Migraines and Jaw pain solved with holistic dentistry approach
This patient had migraines, nausea, and TMJ pain symptoms for years. She was able to achieve some relief from sequential modalities of chiropractic, physical therapy, and medications, but only to an extent. At her initial exam we discovered significant muscle tension on the left side of the back of her neck and right side of her face and jaw – a pattern that corresponded with a dysfunctional bite on the right molar. This by itself was not alarming, but the facial asymmetry was – she reported it had become worse over time.
R TMJ, anteriorly displaced. Disk in red.
Graphic representation of normal disk on top of condyle. Disk in red. Courtesy of Anomalous Software.
We decided to take a thorough and holistic approach to her problems of migraine and TMJ pain and asymmetry by first achieving an accurate diagnosis.
The MRI of her TMJs showed the origin of the facial asymmetry: damage in both joints with arthritis and bony breakdown in the left joint. At such a young age, she wanted to take whatever precautions available to slow down the future damage to the jaw joints. Our treatment planning included improving the bite through braces – but we wanted to make sure first that she would be able to tolerate the pressure that orthodontics places on the already-tender jaw muscles. To rule that out, the patient wore a bite splint for 6 months prior.
A dental bite splint can be made many ways, and in our practice, we custom design each splint to fit the patient’s unique needs. In this patient’s case, the goal was to reduce pressure inside the left joint, so the splint was a bit thicker covering the teeth on her left side. She was then over time able to adapt to the position in a neuromuscular way, and reduce the functional or positional part of the asymmetry of her jaw. (The tiny left joint seen on MRI and matching shorter jaw length on her left side would prevent us from being able to correct all the asymmetry). By providing the patient a feeling of a balanced bite, she was able to preview the feeling of her future result, reinforcing her decision to proceed with treatment. The results were more comfortable muscle, and stable bite on the splint.
As a result of wearing the bite splint, the patient’s TMJ pain dissipated completely, and her migraines had resolved as well. I believe that patients for whom migraine medication seems ineffective should have a skilled dentist look at the role of the occlusion (dental bite) and TMJ conditions – in many cases, medication-free migraine treatment in the form of bite splint therapy will also resolve a more generic tension headache, neck pain, and stabilize the TM Joints.
Ortho finish.
The patient then underwent 9 months of orthodontic braces. Our pre-treatment analysis revealed that her top front teeth would be left with spaces between them, once the bite was improved. The patient accepted that she would need to restore the teeth to close the spaces.
Pre-treatment: 4 veneers on front teeth. Front.
Pre-treatment: 4 veneers on front teeth. Left.
Post-treatment: 4 veneers on front teeth. Front.
Post-treatment: 4 veneers on front teeth. Left.
Finally, the treatment plan was completed using custom feldspathic porcelain veneers on the top four front teeth. Because the veneers would be adding dimension to the teeth, the preparations were very conservative, leaving the teeth very strong. We were able to create an ideal match of blended porcelains to match the adjacent teeth, and accomplish space closing as well. Closing spaces (diastema) between the teeth with veneers serves the dual purposes of addressing a cosmetic defect, as well as providing lateral support for the teeth in their new position. The patient is thrilled with the new look of her teeth, and delighted to no longer have headaches!
For more cases like this, see our FlickR page at https://www.flickr.com/photos/drcaughey/sets/