Monday, September 13, 2010
Thursday, July 22, 2010
Tuesday, June 29, 2010
Wednesday, June 9, 2010
4 ways to get cheaper dental care
By Michelle AndrewsJune 9, 2010: 6:49 AM ET
(Money Magazine) -- Dental care can really take a bite out of your wallet. Even if you have insurance -- and just over half of people do, says the National Association of Dental Plans -- the typical co-insurance is only 50% on major procedures such as root canals, bridges, and crowns, which run $750 and up.
Here's how to manage those costs so that you don't end up putting too much money where your mouth is.
1. Don't rush for coverage. Monthly dental insurance premiums may be modest -- averaging $97 for a family, per the National Association of Dental Plans -- but that's because benefits tend to cap out at around $1,000 a person.
So if you don't already have coverage, you'll want to review premiums and out-of-pocket costs in light of your past and potential future usage. (Search ehealthinsurance.com for plans.)
Unlike medical care, dental needs are often foreseeable, says Matthew Messina, a Cleveland dentist and adviser for the American Dental Association. He suggests asking your dentist what you might expect this year -- from implants to replacement fillings -- and look back on last year's visits. If you typically get only cleanings, insurance probably won't be cost-effective.
"But if you've had a lot of root canals and crowns, chances are you'll need more," says Iowa City dentist Patricia Meredith. In that case, insurance may be a good buy -- as long as you get a plan in which your dentist is in-network.
2. Pay for prevention. Decided not to buy insurance? Don't skimp on those regular checkups. They may cost a few hundred dollars a year, but "investing in maintaining your teeth can help you avoid more expensive procedures down the road," says Meredith. A simple crack can be easily filled, for instance, but if it goes too long without care, it may require a more costly root canal.
3. Investigate discounts. Should you suddenly face a big-ticket procedure, consider enrolling in a dental discount program. Such plans entitle you to 10% to 60% off care within a few days of signing up. Prices run $80 to $160 a year for singles, $130 to $200 for families.
"Some are good deals, but you need to do your research," says Meredith. To avoid fly-by-night operations, don't buy based on an ad. Instead, call your dentist's office to find out what plans are accepted, and which give the best benefit for the care you need. Then weigh the discount against the cost.
Alternatively, see whether your dentist will give you a break for paying cash upfront, says Messina; he says you might get up to 10% off.
4. Ask about stopgaps. If you do have insurance but have maxed out the benefit, ask if any temporary measures will get you through until next year, when your benefits re-up; for example, a filling may stand in for a crown.
Credit card horror stories: Did your card issuer double your interest rate, shut down your credit line or tack on exorbitant fees? Tell us about it and you could be included in an upcoming story on CNNMoney.com.
By Michelle AndrewsJune 9, 2010: 6:49 AM ET
(Money Magazine) -- Dental care can really take a bite out of your wallet. Even if you have insurance -- and just over half of people do, says the National Association of Dental Plans -- the typical co-insurance is only 50% on major procedures such as root canals, bridges, and crowns, which run $750 and up.
Here's how to manage those costs so that you don't end up putting too much money where your mouth is.
1. Don't rush for coverage. Monthly dental insurance premiums may be modest -- averaging $97 for a family, per the National Association of Dental Plans -- but that's because benefits tend to cap out at around $1,000 a person.
So if you don't already have coverage, you'll want to review premiums and out-of-pocket costs in light of your past and potential future usage. (Search ehealthinsurance.com for plans.)
Unlike medical care, dental needs are often foreseeable, says Matthew Messina, a Cleveland dentist and adviser for the American Dental Association. He suggests asking your dentist what you might expect this year -- from implants to replacement fillings -- and look back on last year's visits. If you typically get only cleanings, insurance probably won't be cost-effective.
"But if you've had a lot of root canals and crowns, chances are you'll need more," says Iowa City dentist Patricia Meredith. In that case, insurance may be a good buy -- as long as you get a plan in which your dentist is in-network.
2. Pay for prevention. Decided not to buy insurance? Don't skimp on those regular checkups. They may cost a few hundred dollars a year, but "investing in maintaining your teeth can help you avoid more expensive procedures down the road," says Meredith. A simple crack can be easily filled, for instance, but if it goes too long without care, it may require a more costly root canal.
3. Investigate discounts. Should you suddenly face a big-ticket procedure, consider enrolling in a dental discount program. Such plans entitle you to 10% to 60% off care within a few days of signing up. Prices run $80 to $160 a year for singles, $130 to $200 for families.
"Some are good deals, but you need to do your research," says Meredith. To avoid fly-by-night operations, don't buy based on an ad. Instead, call your dentist's office to find out what plans are accepted, and which give the best benefit for the care you need. Then weigh the discount against the cost.
Alternatively, see whether your dentist will give you a break for paying cash upfront, says Messina; he says you might get up to 10% off.
4. Ask about stopgaps. If you do have insurance but have maxed out the benefit, ask if any temporary measures will get you through until next year, when your benefits re-up; for example, a filling may stand in for a crown.
Credit card horror stories: Did your card issuer double your interest rate, shut down your credit line or tack on exorbitant fees? Tell us about it and you could be included in an upcoming story on CNNMoney.com.
Thursday, June 3, 2010
Studies supporting the Efficacy of Neuromuscular Dentistry and NM Occlusion
There is a vast body of literature supporting the science of neuromuscular dentistry and neuromuscular occlusion. The following is a partial list of studies that investigate patient population’s response to NM treatment. These articles published in refereed journals document the efficacy of neuromuscular principles in the evaluation and treatment of malocclusion.
1) Cooper, Barry C. (1997) The role of bioelectric instrumentation in the documentation of management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:1, pp 91-100
Otolaryngology Department Manhattan Eye, Ear & Throat Hospital
Summary: Temporomandibular disorders (TMDs) can affect the form and function of the temporomandibular joint, masticatory muscles and dental apparatus. Electronic measurement of mandibular movement and masticatory muscle function provides objective data that are defined by commonly accepted parameters in patients with TMDs; these data can then be used to design and monitor therapy and enhance treatment therapy. In this study, data on 3681 patients with TMD are presented, including electronic test data on 1182 treated patients with TMDs. Electronic jaw tracking was used to record mandibular movement and to compare the presenting and therapeutic dental occlusal positions.
Electromyography was used to analyze the resting status of masticatory muscles and occlusal function at presentation and after therapeutic intervention. Transcutaneous electrical nerve stimulation therapy relaxed masticatory muscles and aided in the determination of a therapeutic occlusal position. The data show a positive correlation between the clinical symptoms of TMD and the presenting occlusion, accompanied by muscle activity. A strong positive correlation also appears to exist between a therapeutic change in the dental occlusion to a neuromuscularly healthy position with use of a precision orthotic appliance and the significant relief of symptoms within 1 month and at 3 months.
2) Hickman, D.M., Cramer, R. The effect of different condylar positions on masticatory muscle electromyographic activity in humans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul;86(1):2-3.
West Virginia University Health Sciences Center North, Morgantown, USA.
Objectives: The purpose of this study was to determine a condylar position that permitted the greatest total temporalis and masseter muscle activity in maximum static clench. Study Design: Twenty normal adults, 9 women and 11 men, were evaluated to determine masseter and temporalis activity in maximum static clench with mandibular condyles in different therapeutic positions. Bimanually manipulated, leaf gauge, centric occlusion, and neuromuscular condylar positions were studied. Results: When mandibular condyles were placed anteroinferiorly in a neuromuscular position, total masticatory muscle recruitment was the greatest. In a bimanually manipulated or a leaf gauge position, mandibular condyles were positioned superoposteriorly, producing the least amount of muscle recruitment. Conclusions: The result of any therapeutic position should be an improvement in muscle function. With respect to balance and activation, a neuromuscular condylar position proved to be the position capable of recruiting the greatest motor unit activity when compared with a bimanually manipulated position, a leaf gauge position, and a neuromuscular position.
3) Hickman, David, M., Cramer, Richard, Stauber, William T. (1993) The effect of four jaw relations on electromyographic activity in human masticatory muscles. Archs Oral Biol 38:3, pp 261-264.
School of Dentistry and Departments of Physiology and Neurology, West Virginia University Health Sciences Center North, Morgantown, WV.
Summary: Significant differences were found in the electromyographic (EMG) activation between the masseter and temporalis muscles for the leaf gauge (LG), manually manipulated (CR) and neuromuscular (NM) bite positions during maximal static clench. The LG position consistently demonstrated the lowest EMG activity, while the NM position displayed the highest degree of muscle activity. Similarly, the ratio of the masseter/temporalis EMG activity during maximal clench was lower for the LG and CR positions and highest for the NM position. These data indicate that the NM position produced the greatest total muscle recruitment, with more masseter involvement during maximal clench, and enabled the subjects to generate greater clenching forces in the NM position as compared to the LG and CR positions.
4) Lynn, Jack M., Mazzocco, Mike W., Miloser, Stephen J., Zullo, Thomas, (1992) Diagnosis and Treatment of Craniocervical Pain and Headache based on Neuromuscular Parameters, American Journal of Pain Management, 2:3, pp 143-151.
Summary: There is increasing evidence supporting the premise that hypertonicity within facial muscles is an etiologic factor for some chronic headache patients. This muscular hypertonicity is the result of neuromuscular imbalances within the head and neck. Through the analysis of electromyograph (EMG) data, it is possible to construct an intraoral orthosis which creates neuromuscular balance and subsequently relieves the pain.
This study attempted to identify (i) the relationship of EMG-measured dysfunction to reported craniocervical pain and (ii) the effectiveness of EMG-based orthoses on reversing myospastic conditions. Results of the study (N=203) indicate a significant (p<.0001) decrease in muscular myospasm at rest and a significant (p<.0001) increase in muscular activity during function following treatment with EMG-based orthoses. Reported craniocervical pain was significantly reduced. Results of this study support the hypothesis that creation of a physiologic neuromuscular envelope of craniocervical motion allows reduction of muscular hypertonicity resulting in reduction of pain. Furthermore, utilization of electromyography is a valuable tool during assessment and treatment of chronic facial pain patients.
5) Coy, Richard E., Flocken, John E., Adib, Fray (1991) Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction. Cranio Clinics Intl, Williams and Wilkens, Baltimore, pp 163-173.
Summary: The investigators sent questionnaires and guidelines for submission of case histories to Fellows of the International College of Craniomandibular Orthopedics, who are geographically dispersed over the United States. The practitioners were requested to supply data and case histories on patients who were treated specifically for Craniomandibular pain or dysfunction. Sixty-eight case histories received from 20 practitioners that met the study guidelines were included.
Electronically derived measurement provides an objective quantitative database for diagnosing the existence and extent of myostatic contracture and skeletal malrelation. Compilation of the electronically derived data, correlated with the subjective evaluations of both patient and therapist, establish the existence of significant skeletal malrelation of the mandible to the cranium and consequent myostatic contracture in the pain and dysfunction population. The data reported in these case histories indicate that a common measurable etiology is responsible for the many ostensibly diverse manifestations of craniomandibular pain and dysfunction. The diagnostic validity and usefulness of the electronically derived quantitative data are supported by the correlative subjective perception by the patient of alleviation of symptoms in response to the correction of skeletal malrelation and the consequent reduction of muscle tension (table 7). The course of treatment provides rapid initial palliation followed by long-term resolution as a result of orthopedic correction of skeletal malrelation.
The data clearly established that in the patient population under study:
The average electromyograph activity with the patient at rest decreased substantially in the left and right anterior temporalis and masseter muscles after treatment.
The average electromyograph activity with the patient clenching increased substantially in the left and right anterior temporalis and masseter muscles after treatment.
Following the orthopedic correction of skeletal malrelation, over half of the patients had complete alleviation of symptoms, with the remaining patients experiencing a substantial reduction in the number of their symptoms.
The continuing positive responses to this noninvasive treatment based on quantitative as well as subjective diagnosis indicate the need in every case of craniomandibular pain or dysfunction to rule in or rule out musculoskeletal dysfunction as the most common underlying etiologic factor in most aspects of craniomandibular pain and dysfunction.
In cases in which the data rule out existing musculoskeletal dysfunction as a possible etiology, the patient may then be referred to other appropriate specialties such as neurology, otolaryngology, orthopedics, or psychiatry with the assurance to that specialty that the etiologic possibility of musculoskeletal dysfunction has been explored and ruled out.
6) Cooper, BC, Kleinberg, I, Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. J. Craniomandibular Practice, 2008; 26(2) 104-115
SUMMARY - The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
There is a vast body of literature supporting the science of neuromuscular dentistry and neuromuscular occlusion. The following is a partial list of studies that investigate patient population’s response to NM treatment. These articles published in refereed journals document the efficacy of neuromuscular principles in the evaluation and treatment of malocclusion.
1) Cooper, Barry C. (1997) The role of bioelectric instrumentation in the documentation of management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:1, pp 91-100
Otolaryngology Department Manhattan Eye, Ear & Throat Hospital
Summary: Temporomandibular disorders (TMDs) can affect the form and function of the temporomandibular joint, masticatory muscles and dental apparatus. Electronic measurement of mandibular movement and masticatory muscle function provides objective data that are defined by commonly accepted parameters in patients with TMDs; these data can then be used to design and monitor therapy and enhance treatment therapy. In this study, data on 3681 patients with TMD are presented, including electronic test data on 1182 treated patients with TMDs. Electronic jaw tracking was used to record mandibular movement and to compare the presenting and therapeutic dental occlusal positions.
Electromyography was used to analyze the resting status of masticatory muscles and occlusal function at presentation and after therapeutic intervention. Transcutaneous electrical nerve stimulation therapy relaxed masticatory muscles and aided in the determination of a therapeutic occlusal position. The data show a positive correlation between the clinical symptoms of TMD and the presenting occlusion, accompanied by muscle activity. A strong positive correlation also appears to exist between a therapeutic change in the dental occlusion to a neuromuscularly healthy position with use of a precision orthotic appliance and the significant relief of symptoms within 1 month and at 3 months.
2) Hickman, D.M., Cramer, R. The effect of different condylar positions on masticatory muscle electromyographic activity in humans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul;86(1):2-3.
West Virginia University Health Sciences Center North, Morgantown, USA.
Objectives: The purpose of this study was to determine a condylar position that permitted the greatest total temporalis and masseter muscle activity in maximum static clench. Study Design: Twenty normal adults, 9 women and 11 men, were evaluated to determine masseter and temporalis activity in maximum static clench with mandibular condyles in different therapeutic positions. Bimanually manipulated, leaf gauge, centric occlusion, and neuromuscular condylar positions were studied. Results: When mandibular condyles were placed anteroinferiorly in a neuromuscular position, total masticatory muscle recruitment was the greatest. In a bimanually manipulated or a leaf gauge position, mandibular condyles were positioned superoposteriorly, producing the least amount of muscle recruitment. Conclusions: The result of any therapeutic position should be an improvement in muscle function. With respect to balance and activation, a neuromuscular condylar position proved to be the position capable of recruiting the greatest motor unit activity when compared with a bimanually manipulated position, a leaf gauge position, and a neuromuscular position.
3) Hickman, David, M., Cramer, Richard, Stauber, William T. (1993) The effect of four jaw relations on electromyographic activity in human masticatory muscles. Archs Oral Biol 38:3, pp 261-264.
School of Dentistry and Departments of Physiology and Neurology, West Virginia University Health Sciences Center North, Morgantown, WV.
Summary: Significant differences were found in the electromyographic (EMG) activation between the masseter and temporalis muscles for the leaf gauge (LG), manually manipulated (CR) and neuromuscular (NM) bite positions during maximal static clench. The LG position consistently demonstrated the lowest EMG activity, while the NM position displayed the highest degree of muscle activity. Similarly, the ratio of the masseter/temporalis EMG activity during maximal clench was lower for the LG and CR positions and highest for the NM position. These data indicate that the NM position produced the greatest total muscle recruitment, with more masseter involvement during maximal clench, and enabled the subjects to generate greater clenching forces in the NM position as compared to the LG and CR positions.
4) Lynn, Jack M., Mazzocco, Mike W., Miloser, Stephen J., Zullo, Thomas, (1992) Diagnosis and Treatment of Craniocervical Pain and Headache based on Neuromuscular Parameters, American Journal of Pain Management, 2:3, pp 143-151.
Summary: There is increasing evidence supporting the premise that hypertonicity within facial muscles is an etiologic factor for some chronic headache patients. This muscular hypertonicity is the result of neuromuscular imbalances within the head and neck. Through the analysis of electromyograph (EMG) data, it is possible to construct an intraoral orthosis which creates neuromuscular balance and subsequently relieves the pain.
This study attempted to identify (i) the relationship of EMG-measured dysfunction to reported craniocervical pain and (ii) the effectiveness of EMG-based orthoses on reversing myospastic conditions. Results of the study (N=203) indicate a significant (p<.0001) decrease in muscular myospasm at rest and a significant (p<.0001) increase in muscular activity during function following treatment with EMG-based orthoses. Reported craniocervical pain was significantly reduced. Results of this study support the hypothesis that creation of a physiologic neuromuscular envelope of craniocervical motion allows reduction of muscular hypertonicity resulting in reduction of pain. Furthermore, utilization of electromyography is a valuable tool during assessment and treatment of chronic facial pain patients.
5) Coy, Richard E., Flocken, John E., Adib, Fray (1991) Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction. Cranio Clinics Intl, Williams and Wilkens, Baltimore, pp 163-173.
Summary: The investigators sent questionnaires and guidelines for submission of case histories to Fellows of the International College of Craniomandibular Orthopedics, who are geographically dispersed over the United States. The practitioners were requested to supply data and case histories on patients who were treated specifically for Craniomandibular pain or dysfunction. Sixty-eight case histories received from 20 practitioners that met the study guidelines were included.
Electronically derived measurement provides an objective quantitative database for diagnosing the existence and extent of myostatic contracture and skeletal malrelation. Compilation of the electronically derived data, correlated with the subjective evaluations of both patient and therapist, establish the existence of significant skeletal malrelation of the mandible to the cranium and consequent myostatic contracture in the pain and dysfunction population. The data reported in these case histories indicate that a common measurable etiology is responsible for the many ostensibly diverse manifestations of craniomandibular pain and dysfunction. The diagnostic validity and usefulness of the electronically derived quantitative data are supported by the correlative subjective perception by the patient of alleviation of symptoms in response to the correction of skeletal malrelation and the consequent reduction of muscle tension (table 7). The course of treatment provides rapid initial palliation followed by long-term resolution as a result of orthopedic correction of skeletal malrelation.
The data clearly established that in the patient population under study:
The average electromyograph activity with the patient at rest decreased substantially in the left and right anterior temporalis and masseter muscles after treatment.
The average electromyograph activity with the patient clenching increased substantially in the left and right anterior temporalis and masseter muscles after treatment.
Following the orthopedic correction of skeletal malrelation, over half of the patients had complete alleviation of symptoms, with the remaining patients experiencing a substantial reduction in the number of their symptoms.
The continuing positive responses to this noninvasive treatment based on quantitative as well as subjective diagnosis indicate the need in every case of craniomandibular pain or dysfunction to rule in or rule out musculoskeletal dysfunction as the most common underlying etiologic factor in most aspects of craniomandibular pain and dysfunction.
In cases in which the data rule out existing musculoskeletal dysfunction as a possible etiology, the patient may then be referred to other appropriate specialties such as neurology, otolaryngology, orthopedics, or psychiatry with the assurance to that specialty that the etiologic possibility of musculoskeletal dysfunction has been explored and ruled out.
6) Cooper, BC, Kleinberg, I, Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. J. Craniomandibular Practice, 2008; 26(2) 104-115
SUMMARY - The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.
Wednesday, May 19, 2010
Luis Miguel Ramírez 1, Luis Ernestos Ballesteros 2, German Pablo Sandoval 3
(1) Doctor of Odontology with a degree in Prosthetic Dentistry and Temporomandibular Disorders in Universidad Javeriana– Santa fe de
Bogota - Colombia. Medical Education in Orofacial-Otic referred symptoms. Associate Professor of Morphology in the Department of Basic
Sciences of the Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga - Colombia.
(2) Medical Doctor with Degree in Anatomy. Universidad Industrial de Santander (UIS). Basic Sciences Department Director, Professor
of Morphology in the Department of Basic Sciences of the Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga
- Colombia
(3) Medical Doctor with degree in Otolaryngology from Hospital Militar- Santa fe de Bogota - Colombia. Surgery Professor of the
Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga - Colombia. Otolaryngology and head-neck surgery’s
Chief of Carlos Ardila Lule ClinicCorrespondence:
Dr. Luis Miguel Ramirez
E-mail: lmra3@yahoo.com
Received: 2-10-2005
Accepted: 17-12-2006
Ramírez LM, Ballesteros LE, Sandoval GP. Tensor tympani muscle:
strange chewing muscle. Med Oral Patol Oral Cir Bucal 2007;12:E96-
100.
© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946
ABSTRACT
This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for
detecting different pathologies’ common otic symptoms. It offers better tools for this shared symptomatology during
therapy’s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even
when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional
clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial
muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the
stomatognathic system; these muscles’ increased tonicity ceases to be a phenomenon having no logical connections. It
offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom
pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing
organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There
is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic
and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed
in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline
from a broad, anatomical and clinical perspective.
Key words: Oscicular chain, temporomandibular disorders, otic symptoms, malleus, tensor veli palatini, tensor tympani.
RESUMEN
Con este trabajo se pretende alertar al medico y al odontólogo en el entendimiento y la integración del manejo interdisciplinario
para la detección de síntomas de oido comunes en patologías diferentes, brindando mayores herramientas en
la fase conservadora de la terapia para esta sintomatología compartida. La fisiología del músculo tensor del tímpano y
su funcionalidad en el oído medio ha sido velada aun cuando su disfunción y relaciones anatómicas están explicando
un grupo de síntomas óticos confusos a la evaluación clínica convencional. Los músculos del oído medio comparten
un origen embriológico y funcional común con los músculos masticatorios y faciales. En este artículo se pretende hacer
énfasis en la dimensión neurológica y anatómica de la funcionalidad (individual y compartida) de estos músculos entre
si y el sistema estomatognático. La tonicidad aumentada de este músculo deja de ser un fenómeno sin conexiones lógicas,
ofreciendo a su actividad normal o disfuncional el protagonismo que se merece y redefiniendo su funcionalidad
e importancia en la comprensión de los síntomas óticos referidos muy en común con síntomas de otras patologías de
origen extra-ótico. El tinitus, vértigo, sensación de oído tapado, hipoacusia, hiperacusia y la otalgia son síntomas que al
Indexed in:
-Index Medicus / MEDLINE / PubMed
-EMBASE, Excerpta Medica
-SCOPUS
-Indice Médico Español
-IBECS
E97
Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle INTRODUCTION
Most people suffering from temporomandibular disorders (TMD) suffer from local or referred chronic muscular pain. This is found in the orofacial muscles, accompanied by painful and non-painful symptomatology, affecting the cervical musculature and middle ear muscles with varied otic symptoms ranging from vertigo, tinnitus, otic fullness sensation, hyperacusia-hypoacusia to otalgia. Multiple anatomical or neurological possibilities start from muscular or articular dysfunction which can generate otic conditions which do not seem to correspond to clinical discoveries arising from initial evaluation.(1) Such possible inroads have more in common than the purely descriptive focus of anatomical structures. This can be seen in the temporomandibular joint (TMJ), the ear and closeness between muscular structures and the middle ear.(2) This review seeks to develop the connection between the ear and stomatognathic system from a mainly anatomical focus. This work is aimed at understanding otic symptomatology having no otic origin, rationalizing the muscle-skeletal bond from an anatomical perspective and integrating health disciplines.
REVIEW
The tensor tympani muscle’s normal activity is related to a reflex neurological mechanism known as centrifuge auditory inhibition control (CAIC). This works in sound trauma protection and hearing discrimination of low tones, besides complex co-activation during velopharyngeal movements. The tensor tympani muscle’s normal physiology becomes changed during abnormal activity (seemingly during TMD) and is associated with otic symptoms expressed as otalgia, otic fullness sensation, tinnitus, vertigo and hyperacusia-hypoacusia, no justified otic pathology being presented such as Meniere’s syndrome, otitis, pontocerebellar angle neurinoma and/or otosclerosis. TMD is a sub-classification of muscle-skeletal disorders, including a series of craniofacial conditions having multifactor aetiology in adults and children.(3) Simultaneous tension of temporal and tensor tympani muscles has been electromyographically evaluated. This suggests a kindred relationship between orofacial, chewing and middle ear muscle operation due to TMD. Greater sympathetic tonus during emotional stress may be present because they share common pathophysiological scenarios.(4)
Increased emotional tension produces dysfunctional muscular activity and consequently TMD. Lam et al., (5) have stated that otalgia and other non-otological symptom prevalence in TMD patients varies from 3.5% to 42%. Tinnitus prevalence in TMD patients seems to be greater than in the general population.(6) Tinnitus frequency in patients with TMD varies from 33% to 76%.( 7,8) There is 40% to 70% dizziness and 5% to 40% vertigo prevalence in patients suffering from TMD. (9,10 )
TMD prevalence is twice to nine times greater in women than in men. These are complex pathologies having consequences ranging from difficulty in chewing and other oral functions to acute-chronic pain. TMD aetiology can be summarized as macro trauma and micro trauma (bruxism or pain). Bruxism plays an important role in TMD and referred orofacial symptoms, although many investigations have considered such association inconclusive.(11) The intimate nexus between dysfunctional masticatory activity, such as bruxism, TMD and emotional stress, can lead to the cause-effect relationship between them. TMD aetiology thus has a multifactor origin involving environmental, physiological and behavioural agents.
TMD produces contraction and tension of the masticatory muscles and reflex contraction in tensor veli palatini and tensor tympani muscles due to common motor innervation from the trigeminal mandibular branch (V3) (12-17) Schames et al., (18) have stated that the dysfunction of these muscles (accessory mastication muscles) plays an important role in otic symptoms. Otalgia can be felt by tympanic membrane tension due to constant tensor tympani muscle contracture. Such tension can produce dysacusia (a more general tinnitus symptom) accompanied by strange or hallucinatory acoustic sensations perceived as rings, clicks, pops, whispers or friction noises. Middle ear muscular tension can also be associated with hyperacusia and hypoacusia from a conductive origin and subjective presentation (even with normal audiometric values). The physical tension increased by emotional stress and headaches concomitantly accompanies such otic symptomatology.
The complex neuromuscular interaction between the muscles of mastication and the ear was referred to as otognatic syndrome by Myrhaug (13) in 1964 and otomandibular syndrome by Bernstein in 1969 (14) and by Arlen in 1977.(19) Patients suffering from otomandibular syndrome present one or more otic symptoms without ear, nose or throat pathology, but have one or more mastication muscles in a state of constant spasm.
Ogutcen-Toller and Juniper (20) noticed that the structures driving sound in the middle ear can be affected by reflex tensor tympani contraction in TMD patients. They evaluano
ser primarios de patologías en oído, deben ser descartados por el medico y relacionados con patologías vecinas que pueden producirlos. Ya existe la necesidad de entender los desordenes temporomandibulares y la sintomatología referida cráneo-facial desde una perspectiva neurofisiológica y músculo-esquelética comprendida en el sistema estomatognático. En la práctica diaria se observa con frecuencia una sintomatología común para los síntomas oticos y los desordenes temporomandibulares que se deben entender bajo una perspectiva amplia, anatómica, neuroanatómica y clínica.
Palabras clave: Cadena oscicular, desordenes temporomandibulares, síntomas oticos, tensor del tímpano, maleolo, tensor del velo palatino.
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle ted hearing status in TMD-otic symptom patients without finding clear middle ear or Eustachian tube dysfunction. This suggested tensor tympani conductive modulation with subjective hearing loss. Travell and Simons (21) explained tinnitus as being a referred sensitive phenomenon, starting as reflex muscular spasm from middle ear stapedial and tensor tympani muscles.
Myrhaug (13) agreed that there is reflex contraction of the tensor tympani in subjective tinnitus and rhythmic opening and closing of the Eustachian tube (palatine mioclonus) in objective tinnitus (externally perceived). Reflex muscular contraction is present in tensor tympani and tensor veli palatini muscles.(22) Objective tinnitus is much less common than subjective tinnitus. Zipfel et al., (23) supported the above and explained that the more common mechanical causes of objective tinnitus were palatine mioclonus and middle ear mioclonus producing tympanic membrane rhythmic movement secondary to repetitive stapedial and tensor tympani muscle contraction. (Figure 1) This muscular behaviour may correspond to a reflex pattern due to constant fatigue originating in these muscles’ abnormal somatomotor function during increased emotional tension and bruxism.
Shapiro and Truex (24) suggested these middle ear muscles’ possible tonic spasm and reflex due to the V and VII pairs being peripherally irritated (TMD); this could lead to impaired hearing of low tones. The balance of the oscicular chain and the functioning of structures driving sound in the middle ear normally depend on the stapedial and tensor tympani (antagonistic muscles). Sustained contraction of these muscles in TMD may alter inner ear perilymphatic and endolymphatic pressure through changes transmitted from the oval window toward the walls of the labyrinth and semicircular canals. This may lead to vestibular and cochlear impulse imbalance and similar symptomatic reaction to Meniere’s syndrome.
It is imperative that the middle ear oscicular chain (malleus, incus and stapes) be seen from an efficient but fragile biomechanical viewpoint. They are practically sustained by weak structures such as the tympanic membrane, some ligaments and stapedial and tensor tympani muscle tendons maintaining these bones in an articulation adapted to sound energy.
Auditory muscle (tensor tympani, tensor veli palatini and stapedial) functions are shown in Table 1. Stapedial muscle contraction happens with strong sounds and immediately before speaking. This improves auditory discrimination ability, external vocalization and reduces the masking effect of autogenous sound.(25,26) The tensor tympani muscle (in spite of common belief) is not an inoperative muscle due to it responding electromyographycally to strong sounds and vocalization, chewing, swallowing and facial muscle external stimulation.(27) If tensor tympani and veli palatini muscles share movements in common (velopharyngeal and facial) and tensor tympani and stapedial muscles together are neurologically activated (hearing protection reflexes and auditory discrimination) by the centrifuge reflex then it may be stated that facial and velopharyngeal movements shared by both tensile muscles have important influence on otic-TMD symptomatology.
Rood and Doyle (28) found from dissecting adult and foetal cadavers that tensor veli palatini anatomy consisted of a medial portion or dilatator tubae (described by Gray in 1918), an external portion consisting of the tensor veli palatini muscle and an intratympanic consisting of the tensor tympani muscle intermingling its fibres with the tensor veli palatini’s external area.(29) The tensor veli palatini’s lateral area originates in the sphenoid spine, scaphoid fossa, lateral bony edge of the sphenoid fissure and tensor tympani muscle. The tensor veli palatini’s medial area originates in the lateral membranous wall of the Eustachian tube’s posterior and middle third. These muscles descend and converge on the pterygoid hamulus in a strong tendon curving around this hook-shaped osseous process to be inserted into the soft palate in a horizontal direction (palatine aponeurosis). Yawning, laughing, swallowing and coughing involve pharyngeal and laryngeal muscles activating the tensor tympani muscle.
Kamerer (26) expressed his astonishment in 1978 that no unified theory had been created for these muscles sharing such close anatomical relationship. Tensor tympani and tensor veli palatini muscles work simultaneously (electromyographically proved) during swallowing, thereby producing a Djupesland air bomb in the middle ear assisting with Eustachian tube ventilation. Tensor tympani and tensor veli palatini muscles together produce tympanic membrane internal deflection breaking the Eustachian tube’s mucous membrane isthmus seal (expelled air), thereby contributing to middle ear ventilation (30). Barsoumian, Kuehn et al., (31) corroborated Lupin and Rood-Doyle’s findings. (Figure 2) The middle ear’s tendinous part, between tensor tympani and tensor veli palatini muscles, shows an anatomical connection between these muscle functions. These synergistic muscles may temporarily raise intratympanic pressure when they contract together.
Fig. 1. Tensor tympani and stapedial muscles in the middle ear cavity. Modification from Ref. 12.
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle It should not be said that the tensor veli palatini has an additional bony origin in the malleus manubrium. Tensor veli palatini dysfunction (TMD or bruxism) may modify malleus and tympanic membrane medial position due to anatomic anchorage with the tensor tympani. Kierner et al., (32) found such connection (histological study) in human cadavers. They stated that this represents an important step in understanding the functional unit between these two muscles in humans. Schames et al., (18) suggested that tensor tympani and tensor veli palatini secondary myofibrotic contracture (adhesions and trigger points) complicates their anatomical relationship and otic symptomatology due to their reduced muscular fibre length.
It should be stressed that understanding middle ear ventilation physiology through the Eustachian tube involves neurological territories referred from the masticatory system. In 1987, Malkin (33) stated that the tensor tympani serves as a barometric pressure receiver. Its propioceptive afference signals (starting from their muscular length) can be triggered in a hypotonic situation caused by low tympanic cavity pressure (due to mucosal air exchange). Such low-pressure medially retracts the tympanic membrane and tensor tympani tendon due to great external environmental pressure accompanied by no resistance to force; such new muscle elongation is perceived by its muscular spindles. The trigeminal motor nucleus produces a reflex mechanism in a polysynaptic central arrangement, beginning tensor muscle contraction involving opening the Eustachian tube, middle ear ventilation and pressure equilibration; such normal physiological mechanisms may be blocked by the tensortympani hypertonic scenario during TMD.
These would be expressed via tube dysfunction and accompanying otic symptomatology, such as hypoacusia, tinnitus, vertigo, otalgia, otic fullness and even otitis media.
For almost one hundred years several investigators have tried to outline possible cause-effect relationship between otic symptoms and TMD from mechanical, vascular, neurological, muscular and embryological viewpoints. As medicine and dentistry became more specialised the hearing organ and stomatognathic systems were abruptly separated; this situation has been discreetly corrected via specialization in otolaryngology and craniofacial pain which has attempted to close the breach in such thematic discussion which had been gaining the stigma of being a no man’s land.
Table I. Intratympanic and extratympanic common movements.
Muscles MovementsTensor tympani Innervation: Trigeminal Tensor veli palatini Innervation: Trigeminal StapedialInnervation: Facial Speaking x x Chewing x x Swallowing x x Jawning x x Laughing x x Coughing x x Breathing x x Acoustic trauma x x Before speaking x x Palpebral reflex x x
Fig. 2. Tensor tympani and tensor veli palatini muscle fiber connection. M. Malleus manubrium, TT. Tensor tympani muscle, TP-L. Tensor veli palatini muscle. Used with permission from Ref. 28.
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle CONCLUSION
This article has concerned itself with the need for understanding the presence of a masticatory muscle in the middle ear which can complicate TMD otic symptomatology. This idea will be developed in articles to follow, as well as other stomatognathic neurological and mechanical causes. This muscle’s anatomy, neuroanatomy and physiology (besides being interesting in itself) is related to intratympanic hearing activity which may be externally modulated by the masticatory system in the presence of muscle skeletal disorder.
It is imperative that the need for a medical and odontological interdisciplinary patient management system be understood. Specialists in a single discipline are not always able to solve a patient’s heterogeneous symptoms without the invaluable support of a multidisciplinary approach. Each specialty contributes its specific knowledge to differential diagnosis aimed at a more assertive treatment plan. Clinical success therefore depends on each specialist’s ability to analyse different aspects of the same problem. Team work can thus be best used for obtaining the best functional state in a particular patient’s stomatognathic system.
REFERENCES
1. Ramirez LM, Sandoval GP, Ballesteros LE. Theories on otic symptoms in temporomandibular disorders: Past and Present. Int J Morphol 2005;23:141-56.
2. Ramirez LM, Sandoval GP, Ballesteros LE. Temporomandibular disorders: referred cranio-cervico-facial clinic. Med Oral Patol Oral Cir Bucal. 2005;10:E18-26.
3. Youniss S. The relationship between craniomandibular disorders and otitis media in children. Cranio 1991;9:169-73
4. Klockhoff I, Lindholm L, Westerberg CE. Spontaneous impedance fluctuation--a “tensor tympani syndrome” with special reference to tension headache. Nord Med 1971;85:577.
5. Lam DK, Lawrence HP, Tenenbaum HC. Aural symptoms in temporomandibular disorder patients attending a orofacial pain unit. J Orofac Pain 2001;15:146-57.
6. Cooper BC, Cooper DL. Recognizing otolaryngologic symptoms in patients with temporomandibular disorders. Cranio 1993;11:260-7
7. Parker WS, Chole RA. Tinnitus, vertigo and temporomandibular disorders. Am J Orthod Dentofacial Orthop 1995;107:153-8
8. Rubinstein B. Tinnitus and craniomandibular disorders-- Is there a link?. Swed Dent J Suppl 1993;95:1-46
9. Chole RA, Parker WS. Tinnitus and vertigo in patients with temporomandibular disorders. Arch Otolaryngol Head Neck Surg 1992;118:817-21.
10. Bush FM. Tinnitus and Otalgia in temporomandibular disorders. J Prosthet Dent 1987;58:495-8
11. Pergamalian A, Rudy TE, Zaki HS, Greco CM. The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders. J Prosthet Dent 2003;90:194-200.
12. Anatomía de Bouchet y Guilleret. Editorial Panamericana.
13. Myrhaug H. The incidence of the ear symptoms in cases of malocclusion and temporomandibular joint disturbances. Br J Oral Maxillofac Surg 1964;2:28-32
14. Bernstein JM, Mohl ND, Spiller H. Temporomandibular joint dysfunction masquerading as disease of ear, nose and throat. Trans Am Acad Ophthalmol Otolaryngol 1969;73:1208-17.
15. Manni A, Brunori P, Giuliani M, Modoni M, Bizzi G. Oto-vestibular symptoms in patients with temporomandibular joint dysfunction. Electromyographic study. Minerva Stomatol 1996;45:1-7
16. Ciancaglini R, Loreti P, Radaelli G. Ear, nose and throat symptoms in patients with TMD: The association of symptoms according to severity of arthropathy. J Orofac Pain 1994;8:293-7.
17. Eckerdal O. The petrotynpanic Fissure: A link connecting the tympanic cavity and the temporomandibular joint. Cranio 1991;9:15-21.
18. Schames J, Schames M, King E, Ulansey S, Boyd J, Schames E. Trigeminal Pharyngioplasty: Treatment of the forgotten accessory muscles of mastication which are associated with orofacial pain and ear symptomatology. AJPM 2002;12:102-12.
19. Arlen H. The otomandibular syndrome: A new concept. Ear Nose Throat J 1977;56:60-2.
20. Ogutcen-Toller M, Juniper RP. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993;21:2-8.
21. Travell JG, Simons DG, eds. Dolor y disfunción miofascial. El manual de los puntos gatillo, Mitad superior del cuerpo. Madrid: Editorial Panamericana; 2002. p. 419,476.
22. Virtanen H. Objective tubal tinnitus: a report of two cases. J Laryngol Otol 1983;97:857-62.
23. Zipfel TE, Kaza SR, Greene JS. Middle-ear myoclonus. J Laryngol Otol 2000;114:207-9.
24. Shapiro HH, Truex RC. The temporomandibular joint and the auditory function. J Am Dent Assoc 1943;30:1147-68.
25. Klockhoff I, Anderson H. Reflex activity in the tensor tympani muscle recorded in man; preliminary report. Acta Otolaryngol 1960 ;51:184-8.
26. Kamerer DB. Electromyographic correlation of tensor tympani and tensor veli palatini muscles in man. Laryngoscope 1978;88:651-62.
27. Gray LP. The relationship between the “superior constrictor swallow” clicking of the ears and ear disease. J Laryngol Otol 1983;97:1121-8.
28. Rood SR, Doyle WJ. Morphology of the tensor veli palatiny, tensor tympani and dilatator tubae muscles. Ann Otol Rhinol Laryngol 1978;87:202-10.
29. Rood SR. The morphology of muscle tensor veli palatini in the five month human fetus. Am J Anat 1973;138:191-5.
30. Salen B, Zakrisson JE. Electromyogram of the tensor tympani muscle in man during swallowing. Acta Otolaryngol 1978;85:453-5.
31. Barsoumian R, Kuehn DP, Moon JB, Canady JW. An anatomic study of the tensor veli palatini and dilatator tubae muscles in relation to eustachian tube and velar function. Cleft Palate Craniofac J 1998;35:101-10.
32. Kierner AC, Mayer R, v Kirschhofer K. Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections. Hear Res 2002;165:48-52.
33. Malkin DP. The role of TMD dysfunction in the etiology of middle ear diseases. Int J Orthod 1987;25:20-1
(1) Doctor of Odontology with a degree in Prosthetic Dentistry and Temporomandibular Disorders in Universidad Javeriana– Santa fe de
Bogota - Colombia. Medical Education in Orofacial-Otic referred symptoms. Associate Professor of Morphology in the Department of Basic
Sciences of the Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga - Colombia.
(2) Medical Doctor with Degree in Anatomy. Universidad Industrial de Santander (UIS). Basic Sciences Department Director, Professor
of Morphology in the Department of Basic Sciences of the Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga
- Colombia
(3) Medical Doctor with degree in Otolaryngology from Hospital Militar- Santa fe de Bogota - Colombia. Surgery Professor of the
Medicine Faculty - Universidad Industrial de Santander (UIS) - Bucaramanga - Colombia. Otolaryngology and head-neck surgery’s
Chief of Carlos Ardila Lule ClinicCorrespondence:
Dr. Luis Miguel Ramirez
E-mail: lmra3@yahoo.com
Received: 2-10-2005
Accepted: 17-12-2006
Ramírez LM, Ballesteros LE, Sandoval GP. Tensor tympani muscle:
strange chewing muscle. Med Oral Patol Oral Cir Bucal 2007;12:E96-
100.
© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946
ABSTRACT
This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for
detecting different pathologies’ common otic symptoms. It offers better tools for this shared symptomatology during
therapy’s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even
when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional
clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial
muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the
stomatognathic system; these muscles’ increased tonicity ceases to be a phenomenon having no logical connections. It
offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom
pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing
organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There
is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic
and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed
in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline
from a broad, anatomical and clinical perspective.
Key words: Oscicular chain, temporomandibular disorders, otic symptoms, malleus, tensor veli palatini, tensor tympani.
RESUMEN
Con este trabajo se pretende alertar al medico y al odontólogo en el entendimiento y la integración del manejo interdisciplinario
para la detección de síntomas de oido comunes en patologías diferentes, brindando mayores herramientas en
la fase conservadora de la terapia para esta sintomatología compartida. La fisiología del músculo tensor del tímpano y
su funcionalidad en el oído medio ha sido velada aun cuando su disfunción y relaciones anatómicas están explicando
un grupo de síntomas óticos confusos a la evaluación clínica convencional. Los músculos del oído medio comparten
un origen embriológico y funcional común con los músculos masticatorios y faciales. En este artículo se pretende hacer
énfasis en la dimensión neurológica y anatómica de la funcionalidad (individual y compartida) de estos músculos entre
si y el sistema estomatognático. La tonicidad aumentada de este músculo deja de ser un fenómeno sin conexiones lógicas,
ofreciendo a su actividad normal o disfuncional el protagonismo que se merece y redefiniendo su funcionalidad
e importancia en la comprensión de los síntomas óticos referidos muy en común con síntomas de otras patologías de
origen extra-ótico. El tinitus, vértigo, sensación de oído tapado, hipoacusia, hiperacusia y la otalgia son síntomas que al
Indexed in:
-Index Medicus / MEDLINE / PubMed
-EMBASE, Excerpta Medica
-SCOPUS
-Indice Médico Español
-IBECS
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle INTRODUCTION
Most people suffering from temporomandibular disorders (TMD) suffer from local or referred chronic muscular pain. This is found in the orofacial muscles, accompanied by painful and non-painful symptomatology, affecting the cervical musculature and middle ear muscles with varied otic symptoms ranging from vertigo, tinnitus, otic fullness sensation, hyperacusia-hypoacusia to otalgia. Multiple anatomical or neurological possibilities start from muscular or articular dysfunction which can generate otic conditions which do not seem to correspond to clinical discoveries arising from initial evaluation.(1) Such possible inroads have more in common than the purely descriptive focus of anatomical structures. This can be seen in the temporomandibular joint (TMJ), the ear and closeness between muscular structures and the middle ear.(2) This review seeks to develop the connection between the ear and stomatognathic system from a mainly anatomical focus. This work is aimed at understanding otic symptomatology having no otic origin, rationalizing the muscle-skeletal bond from an anatomical perspective and integrating health disciplines.
REVIEW
The tensor tympani muscle’s normal activity is related to a reflex neurological mechanism known as centrifuge auditory inhibition control (CAIC). This works in sound trauma protection and hearing discrimination of low tones, besides complex co-activation during velopharyngeal movements. The tensor tympani muscle’s normal physiology becomes changed during abnormal activity (seemingly during TMD) and is associated with otic symptoms expressed as otalgia, otic fullness sensation, tinnitus, vertigo and hyperacusia-hypoacusia, no justified otic pathology being presented such as Meniere’s syndrome, otitis, pontocerebellar angle neurinoma and/or otosclerosis. TMD is a sub-classification of muscle-skeletal disorders, including a series of craniofacial conditions having multifactor aetiology in adults and children.(3) Simultaneous tension of temporal and tensor tympani muscles has been electromyographically evaluated. This suggests a kindred relationship between orofacial, chewing and middle ear muscle operation due to TMD. Greater sympathetic tonus during emotional stress may be present because they share common pathophysiological scenarios.(4)
Increased emotional tension produces dysfunctional muscular activity and consequently TMD. Lam et al., (5) have stated that otalgia and other non-otological symptom prevalence in TMD patients varies from 3.5% to 42%. Tinnitus prevalence in TMD patients seems to be greater than in the general population.(6) Tinnitus frequency in patients with TMD varies from 33% to 76%.( 7,8) There is 40% to 70% dizziness and 5% to 40% vertigo prevalence in patients suffering from TMD. (9,10 )
TMD prevalence is twice to nine times greater in women than in men. These are complex pathologies having consequences ranging from difficulty in chewing and other oral functions to acute-chronic pain. TMD aetiology can be summarized as macro trauma and micro trauma (bruxism or pain). Bruxism plays an important role in TMD and referred orofacial symptoms, although many investigations have considered such association inconclusive.(11) The intimate nexus between dysfunctional masticatory activity, such as bruxism, TMD and emotional stress, can lead to the cause-effect relationship between them. TMD aetiology thus has a multifactor origin involving environmental, physiological and behavioural agents.
TMD produces contraction and tension of the masticatory muscles and reflex contraction in tensor veli palatini and tensor tympani muscles due to common motor innervation from the trigeminal mandibular branch (V3) (12-17) Schames et al., (18) have stated that the dysfunction of these muscles (accessory mastication muscles) plays an important role in otic symptoms. Otalgia can be felt by tympanic membrane tension due to constant tensor tympani muscle contracture. Such tension can produce dysacusia (a more general tinnitus symptom) accompanied by strange or hallucinatory acoustic sensations perceived as rings, clicks, pops, whispers or friction noises. Middle ear muscular tension can also be associated with hyperacusia and hypoacusia from a conductive origin and subjective presentation (even with normal audiometric values). The physical tension increased by emotional stress and headaches concomitantly accompanies such otic symptomatology.
The complex neuromuscular interaction between the muscles of mastication and the ear was referred to as otognatic syndrome by Myrhaug (13) in 1964 and otomandibular syndrome by Bernstein in 1969 (14) and by Arlen in 1977.(19) Patients suffering from otomandibular syndrome present one or more otic symptoms without ear, nose or throat pathology, but have one or more mastication muscles in a state of constant spasm.
Ogutcen-Toller and Juniper (20) noticed that the structures driving sound in the middle ear can be affected by reflex tensor tympani contraction in TMD patients. They evaluano
ser primarios de patologías en oído, deben ser descartados por el medico y relacionados con patologías vecinas que pueden producirlos. Ya existe la necesidad de entender los desordenes temporomandibulares y la sintomatología referida cráneo-facial desde una perspectiva neurofisiológica y músculo-esquelética comprendida en el sistema estomatognático. En la práctica diaria se observa con frecuencia una sintomatología común para los síntomas oticos y los desordenes temporomandibulares que se deben entender bajo una perspectiva amplia, anatómica, neuroanatómica y clínica.
Palabras clave: Cadena oscicular, desordenes temporomandibulares, síntomas oticos, tensor del tímpano, maleolo, tensor del velo palatino.
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle ted hearing status in TMD-otic symptom patients without finding clear middle ear or Eustachian tube dysfunction. This suggested tensor tympani conductive modulation with subjective hearing loss. Travell and Simons (21) explained tinnitus as being a referred sensitive phenomenon, starting as reflex muscular spasm from middle ear stapedial and tensor tympani muscles.
Myrhaug (13) agreed that there is reflex contraction of the tensor tympani in subjective tinnitus and rhythmic opening and closing of the Eustachian tube (palatine mioclonus) in objective tinnitus (externally perceived). Reflex muscular contraction is present in tensor tympani and tensor veli palatini muscles.(22) Objective tinnitus is much less common than subjective tinnitus. Zipfel et al., (23) supported the above and explained that the more common mechanical causes of objective tinnitus were palatine mioclonus and middle ear mioclonus producing tympanic membrane rhythmic movement secondary to repetitive stapedial and tensor tympani muscle contraction. (Figure 1) This muscular behaviour may correspond to a reflex pattern due to constant fatigue originating in these muscles’ abnormal somatomotor function during increased emotional tension and bruxism.
Shapiro and Truex (24) suggested these middle ear muscles’ possible tonic spasm and reflex due to the V and VII pairs being peripherally irritated (TMD); this could lead to impaired hearing of low tones. The balance of the oscicular chain and the functioning of structures driving sound in the middle ear normally depend on the stapedial and tensor tympani (antagonistic muscles). Sustained contraction of these muscles in TMD may alter inner ear perilymphatic and endolymphatic pressure through changes transmitted from the oval window toward the walls of the labyrinth and semicircular canals. This may lead to vestibular and cochlear impulse imbalance and similar symptomatic reaction to Meniere’s syndrome.
It is imperative that the middle ear oscicular chain (malleus, incus and stapes) be seen from an efficient but fragile biomechanical viewpoint. They are practically sustained by weak structures such as the tympanic membrane, some ligaments and stapedial and tensor tympani muscle tendons maintaining these bones in an articulation adapted to sound energy.
Auditory muscle (tensor tympani, tensor veli palatini and stapedial) functions are shown in Table 1. Stapedial muscle contraction happens with strong sounds and immediately before speaking. This improves auditory discrimination ability, external vocalization and reduces the masking effect of autogenous sound.(25,26) The tensor tympani muscle (in spite of common belief) is not an inoperative muscle due to it responding electromyographycally to strong sounds and vocalization, chewing, swallowing and facial muscle external stimulation.(27) If tensor tympani and veli palatini muscles share movements in common (velopharyngeal and facial) and tensor tympani and stapedial muscles together are neurologically activated (hearing protection reflexes and auditory discrimination) by the centrifuge reflex then it may be stated that facial and velopharyngeal movements shared by both tensile muscles have important influence on otic-TMD symptomatology.
Rood and Doyle (28) found from dissecting adult and foetal cadavers that tensor veli palatini anatomy consisted of a medial portion or dilatator tubae (described by Gray in 1918), an external portion consisting of the tensor veli palatini muscle and an intratympanic consisting of the tensor tympani muscle intermingling its fibres with the tensor veli palatini’s external area.(29) The tensor veli palatini’s lateral area originates in the sphenoid spine, scaphoid fossa, lateral bony edge of the sphenoid fissure and tensor tympani muscle. The tensor veli palatini’s medial area originates in the lateral membranous wall of the Eustachian tube’s posterior and middle third. These muscles descend and converge on the pterygoid hamulus in a strong tendon curving around this hook-shaped osseous process to be inserted into the soft palate in a horizontal direction (palatine aponeurosis). Yawning, laughing, swallowing and coughing involve pharyngeal and laryngeal muscles activating the tensor tympani muscle.
Kamerer (26) expressed his astonishment in 1978 that no unified theory had been created for these muscles sharing such close anatomical relationship. Tensor tympani and tensor veli palatini muscles work simultaneously (electromyographically proved) during swallowing, thereby producing a Djupesland air bomb in the middle ear assisting with Eustachian tube ventilation. Tensor tympani and tensor veli palatini muscles together produce tympanic membrane internal deflection breaking the Eustachian tube’s mucous membrane isthmus seal (expelled air), thereby contributing to middle ear ventilation (30). Barsoumian, Kuehn et al., (31) corroborated Lupin and Rood-Doyle’s findings. (Figure 2) The middle ear’s tendinous part, between tensor tympani and tensor veli palatini muscles, shows an anatomical connection between these muscle functions. These synergistic muscles may temporarily raise intratympanic pressure when they contract together.
Fig. 1. Tensor tympani and stapedial muscles in the middle ear cavity. Modification from Ref. 12.
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Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle It should not be said that the tensor veli palatini has an additional bony origin in the malleus manubrium. Tensor veli palatini dysfunction (TMD or bruxism) may modify malleus and tympanic membrane medial position due to anatomic anchorage with the tensor tympani. Kierner et al., (32) found such connection (histological study) in human cadavers. They stated that this represents an important step in understanding the functional unit between these two muscles in humans. Schames et al., (18) suggested that tensor tympani and tensor veli palatini secondary myofibrotic contracture (adhesions and trigger points) complicates their anatomical relationship and otic symptomatology due to their reduced muscular fibre length.
It should be stressed that understanding middle ear ventilation physiology through the Eustachian tube involves neurological territories referred from the masticatory system. In 1987, Malkin (33) stated that the tensor tympani serves as a barometric pressure receiver. Its propioceptive afference signals (starting from their muscular length) can be triggered in a hypotonic situation caused by low tympanic cavity pressure (due to mucosal air exchange). Such low-pressure medially retracts the tympanic membrane and tensor tympani tendon due to great external environmental pressure accompanied by no resistance to force; such new muscle elongation is perceived by its muscular spindles. The trigeminal motor nucleus produces a reflex mechanism in a polysynaptic central arrangement, beginning tensor muscle contraction involving opening the Eustachian tube, middle ear ventilation and pressure equilibration; such normal physiological mechanisms may be blocked by the tensortympani hypertonic scenario during TMD.
These would be expressed via tube dysfunction and accompanying otic symptomatology, such as hypoacusia, tinnitus, vertigo, otalgia, otic fullness and even otitis media.
For almost one hundred years several investigators have tried to outline possible cause-effect relationship between otic symptoms and TMD from mechanical, vascular, neurological, muscular and embryological viewpoints. As medicine and dentistry became more specialised the hearing organ and stomatognathic systems were abruptly separated; this situation has been discreetly corrected via specialization in otolaryngology and craniofacial pain which has attempted to close the breach in such thematic discussion which had been gaining the stigma of being a no man’s land.
Table I. Intratympanic and extratympanic common movements.
Muscles MovementsTensor tympani Innervation: Trigeminal Tensor veli palatini Innervation: Trigeminal StapedialInnervation: Facial Speaking x x Chewing x x Swallowing x x Jawning x x Laughing x x Coughing x x Breathing x x Acoustic trauma x x Before speaking x x Palpebral reflex x x
Fig. 2. Tensor tympani and tensor veli palatini muscle fiber connection. M. Malleus manubrium, TT. Tensor tympani muscle, TP-L. Tensor veli palatini muscle. Used with permission from Ref. 28.
E100
Med Oral Patol Oral Cir Bucal 2007;12:E96-100. Tensor tympani muscle CONCLUSION
This article has concerned itself with the need for understanding the presence of a masticatory muscle in the middle ear which can complicate TMD otic symptomatology. This idea will be developed in articles to follow, as well as other stomatognathic neurological and mechanical causes. This muscle’s anatomy, neuroanatomy and physiology (besides being interesting in itself) is related to intratympanic hearing activity which may be externally modulated by the masticatory system in the presence of muscle skeletal disorder.
It is imperative that the need for a medical and odontological interdisciplinary patient management system be understood. Specialists in a single discipline are not always able to solve a patient’s heterogeneous symptoms without the invaluable support of a multidisciplinary approach. Each specialty contributes its specific knowledge to differential diagnosis aimed at a more assertive treatment plan. Clinical success therefore depends on each specialist’s ability to analyse different aspects of the same problem. Team work can thus be best used for obtaining the best functional state in a particular patient’s stomatognathic system.
REFERENCES
1. Ramirez LM, Sandoval GP, Ballesteros LE. Theories on otic symptoms in temporomandibular disorders: Past and Present. Int J Morphol 2005;23:141-56.
2. Ramirez LM, Sandoval GP, Ballesteros LE. Temporomandibular disorders: referred cranio-cervico-facial clinic. Med Oral Patol Oral Cir Bucal. 2005;10:E18-26.
3. Youniss S. The relationship between craniomandibular disorders and otitis media in children. Cranio 1991;9:169-73
4. Klockhoff I, Lindholm L, Westerberg CE. Spontaneous impedance fluctuation--a “tensor tympani syndrome” with special reference to tension headache. Nord Med 1971;85:577.
5. Lam DK, Lawrence HP, Tenenbaum HC. Aural symptoms in temporomandibular disorder patients attending a orofacial pain unit. J Orofac Pain 2001;15:146-57.
6. Cooper BC, Cooper DL. Recognizing otolaryngologic symptoms in patients with temporomandibular disorders. Cranio 1993;11:260-7
7. Parker WS, Chole RA. Tinnitus, vertigo and temporomandibular disorders. Am J Orthod Dentofacial Orthop 1995;107:153-8
8. Rubinstein B. Tinnitus and craniomandibular disorders-- Is there a link?. Swed Dent J Suppl 1993;95:1-46
9. Chole RA, Parker WS. Tinnitus and vertigo in patients with temporomandibular disorders. Arch Otolaryngol Head Neck Surg 1992;118:817-21.
10. Bush FM. Tinnitus and Otalgia in temporomandibular disorders. J Prosthet Dent 1987;58:495-8
11. Pergamalian A, Rudy TE, Zaki HS, Greco CM. The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders. J Prosthet Dent 2003;90:194-200.
12. Anatomía de Bouchet y Guilleret. Editorial Panamericana.
13. Myrhaug H. The incidence of the ear symptoms in cases of malocclusion and temporomandibular joint disturbances. Br J Oral Maxillofac Surg 1964;2:28-32
14. Bernstein JM, Mohl ND, Spiller H. Temporomandibular joint dysfunction masquerading as disease of ear, nose and throat. Trans Am Acad Ophthalmol Otolaryngol 1969;73:1208-17.
15. Manni A, Brunori P, Giuliani M, Modoni M, Bizzi G. Oto-vestibular symptoms in patients with temporomandibular joint dysfunction. Electromyographic study. Minerva Stomatol 1996;45:1-7
16. Ciancaglini R, Loreti P, Radaelli G. Ear, nose and throat symptoms in patients with TMD: The association of symptoms according to severity of arthropathy. J Orofac Pain 1994;8:293-7.
17. Eckerdal O. The petrotynpanic Fissure: A link connecting the tympanic cavity and the temporomandibular joint. Cranio 1991;9:15-21.
18. Schames J, Schames M, King E, Ulansey S, Boyd J, Schames E. Trigeminal Pharyngioplasty: Treatment of the forgotten accessory muscles of mastication which are associated with orofacial pain and ear symptomatology. AJPM 2002;12:102-12.
19. Arlen H. The otomandibular syndrome: A new concept. Ear Nose Throat J 1977;56:60-2.
20. Ogutcen-Toller M, Juniper RP. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993;21:2-8.
21. Travell JG, Simons DG, eds. Dolor y disfunción miofascial. El manual de los puntos gatillo, Mitad superior del cuerpo. Madrid: Editorial Panamericana; 2002. p. 419,476.
22. Virtanen H. Objective tubal tinnitus: a report of two cases. J Laryngol Otol 1983;97:857-62.
23. Zipfel TE, Kaza SR, Greene JS. Middle-ear myoclonus. J Laryngol Otol 2000;114:207-9.
24. Shapiro HH, Truex RC. The temporomandibular joint and the auditory function. J Am Dent Assoc 1943;30:1147-68.
25. Klockhoff I, Anderson H. Reflex activity in the tensor tympani muscle recorded in man; preliminary report. Acta Otolaryngol 1960 ;51:184-8.
26. Kamerer DB. Electromyographic correlation of tensor tympani and tensor veli palatini muscles in man. Laryngoscope 1978;88:651-62.
27. Gray LP. The relationship between the “superior constrictor swallow” clicking of the ears and ear disease. J Laryngol Otol 1983;97:1121-8.
28. Rood SR, Doyle WJ. Morphology of the tensor veli palatiny, tensor tympani and dilatator tubae muscles. Ann Otol Rhinol Laryngol 1978;87:202-10.
29. Rood SR. The morphology of muscle tensor veli palatini in the five month human fetus. Am J Anat 1973;138:191-5.
30. Salen B, Zakrisson JE. Electromyogram of the tensor tympani muscle in man during swallowing. Acta Otolaryngol 1978;85:453-5.
31. Barsoumian R, Kuehn DP, Moon JB, Canady JW. An anatomic study of the tensor veli palatini and dilatator tubae muscles in relation to eustachian tube and velar function. Cleft Palate Craniofac J 1998;35:101-10.
32. Kierner AC, Mayer R, v Kirschhofer K. Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections. Hear Res 2002;165:48-52.
33. Malkin DP. The role of TMD dysfunction in the etiology of middle ear diseases. Int J Orthod 1987;25:20-1
Thursday, May 13, 2010
Your Commitment to Your Dental Health
Exceptional Dentistry takes commitment from you as well as from us. This relationship involves teamwork. Just as we place high standards on ourselves, we ask the same from our patients.
Our Expectations of You, Our Patient:
Communication – We want to know how you feel about all aspects of your experience with us. We will develop a Personalized Dental Plan for you and expect you to tell us honestly about your thoughts and feelings. We are here to serve you and want you to be comfortable in making decisions concerning your appearance and your dental health.
Time – We stand alone in the medical / dental community by seeing one patient at a time and always being prompt. While we understand that emergencies do arise, we choose not to work with patients who have missed three appointments in our office. Reserving time in our office is a privilege you will want to guard.
Finances / Investment - You’ve noticed our office is different. Please don’t be surprised to discover that our fees are higher than those of an average office. We could not offer the level of technology and service we do otherwise. Because of this, we have designed payment arrangements that are comfortable and convent, so cost is rarely a concern. You will receive value, that’s our commitment
For our patients with dental insurance coverage, we will be happy to assist you in the filing of your claim. We have found that far too often insurance companies do not have your best dental health in mind it is for this reason that we do not let them dictate our relationship with you.
Referrals - We enjoy working with patients just like you! The only problem is, our dentistry is considered permanent and, “once you are fixed, you are fixed”! We ask that whenever you have the opportunity to mention our name to your family and friends that you do so. Please know that we will do our best to provide them with the same in Exceptional Dentistry. We especially enjoy treating patients that referred by our existing patients.
Following these guidelines will insure a long lasting relationship between us! This is your commitment to us.
Exceptional Dentistry takes commitment from you as well as from us. This relationship involves teamwork. Just as we place high standards on ourselves, we ask the same from our patients.
Our Expectations of You, Our Patient:
Communication – We want to know how you feel about all aspects of your experience with us. We will develop a Personalized Dental Plan for you and expect you to tell us honestly about your thoughts and feelings. We are here to serve you and want you to be comfortable in making decisions concerning your appearance and your dental health.
Time – We stand alone in the medical / dental community by seeing one patient at a time and always being prompt. While we understand that emergencies do arise, we choose not to work with patients who have missed three appointments in our office. Reserving time in our office is a privilege you will want to guard.
Finances / Investment - You’ve noticed our office is different. Please don’t be surprised to discover that our fees are higher than those of an average office. We could not offer the level of technology and service we do otherwise. Because of this, we have designed payment arrangements that are comfortable and convent, so cost is rarely a concern. You will receive value, that’s our commitment
For our patients with dental insurance coverage, we will be happy to assist you in the filing of your claim. We have found that far too often insurance companies do not have your best dental health in mind it is for this reason that we do not let them dictate our relationship with you.
Referrals - We enjoy working with patients just like you! The only problem is, our dentistry is considered permanent and, “once you are fixed, you are fixed”! We ask that whenever you have the opportunity to mention our name to your family and friends that you do so. Please know that we will do our best to provide them with the same in Exceptional Dentistry. We especially enjoy treating patients that referred by our existing patients.
Following these guidelines will insure a long lasting relationship between us! This is your commitment to us.
NEUROMUSCULAR DENTISTRY’S APPROACH IN TREATING
TMJ RELATED PROBLEMS
Do you get headaches on a consistent basis? Do you blame it on stress? You are not alone. Using a neuromuscular approach to treating patients can help the many headache sufferers. But what exactly is it?
Neuromuscular dentistry is nothing new. Actually, it has been around some 30 years, but is not the traditional approach to patient care in dentistry. It refers to the muscles of the head and neck, the nerves related to them, and how they all work together. The symptoms of neuromuscular disharmony are related to the TJM or temporamandibular joint. Many patients complain that the jaw pops and clicks. They often complain of pain around the neck and back. If you have these symptoms, then you are not alone.
In reality however, 99% of people do not have true “TMJ” problems. Unless trauma or injury is involved, pain from the joint comes from the surrounding muscles. If you treat the muscles and get them “relaxed”, then the majority of symptoms will resolve. But what are the symptoms? As you read them, think of how they apply to you.
SYMPTOMS
The symptoms most commonly cited are as follows:
• Headaches or migraines
• Snoring
• Insomnia – difficulty sleeping
• Vertigo (dizziness)
• Sinus problems/ or sinus like symptoms
• Stiffness or soreness in the neck, shoulders and back
• Ear pain, diminished hearing
• Back, neck, cervical pain
• Visual disturbances
• Clenching or grinding your teeth
• Sensitive teeth
• Pain or pressure in and about the eyes
• Swelling on the side of the face and/ or mouth
• The jaw locking open or closed/ or pain around the jaw.
• Postural problems (forward head postures)
These are just a few of the symptoms that may be related to neuromuscular disharmony. Make no mistake headaches are not just from stress. Neck and shoulder problems are not just from sitting at a computer for many hours. Sinus problems are not just from allergies. But how does all of this relate to your teeth?
If you have ever seen a person with no teeth in their mouth it almost appears as if their chin can touch their nose. That is because their teeth are not present to create a vertical stop as to how far they can close at the correct position. As you use your teeth they wear and shorten, causing you to be over-closed when your teeth are in contact. Now, here is where the muscles come into play. At complete rest, your teeth are separated by a certain amount. Dentists call this freeway space. When it is time for your teeth to be put to use for eating or speaking, the muscles contract. Now imagine that you have worn or shortened teeth. Your freeway space is larger than ideal and the muscles have to work to get the teeth to make contact. The muscles do not compensate by STAYING perpetually contracted, causing pain and soreness. After a while they get fatigued, producing acid (which is what causes the spasms and discomfort.) Thus destroying more muscles and reducing blood flow.
Using a neuromuscular approach to treating patients can help the many headache sufferers. Clinic research and clinical experience have shown this technique effective in treating patients with various levels of head and neck pain. It is also used in finding the optimal jaw position before restorative dentistry and greatly increases the longevity of restorations and natural dentition. The cause of these signs and symptoms are structural, biochemical and emotional. Structural problems are almost always present and these lead to over activation of the jaw, head and neck muscles. Over the period of time it can lead to pain, tension and spasm.
But what exactly is neuromuscular dentistry? Neuromuscular dentistry is the art and science of using the relaxed position of the muscles of the head and neck to place the jaw into an optimal physiologic position. Neuromuscular dentistry is nothing new. What is new is computer imaging to locate, isolate, and resolve the problem.
The neuromuscular treatment approach in dealing with TMJ problems will increase the much needed blood flow and oxygen into the fatigued muscle reversing the damage done over the years. Over time during the treatment, facial tones are RESTORED back to younger days.
DOUGLAS HAUCK D.D.S.
TMJ RELATED PROBLEMS
Do you get headaches on a consistent basis? Do you blame it on stress? You are not alone. Using a neuromuscular approach to treating patients can help the many headache sufferers. But what exactly is it?
Neuromuscular dentistry is nothing new. Actually, it has been around some 30 years, but is not the traditional approach to patient care in dentistry. It refers to the muscles of the head and neck, the nerves related to them, and how they all work together. The symptoms of neuromuscular disharmony are related to the TJM or temporamandibular joint. Many patients complain that the jaw pops and clicks. They often complain of pain around the neck and back. If you have these symptoms, then you are not alone.
In reality however, 99% of people do not have true “TMJ” problems. Unless trauma or injury is involved, pain from the joint comes from the surrounding muscles. If you treat the muscles and get them “relaxed”, then the majority of symptoms will resolve. But what are the symptoms? As you read them, think of how they apply to you.
SYMPTOMS
The symptoms most commonly cited are as follows:
• Headaches or migraines
• Snoring
• Insomnia – difficulty sleeping
• Vertigo (dizziness)
• Sinus problems/ or sinus like symptoms
• Stiffness or soreness in the neck, shoulders and back
• Ear pain, diminished hearing
• Back, neck, cervical pain
• Visual disturbances
• Clenching or grinding your teeth
• Sensitive teeth
• Pain or pressure in and about the eyes
• Swelling on the side of the face and/ or mouth
• The jaw locking open or closed/ or pain around the jaw.
• Postural problems (forward head postures)
These are just a few of the symptoms that may be related to neuromuscular disharmony. Make no mistake headaches are not just from stress. Neck and shoulder problems are not just from sitting at a computer for many hours. Sinus problems are not just from allergies. But how does all of this relate to your teeth?
If you have ever seen a person with no teeth in their mouth it almost appears as if their chin can touch their nose. That is because their teeth are not present to create a vertical stop as to how far they can close at the correct position. As you use your teeth they wear and shorten, causing you to be over-closed when your teeth are in contact. Now, here is where the muscles come into play. At complete rest, your teeth are separated by a certain amount. Dentists call this freeway space. When it is time for your teeth to be put to use for eating or speaking, the muscles contract. Now imagine that you have worn or shortened teeth. Your freeway space is larger than ideal and the muscles have to work to get the teeth to make contact. The muscles do not compensate by STAYING perpetually contracted, causing pain and soreness. After a while they get fatigued, producing acid (which is what causes the spasms and discomfort.) Thus destroying more muscles and reducing blood flow.
Using a neuromuscular approach to treating patients can help the many headache sufferers. Clinic research and clinical experience have shown this technique effective in treating patients with various levels of head and neck pain. It is also used in finding the optimal jaw position before restorative dentistry and greatly increases the longevity of restorations and natural dentition. The cause of these signs and symptoms are structural, biochemical and emotional. Structural problems are almost always present and these lead to over activation of the jaw, head and neck muscles. Over the period of time it can lead to pain, tension and spasm.
But what exactly is neuromuscular dentistry? Neuromuscular dentistry is the art and science of using the relaxed position of the muscles of the head and neck to place the jaw into an optimal physiologic position. Neuromuscular dentistry is nothing new. What is new is computer imaging to locate, isolate, and resolve the problem.
The neuromuscular treatment approach in dealing with TMJ problems will increase the much needed blood flow and oxygen into the fatigued muscle reversing the damage done over the years. Over time during the treatment, facial tones are RESTORED back to younger days.
DOUGLAS HAUCK D.D.S.
Wednesday, April 7, 2010
How it works in a nut shell…
The Pure power Mouth Guard
"There is something called the postural chain......
there are muscles that attach from your lower jaw to your shoulder blades, from your shoulder blades to your spine, from your spine to your hips, from your hips to your knees and from your knees to your feet. If your teeth hold your lower jaw in a torqued postion, this cause your shoulders to be crooked, your spine to be off and mis-alignment in your hips, knees and feet. When your shoulders, spine, hips, knees and feet are crooked, your body does not perform at maximum efficiency.
A neuromuscular mouthpiece levels your lower jaw, which in turn levels your shoulders, spine, hips, knees and feet. When everything in the postural chain from your mouth to your feet is in alignment, we see a significant improvement in your athletic performance."
If you want to add more to it then that, talk to them about .....
"a neuromuscluar sports moutpiece also opens up your airway, which allows you to go longer without fatigue, and once fatigued, to recover faster. Increased oxygenation to the brain also allows for increased mental alertness while under physical stress."
The Pure power Mouth Guard
"There is something called the postural chain......
there are muscles that attach from your lower jaw to your shoulder blades, from your shoulder blades to your spine, from your spine to your hips, from your hips to your knees and from your knees to your feet. If your teeth hold your lower jaw in a torqued postion, this cause your shoulders to be crooked, your spine to be off and mis-alignment in your hips, knees and feet. When your shoulders, spine, hips, knees and feet are crooked, your body does not perform at maximum efficiency.
A neuromuscular mouthpiece levels your lower jaw, which in turn levels your shoulders, spine, hips, knees and feet. When everything in the postural chain from your mouth to your feet is in alignment, we see a significant improvement in your athletic performance."
If you want to add more to it then that, talk to them about .....
"a neuromuscluar sports moutpiece also opens up your airway, which allows you to go longer without fatigue, and once fatigued, to recover faster. Increased oxygenation to the brain also allows for increased mental alertness while under physical stress."
FDA issues precautionary note on silver fillings
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Silver dental fillings contain mercury, and the government for the first time is warning that they may pose a safety concern for pregnant women and young children. The Food and Drug Administration posted the precaution on its Web site earlier this month, to settle a lawsuit — making the move a victory for anti-mercury activists.
The warning is not aimed at the general population, only at two groups already urged to limit mercury from another source — seafood — because too much can harm a developing brain.
The fillings, formally known as dental amalgams, "contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," reads the FDA Web posting.
That doesn't mean it truly harms, and the FDA advises against removing existing fillings.
The agency still is studying whether the small amount of mercury vapor released by chewing and brushing is enough to cause neurologic disorders or other problems in youngsters. There have been only a handful of rigorous studies comparing children given either amalgam fillings or tooth-colored resin composite fillings that are mercury-free — and those studies haven't detected any brain problems. Nor has that research settled the long-simmering scientific controversy. Two years ago, the FDA's own independent scientific advisers said that while amalgam fillings were safe for most people, more research was needed about potential effects on fetuses and children under 6. And this spring, the FDA put dentists on notice that it is considering additional controls, including whether to require warnings that would advise consumers of the mercury in amalgams before they have a cavity filled, or perhaps even restrict use in small children and certain other patients. It is accepting public comments until July 28. "It's an open question what we will do," FDA Deputy Commissioner Randall Lutter told The Associated Press. But, "what this says is there's a clear intent on our part on labeling for sensitive subpopulations." Expect a final ruling by July 28, 2009, a date set by that legal settlement. "It's a watershed moment," said Michael Bender of the Mercury Policy Project, who with other advocacy groups had sued the FDA in hopes of forcing restrictions on amalgams. "This court settlement signals the death knell for mercury fillings," added Charles Brown, an attorney for Consumers for Dental Choice. Not so fast, say dentists who point to medically crucial reasons to use amalgams — and worry that people who can't afford more expensive alternatives might avoid dental care. "We don't want these choices taken away based on junk science. We don't want them taken away based on misguided fears," said Dr. Edmond Hewlett, a dental professor at the University of California, Los Angeles, and an American Dental Association adviser. Amalgam fillings are about 50 percent mercury, joined with silver, copper and tin. The hardened mixture makes the mercury less absorbable by the body than the kind found in fish, said Hewlett, who chose an amalgam filling for his own 7-year-old son. Used since the 1800s, amalgams' popularity already is dropping. They account for about 30 percent of U.S. fillings, still millions of people a year. They're cheaper than alternatives — roughly $100 for an amalgam filling versus $150 or more for a composite, Hewlett estimates — and they're known as particularly durable. Hewlett said two conditions that demand amalgams: Spots on back teeth that dentists can't keep dry long enough for a composite filling to bond, and in people who forcefully grind their teeth. Science operates on "a precautionary principle," said Dr. Karl Kieburtz, a University of Rochester neurologist who co-chaired the 2006 FDA advisory committee and praised the new warning. "For 99 percent-plus of people, there probably isn't harm. But if there is a group of people who might be at risk, they should at least have the knowledge that may be so," he said. Several other countries limit amalgams, either as a precaution in pregnant women and small children or because of environmental concern. Dental workers make amalgam fillings by mixing liquid mercury with powdered ingredients, requiring special safety steps and filters to limit waste seeping back into the environment.
WASHINGTON - Silver dental fillings contain mercury, and the government for the first time is warning that they may pose a safety concern for pregnant women and young children. The Food and Drug Administration posted the precaution on its Web site earlier this month, to settle a lawsuit — making the move a victory for anti-mercury activists.
The warning is not aimed at the general population, only at two groups already urged to limit mercury from another source — seafood — because too much can harm a developing brain.
The fillings, formally known as dental amalgams, "contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," reads the FDA Web posting.
That doesn't mean it truly harms, and the FDA advises against removing existing fillings.
The agency still is studying whether the small amount of mercury vapor released by chewing and brushing is enough to cause neurologic disorders or other problems in youngsters. There have been only a handful of rigorous studies comparing children given either amalgam fillings or tooth-colored resin composite fillings that are mercury-free — and those studies haven't detected any brain problems. Nor has that research settled the long-simmering scientific controversy. Two years ago, the FDA's own independent scientific advisers said that while amalgam fillings were safe for most people, more research was needed about potential effects on fetuses and children under 6. And this spring, the FDA put dentists on notice that it is considering additional controls, including whether to require warnings that would advise consumers of the mercury in amalgams before they have a cavity filled, or perhaps even restrict use in small children and certain other patients. It is accepting public comments until July 28. "It's an open question what we will do," FDA Deputy Commissioner Randall Lutter told The Associated Press. But, "what this says is there's a clear intent on our part on labeling for sensitive subpopulations." Expect a final ruling by July 28, 2009, a date set by that legal settlement. "It's a watershed moment," said Michael Bender of the Mercury Policy Project, who with other advocacy groups had sued the FDA in hopes of forcing restrictions on amalgams. "This court settlement signals the death knell for mercury fillings," added Charles Brown, an attorney for Consumers for Dental Choice. Not so fast, say dentists who point to medically crucial reasons to use amalgams — and worry that people who can't afford more expensive alternatives might avoid dental care. "We don't want these choices taken away based on junk science. We don't want them taken away based on misguided fears," said Dr. Edmond Hewlett, a dental professor at the University of California, Los Angeles, and an American Dental Association adviser. Amalgam fillings are about 50 percent mercury, joined with silver, copper and tin. The hardened mixture makes the mercury less absorbable by the body than the kind found in fish, said Hewlett, who chose an amalgam filling for his own 7-year-old son. Used since the 1800s, amalgams' popularity already is dropping. They account for about 30 percent of U.S. fillings, still millions of people a year. They're cheaper than alternatives — roughly $100 for an amalgam filling versus $150 or more for a composite, Hewlett estimates — and they're known as particularly durable. Hewlett said two conditions that demand amalgams: Spots on back teeth that dentists can't keep dry long enough for a composite filling to bond, and in people who forcefully grind their teeth. Science operates on "a precautionary principle," said Dr. Karl Kieburtz, a University of Rochester neurologist who co-chaired the 2006 FDA advisory committee and praised the new warning. "For 99 percent-plus of people, there probably isn't harm. But if there is a group of people who might be at risk, they should at least have the knowledge that may be so," he said. Several other countries limit amalgams, either as a precaution in pregnant women and small children or because of environmental concern. Dental workers make amalgam fillings by mixing liquid mercury with powdered ingredients, requiring special safety steps and filters to limit waste seeping back into the environment.
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