A recent patient who suffered a constant headache for over 50 years is now pain free without dependence on medication. Patient M was married to a physician and had access to the finest care available but still lived in continuous pain for over 50 years. Patient M met Dr Ira L Shapira by accident. Her husband had sleep apnea and loud snoring and found Dr Sapira through the website http://www.IHateCPAP.com.
M was at her husband’s consultation and Dr Shapira noticed she held her temple during the appointment and asked if she had a headache. She did, and he used a simple technique to turn off a trigger point and to relieve her pain. This was a first for M who had never experienced this in 50 years of living with chronic headache pain. Neuromuscular Dentistry was discussed briefly at that visit and at the second visit her husband received his oral appliance to eliminate his sleep apnea and snoring and M began her Neuromuscular Dentistry treatment.
M recieved a Diagnostic Neuromuscular Orthotic that day and except for one day has been headache free since that time. M does report that when she is sick she may get a headache but it is different than the headaches she lived with for most of her life.
What is Neuromuscular Dentistry and what is a Diagnostic Neuromuscular Orthotic and how does it work?
An article that Dr Shapira was asked to write for the American Equilibration Society is one of the best explanations available online and has been reprinted in Sleep and Health Journal @ http://www.sleepandhealth.com/neuromuscular-dentistry.
A second article “SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER” in Sleep and Health Journal discusses typical patient stories.
In the most simple terms the way Neuromuscular Dentistry works is change input and output from our brains and central nervous system to muscles, joints, and nervous system end organs in the Trigeminal Nervous System. Our brains are similar to computers. GARBAGE IN- GARBAGE OUT explains in computer lingo how bad input leads to bad output. The brain is basically a biological computer and GARBAGE IN- GARBAGE OUT holds true when it comes to our brains.
Input to the brain comes from two sources, input from the spinal column which accounts for 20% of the total input to the brain and input from 12 pairs of cranial nerves that accounts for 80% of brain input. The cranial nerves are responsible for sight, smell, taste, vision, hearing, proprioception and control of the autonomic nervous system.
The trigeminal nerve accounts for approximately 70% of the input to the brain from the 12 cranial nerves or more than half of total brain input. The Trigeminal Nerve is also known as the Dentist’s Nerve. It goes to the teeth, jaw joints, jaw muscles, the periodontal ligaments of the teeth, the muscle that tenses the eardrum, the muscle that opens and closes the eustacian tubes, that innervates the lining of the sinuses and nasal mucosa. It also controls the blood flow to the anterior 2/3 of the meninges of the brain. When we smell menthol that is another trigeminal nerve function which may be why Vicks Vapor Rub works for many pains.
The trigeminal nerve also has a enormous autonomic component and is a chief cause of central sensitization. Central Sensitization is a primary aspect of most headaches and migraines, facial pains, fibromyalgia and almost all other chronic pain syndromes.
GARBAGE IN – GARBAGE OUT takes on new meaning when we are talking about the majority of input to the brain. Neuromuscular Dentistry turns bad data our brain receives into good data. Central Sensitization can turn good input into bad output. Examples are Hyperesthesia where there is an over-reaction to pain stimuli and Allodynia where non-painful input is received as Nociceptive of Pain impulses. Fibromyalgia is considered a disease caused by or accompanied by Central Sensitization. The Trigeminal Nerve is also vital for controlling respiration and airway patency. The National Heart Lung and Blood Institute issued a report “Cardiovascular and Sleep Related Consequences Of Temporomandibular Disorders” which is available at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf.
Dr Shapira created http://www.ihateheadaches.org to help patients understand headaches, migraines and how Neuromuscular Dentistry is an essential and vital treatment resource.
Why do patients suffer for years if there is a treatment that can so drastically improve their lives?
Do problems addressed Neuromuscular Dentistry actually affect health and medical costs?
Cranio, The Journal for CranioMandibular Practice published two articles that answer that question. The studies by Shimshak et al showed that patients with TMJ disorders had a 300% increase in medical utilization in all fields of medicine except obstetrics. In other words, aside from not getting pregnant these patients utilize three times the average in medical expenses. Treatment of Temporomandibular disorders and the neuromuscular pathology that cause them can drastically improve patients lives and possibly drastically decrease medical expenses.
The NHLBI report discusses how respiratory disorders related to TMJ disorders can effect many body systems. Dental Sleep Medicine is an extremely effective approach to treating sleep apnea. It is more effective overall than surgery. CPAP is still considered the Gold Standard of treatment for Sleep Apnea but has horrendous issues with patients compliance.
Poor compliance means it works well if used but most patients do not use it. CPAP that is not used is worthless and dangerous because the patient remains untreated. A recent study showed that 60% of patients did not use their CPAP. Other patients refuse to even have a sleep test because they do not want to use CPAP. One study cited at the Trucking and Sleep Apnea conference presented by the American Sleep Apnea Association showed only 5% of truckers using their CPAP. This is a frightening fact considering than patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents. Patients overwhelmingly prefer oral appliances to CPAP when they offered a choice but most patients are never given a choice. That would be understandable if CPAP compliance wasn’t an issue. Studies of patients who do use their CPAP show that they average only 4-5 hours a night of use not 7-7 1/2 that is ideal.
Patients with untreated sleep apnea have up to a six-fold increase of risk of heart attacks and strokes which usually occur in the early morning hours. Most CPAP users have already stopped utilizing their CPAP during the early morning hours when the risk is greatest.
Dr Shapira created the website I HATE CPAP! to help the majority of patients who could not tolerate treatment with CPAP. Thousands and thousands of patients visit this website every single month which leads them to appropriate and scientifically supported treatment.
Treatment and prevention sleep apnea with oral appliances is now well accepted but is still fighting for its proper place in medicine. In a few years oral appliances will probably account for a vast majority of treatment of mild to moderate sleep apnea.
Morning headaches have two primary causes, TMJ disorders and Sleep Apnea. The NHLBI says Sleep Apnea is a TMJ disorder. There is an FDA approved appliance for preventing migraines the the NTI-TSS appliance.
The Aqualizer appliance, invented by Dr Martin Lerman is an a simple inexpensive appliance that can produce incredible success but does not offer permanent correction. IAn Aqualizer was used to keep M free of pain between her first and second appointment until her diagnostic neuromuscular orthotic was delivered.
Neuromuscular Dental treatment starts with a Diagnostic Orthotic. When treatment effectiveness is assured patients can proceed with long term phase 2 treatment of a permanent removable orthotic, orthodontic correction or a Neuromuscular Reconstruction. Patient M chose reconstruction which not only eliminated her headaches but also gave her a beautiful new smile. Reconstruction can be accomplished in just a few appointments for patients who do not wish to go through extended treatment with orthodontics or wear a long term orthotic.
The Aqualizer and NTI-TSS are excellent tools but they do not provide definitive treatment.
Dr Shapira studied Neuromuscular Dentistry with Barney Jankelson who founded the science and with his son Robert Jankelson. His 30 years of neuromuscular dentistry and pioneer work in Dental Sleep Medicine makes him uniquely suited to treating patients with chronic head and neck pain.
The Las Vegas Institute is the primary educator in Neuromuscular Dentistry and has appointed Dr Norman Thomas to head educational and research studies into Neuromuscular Dentistry. Dr Thomas is a world leading expert in the field of Neuromuscular Dentistry and how it relates to Physiology and Anatomy of masticatory and postural systems.
Dr Barry Cooper also does a superb job at introducing dentists to the field of Neuromuscular Dentistry. Dr Shapira strongly recommends dentists begin their training with Dr Cooper because he teaches small groups of 1-6 doctors which is the ideal learning environment. Dr Shapira limits his sleep apnea and Dental Sleep Medicine classes to six doctors as well. This allows for one on one interaction and follow-up during the most difficult period of the learning curve.
The international college of craniomandibular orthopedics or iccmo is the leading organization representing neuromuscular dentistry. Dr shapira stronly suggests you find a neuromuscular dentist who is a member of iccmo. Iccmo was founded by dr barney jankelson, the father of neuromuscular dentistry.
Patients in Northern Illinois and southern Wiscosin looking for a Neuromuscular Dentist are a comfortable drive to Dr Shapira’s general dentistry office, Delany Dental Care Ltd in Gurnee and to the offices of Chicagoland Dental Sleep Medicine Associates. Dr Shapira currently sees patients in Skokie and Schaumburg and recently announced a new office will open soon in Highland Park, Illinois.
Dr Shapira’s team can make arrangements for patients from outside of the Chicago Metropolitan area
to have an intensive course of treatment. Dr Shapira will consider accepting long distance patients on a case by case basis. Patients wishing to see Dr Shapira can contact his office toll-free at 1-800-TM-Joint or 1-8-NO-PAP-MASK or 847-623-5530
Patients can contact Dr Shapira through the following websites:
http://www.ihatecpap.com
http://ww.ihateheadaches.org
http://delanydentalcare.com
http://www.chicagoland.ihatecpap.com/
Dr Shapira will help patients locate a Sleep Apnea Dentist or Neuromuscular Dentist anywhere in the country. Dr Shapira strongly advises patients to seek out treatment of Sleep Apnea only from dentists trained in treating TMJ disorders preferably by Neuromuscular Dentists.
The American Academy of Sleep Medicine (AASM) advised that patients receive oral appliances from dentists trained in Dental Sleep Medicine and treatment of Temporomandibular Disorders (TMD). The American Academy of Dental Sleep Medicine (AADSM) endorsed the position of the AASM.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, Pesident of I Hate Headaches LLC, President Dato-TECH, and has a General Dental Practice, Delany Dental Care Ltd with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School’s Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.
