoms. Whereas traditional dentistry has focused on the teeth, bones and gums, neuromuscular dentistry focuses on the nerves and muscles responsible for moving the lower jaw and joints. The goal is to achieve a balance between the jawbone and the skull.

When you bite down, your teeth fit together like puzzle pieces. The bite forces your muscles and jaw into a position that may not be ideal, which can lead to muscle spasms and inflammation of the temporomandibular joint, Carroccia says.

Teeth grinding is often a response to the muscle spasms. Grinding wears down the teeth, which shortens the muscles. This increases the tension in the muscles and force on the teeth, resulting in chipped and broken teeth.
 

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A bad bite also can affect your posture. Changes to the bite, whether from wear, trauma, dental work or sleeping habits, cause muscles to continually contract to keep the teeth together. When that happens, the person may alter the way he stands or holds his head to accommodate for the sore muscles, resulting in pain and tension in the head, neck, shoulder and back.

Dealing with constant headaches, neck aches, shoulder or face pain can be debilitating. But diagnosing the symptoms and treating TMD with neuromuscular dentistry is painless and noninvasive.

Neuromuscular dentists conduct computerized tests to track, measure, and analyze muscle activity and jaw movement.

“We think that because you can measure it on a computer, it is much more of a science,” says Dr. Michael T. Rosen, a neuromuscular dentist in Wilmington.

One test is electromyography, which uses the same technology as an electrocardiogram. The EMG measures and records the activity of prominent head and neck muscles attached to the lower jaw. These muscles are responsible for moving the lower jaw, maintaining head posture and keeping the lower teeth close to the upper ones.

By measuring the stress in this musculature, the dentist can identify which muscles are working overtime to compensate for a bad bite. They can compare muscle activity before and after relaxation.

The dentist will then relax the muscles through stimulation. Transcutaneous electrical neural stimulation relieves pain caused by spasms or muscle tension. The TENS machine exercises the facial and jaw muscles, causing them to twitch every second and a half for about 45 minutes. When the muscles are relaxed, the muscle activity is ready to be recorded again.

The dentist will also conduct a computerized mandibular scanning. This test tracks the movement of the lower jaw within 0.2 millimeters. A tiny magnet is placed below the lower front teeth and a lightweight headgear is positioned over the head like a pair of glasses. As the jaw moves, the magnet transmits information to a computer that allows the dentist to track how far the lower jaw shifts backward and sideways. This test provides a baseline for future changes or improvements.

Another test to diagnose TMD is Doppler sonography, which employs the same technology as the echocardiogram. This test indicates the extent of damage to the temporomandibular joint. The test detects clicking or popping in the jaw when it opens and closes.
 

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After the data is analyzed, the dentist creates a custom orthotic appliance to stabilize the lower jaw in a relaxed position. Depending on the severity of symptoms, the dentist may recommend the patient see a physical therapist or chiropractor.

However effective, the orthotic is a temporary solution. Its plastic will eventually wear out through chewing and swallowing. But since the jaw is aligned optimally, the patient is eligible to select a permanent solution. That could mean braces.

Full mouth restoration with crowns and veneers is usually reserved for patients whose teeth are in poor condition or who have already had extensive restorative work.  

Should everyone with an irregular bite seek treatment? “Absolutely not,” Carroccia says. “I like to treat those patients whose problems seem to be more debilitating than the average person.”

Shirlann Wiedenmann is another TMD patient who suffered with jaw pain and migraines for more than 30 years.

“I had popping and clicking and pain in the jaw all the way to the ear,” says Wiedenmann, 48, of Bear.

Wiedenmann tried to correct her bite by wearing braces when she was in her 20s, but the problems persisted. Her muscles were so tense, it took four hours of TENS treatment to relax her jaw. But when it was all said and done, wearing the orthotic made a difference.

“I had a very tense bite and now, when I wear the orthotic, it makes my mouth feel very relaxed,” she says. “I know it’s helped my headaches.”
 

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