TMJ & Migraine Treatment
The Headache Treatment Center at Montvale Health Associates offers patients one of dentistry’s pioneer experts in the treatment of temporo-mandibular joint (TMJ) disorders and migraines, Dr. Mike Pilar, DDS.
Now practicing solely to treat migraines and TMJ disorders, Dr. Pilar has developed a non-invasive, state-of-the-art treatment program that treats the pain source that causes symptoms of temporo-mandibular disorder (TMD). These may include head, neck and shoulder pain, eye/ear sensitivity, stuffy nose, dizziness (imbalance), blurry eyesight, jaw pain and clicking, ringing in the ears, grinding or clenching of teeth and migraines or chronic headaches and sleep disruption.
Dr. Pilar’s highly effective program consists of two phases:
- "Phase One" is the muscle re-education treatment of the inflamed muscles causing all the problems, along with the co-treatment of the diseased trigeminal nerve, which supplies the whole head. This treatment may take anywhere from three to eighteen months for major reversal of the disorder, depending on the severity of your condition.
- First, Dr. Pilar custom models a special orthotic mouth appliance called a Pilar-Type NTI. The Pilar-Type NTI eliminates total back teeth contact between all upper and lower teeth alleviating the associated head and neck muscular contractions. This treatment removes the acute spasms and trigger point connection between muscles and re-balances the hinge rotation movement of the right and left jaw joints.
- A Pilar-Type NTI is much more than just an ordinary night guard. It is a hand-customized orthotic mouth appliance that prevents the jaw clenching and undesirable contact of all upper and lower back teeth. NTIs are the most effective FDA approved method of migraine prevention. NTI orthotics can also help most patients end their reliance on prescription and over-the-counter pain medications.
- Then, follow-up treatments of Laser and Electro Therapeutic Point Stimulation (ETPS) help to remove the built up inflammation of muscles in spasm for sometimes many years. ETPS combines the principles of acutherapy with electric stimulation at extremely low frequency levels to pinpoint and treat the trigger points that cause debilitating muscle contractions and painful symptoms. ETPS is extremely safe and painless.
- "Phase Two" of treatment is instituted after Phase One's muscle re-education protocol has been successful. Phase Two treatment can encompass as little as a bite realignment of the upper teeth to the lower teeth, all the way to a major re-construction of the upper and lower arch of teeth.
“We don't have all the answers to Phase Two treatment until Phase One treatment is completed,” Dr. Pilar explains. “Our ultimate goal is to reverse the TMJ Disorder permanently with reduced reliance on the orthotic. I confer with the patient's dentist to help formulate the best approach to Phase Two treatment.”
Advantages of the Pilar-Type NTI
The Pilar-Type NTI orthotic eliminates total back teeth contact between all upper and lower teeth, specifically the canine through the last molar on both sides. This is done with minimum loss of vertical space between the upper and lower back teeth in a closed position. No other appliance can accomplish this minimal closure of space. Minimum closure of space between upper and lower back teeth with an in-mouth appliance is critical as it prevents excessive lateral sliding movements of the jaw joint. In addition, the total removal of back contact of upper and lower teeth eliminates all temporal muscle excitement (clenching), which can be measured at 600 lbs./sq. inch of pressure plus.
What results with the transfer of clenching forces to the front teeth is minimal clenching pressure of maybe 60 lbs. of force on the front teeth, at which pressure the body can handle very well. In many cases, back teeth clenching is the silent source of ear ringing/congestion, light-headedness/sinus congestion, migraine/ tension headaches and neck and shoulder pain.
Importance of Proper Diagnosis
There is an art to making a Pilar-Type NTI orthotic. Each Pilar-Type NTI orthotic is custom hand made, taking Dr. Pilar over one and a half hours to fabricate at chair side. Dr. Pilar strongly believes an NTI laboratory-made orthotic cannot provide the detail needed to achieve maximum results, and that any deviation from ideal results will end up in failure.
Dr. Pilar has made close to one thousand Pilar-Type NTI orthotics with positive results in almost all TMJ/headache/tension-stress cases presented to him, as well as many tinnitus cases (ringing in the ear) presented without any overt TMJ symptoms present. All too often a physician misses the TMJ involvement of tinnitus and concludes that the ear is just fine, however, the patient continues to suffer. The silent killer is the clenching and forceful pressure of the jaw against the outer part of the inner ear wall which causes lightheadedness/congestion/ringing in the ear (usually unilaterally). Patients in most cases are not aware of night clenching. The telltale sign is for the doctor to feel and palpate the elevator muscles and tendon within the mouth to see signs of inflammation. Over a period of one to three months, the orthotic, in most cases, is effective in treating tinnitus emanating from an undiagnosed TMJ disorder.
What You May Not Know…
Migraine is a disease of the trigeminal nerve and approximately 75% of migraine patients have pain in neck and shoulders. Why? Because the trigeminal nerve also feeds back into the brain stem where it connects to the neck and shoulder nerve branches coming from the cervical spine, thus causing neck and shoulder pain to accompany the migraine.
Migraines can often mimic the symptoms of sinusitis. The thin sinus bone walls become inflamed in the presence of constricted spastic connecting muscles inherent in TMD conditions. These are all reversible physiologic conditions, not medical conditions treated with drugs.
The trigeminal nerve is a cranial nerve with three major branches in the head: the ophthalmic nerve around the eye, the maxillary nerve in the area around the cheek, maxilla, upper teeth and nasal passages, and the mandibular nerve with nerve endings to the jaw, lower teeth and ear region.
The trigeminal nerve endings are supersensitive and supply blood vessels on the surface of the brain and nasal cavity. These nerve endings can cause blood vessels to become dilated and produce a throbbing sensation, swelling and neuropeptide fluid secretions that may inflame neighboring arteries and mucosa.
Internal changes in hormone levels, usually a falling estrogen level, along with stress and sleep deprivation, weather changes, and alcohol will trigger the trigeminal nerves to start firing off, resulting in this painful condition.
Further, even minor clenching of the teeth and jaw in the presence of a “bad bite” can hyperactivate the protective activity of the lateral ptergoid muscle (situated next to the TMJ). The lateral ptergoid muscle must protect the jaw joint and improperly positioned teeth during upper and lower tooth contact, further stimulating the brain’s sensory nucleus, adding to its sensitization. This sensitized sensory nucleus becomes “triggerable,” responding to otherwise harmless noxious stimulations (i.e., odors, glare, food additives, etc.).
The trigeminal nerve also feeds back into the brain stem where it connects to the neck and shoulder nerve branches coming from the cervical spine, thus causing neck and shoulder pain to accompany the migraine.
The ophthalmic nerve endings supply the blood vessels on the surface of the brain and the firing of these nerve endings causes the release of chemicals to the blood vessels, dilating them. This inflammation causes the throbbing pain of the migraine with body movement.
MIGRAINE TREATMENT…. The NTI Tension Suppression System (NTI-tss)
For migraine prevention, there is only one FDA-cleared, non-drug, non-surgical method: the NTI-tss device. This device is approved for the prophylactic treatment of medically diagnosed migraine pain and migraine associated tension headaches and for the prevention of bruxism and TMJ syndrome by reducing trigeminally innervated muscular activity.
The Pilar-type NTI orthotic is a deprogrammer stabilizing refinement of the NTI orthotic. It is a customized version of the NTI and the perfect one takes one and a half hours to fabricate chair-side. A laboratory processed NTI will not have all the critical refinements necessary for treatment success. For a dentist to refine an NTI laboratory processed orthotic is akin to you starting from scratch with border limitations that might not apply… it doesn’t work.
The one-time belief that migraines are a primarily a vascular phenomenon is no longer viable. Today, most theories on the causes of migraines now include a trigeminal pathway, and cite the common pericranial muscular tenderness in migraine sufferers. There still exists a lack of objective evidence for a causative element for migraine pain, keeping the healthcare industry from isolating an acceptable means of prevention.
TOO BAD… THEY SHOULD ALL KNOW ABOUT THE PILAR-TYPE NTI.
Dr. Pilar’s unique “holistic” approach to TMJ pain and migraines often provides patients with amazing results.
For more details, please visit Dr. Pilar’s website at: www.drmikepilar.com
