burns tmj pdf
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AMERICAN ASSOCIATION ofORTHOPEDIC MEDICINE
December 7 & 8, 2007
WORKSHOP
Pain Management and Healing in the 21st Century
Jointly Sponsored by American Association ofOrthopedic Medicine AAOM and the University
of California, San Diego School of Medicine
Contribution from dental to medical
Template Therapy and Irregular Output of the Trigeminal Nervous System
David L. Burns D.D.S.December 7&8 2007
Fort Wayne, Indiana
Dental Occlusion and Health
Dr. David L. BurnsAcademy of Physiological Dentistry
American Dental AssociationIndiana Dental Association
American Academy of Functional OrthodonticsAmerican Academy of Pain Management
International College of Craniomandibular Orthopedics
American Academy of Craniofacial Pain
drdlburns@comcast.netwww.davidlburnsdds.com
260-432-8596
HOW DO WE KNOW IF OCCLUSION IS GOOD OR BAD?
HOW DO WE TREAT TMD?
ANIMAL RESEARCH
CLINICAL CASES
SPORTS DENTISTRY
CONTENTS
HOW DO WE KNOW IF
OCCLUSION IS GOOD
OR BAD?
OCCLUSION
GOOD ----------------- EUSTRESSBAD -------------------DISTRESS
FOR WHOLE BODY
POSTUREPHYSIOLOGY
DYNAMIC FUNCTIONS
WHY DOES OCCLUSION CAUSE EUSTRESS
ORDISTRESS?
A. MECHANICAL FACTORS
B. PHYSIOLOGICAL FACTORS
PHYSIOLOGICAL FACTORS
1. MUSCLES
2. SENSORY- AFFERENT
MUSCLE SPINDLES
GOLGI TENDONS EXTEROCEPTORS
3. CENTRAL NERVOUS SYSTEM
CORTEX BRAINSTEM
4. MOTOR- EFFERENT
ALPHA- GAMMA
AUTONOMIC N.S.
5. PSYCHOSOMATICS
MECHANICAL FACTORS
1. BITE2. GUZAY’S QUADRANT THEOREM
FORCESAXIS-- X&YLEVERS
3. DISCDISPLACEDRUPTURED
4. COMPRESSIONPYRAMUS BONECERVICAL VERTEBRAE
OCCLUSION
GOOD ----------------- EUSTRESSBAD -------------------DISTRESS
FOR WHOLE BODY
POSTUREPHYSIOLOGY
DYNAMIC FUNCTIONS
Quadrant Theorem
Established by
Casey M.Guzay1973:Chicago, USA
Kiyoshi Maehara1985: Osaka, Japan
Center of jawmovement is inthe Sub-Atlas .
In order to masticate or speak properly, the cranium has to keep a stable position.
The posterior cervical muscles and the masticatory muscles always co-work with each other. It is suggested that the length of the posterior cervical muscles goes along with the length of the masticatory muscles.
In case of deep bite or mal occlusion, neuro motor system is activated more than before. This action causes the posterior muscles to constrict more. Cervical vertebrae then receive the force to cause the compression.
Ia and II are proprioception fibers and go into the mesencephalic nucleus, locus cereleus and gray matter of aqueduct of mid-brain. These places act as first ganglia of the trigeminal nerve.
IaII
HOW DO WE TREAT TMD?
What is a Template & Therapy?
1. Kind of mouth piece
2. Stretch of the Masticatory M.
3. Stabilization of the Head Position
4. Improve the diseases and non-specific complaints
5. Connect the medicine and dentistry
How to use the stick in medical care?Template or stick is not a drug
This work stabilizes the brain by cutting off the output signals to the masticatory muscles .
1. During the hospitalization patients should bite stick
2. Never take the dentures out during the sleeping time
3. Ease to pain control when bite the Stick or TP.
4. While under anesthesia bite block is necessary in
order for the stabilization of blood pressure
5. In case of incurable diseases, stick or Tp help for patients
ANIMAL RESEARCH AND THINKING
Conclusion of Animal Experiments
Vertical height loss led to1. Whole body muscle tension changes
2. Imbalance of Autonomic nervous
system.
3. No changes of blood and urine tests
Reference of Animal Experiments
1. Rats : Dr. Tatsuya Ueda Dr. Kiyoshi Maehara
2. Guinea Pigs: Dr. Yukio Azuma, Dr. Hitoshi Taga, Dr. Masaharu Hashimoto Dr. Kiyoshi Maehara
3. Beagle Dogs: Dr. Masaharu Hashimoto, Dr. Kiyoshi Maehara, Dr. Teruaki Sumioka
4. Rhesus Monkeys: Dr. David Burns, Dr. Masaharu Hashimoto, Dr. Keiichi Tamaki, Dr. Kiyoshi Maehara
1-2 Asahi University School of Dentistry Department of Pharmacology
3-4 Fujisawa Pharmaceutical Company Limited
CLINICAL CASES
Clinical Findings 1Clinical Findings 1Clinical Findings 1Clinical Findings 1
1.1.1.1.....Posture: Malposture,Humpback and Malposture,Humpback and Malposture,Humpback and Malposture,Humpback and
Scoliosis etc.Scoliosis etc.Scoliosis etc.Scoliosis etc.
2.2.2.2. Stabilization of cervical vertebra:
Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness of finger/armsof finger/armsof finger/armsof finger/arms
3. Analgesic action : All kind of pain caused All kind of pain caused All kind of pain caused All kind of pain caused from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which is a trigeminal pathway.is a trigeminal pathway.is a trigeminal pathway.is a trigeminal pathway.
Clinical findings 2Clinical findings 2Clinical findings 2Clinical findings 24..Improvement of blood flow to brain
from vertebral arteries :
Consequence of the cerebral infarction, Consequence of the cerebral infarction, Consequence of the cerebral infarction, Consequence of the cerebral infarction, Epilepsy, ParkinsonEpilepsy, ParkinsonEpilepsy, ParkinsonEpilepsy, Parkinson’’’’s disease and Dementias disease and Dementias disease and Dementias disease and Dementia5..Stabilization of autonomic nervous system:
HyperHyperHyperHyper・・・・Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Diabetes and Anxiety neurosisDiabetes and Anxiety neurosisDiabetes and Anxiety neurosisDiabetes and Anxiety neurosis6..Stabilization of immune system:
AsthmaAsthmaAsthmaAsthma、、、、Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease and Myasthenia gravisand Myasthenia gravisand Myasthenia gravisand Myasthenia gravis
Clinical findings 3Clinical findings 3Clinical findings 3Clinical findings 37. Improvement of motor function and
skills: protect from sports injury,
acceleration of motor reflexes:
Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor reflexreflexreflexreflex
8. Improvement of TMJ disorder:
Clicking, can’t open mouth due to lock jaw, arthritis of TMJ and so on
9.9.9.9. Leads to proper occlusionLeads to proper occlusionLeads to proper occlusionLeads to proper occlusion
An actress suffered from whiplash by traffic accident and could not remember her script. She was cured within a week by the template wearing.
Effect of the template therapy with sleep apnea syndrome patients.
Hitoshi TAGA 1) , Teruaki TOMARU1)
Satoshi NAITOH2) , Kiyoshi MAEHARA 3)
1)Showa Univ. Med. Fujigaoka Hosp. Dept. of Anesthesiology
2)Showa Univ. Med. Fujigaoka Hosp. Dept. of Otolaryngology
3)Hamamatsu Med. Univ. Dept. of Oral Surgery
UPPP Template Nosedrops
Septoplasty
Reduceweight
Tonsillectomy
0000
10101010
20202020
30303030
Choice of treatment for the SAS patients.
%
93
93.5
94
94.5
95
95.5
96
96.5
97
AI<20 20≦AI<40 40≦AI
%
before
after
Effect of template on mean SpO2.AI<20:n=17, 20≦≦≦≦AI<40:n=5, 40≦≦≦≦AI:n=4. *p<0.05, **p<0.01.
50
55
60
65
70
75
80
85
90
AI<20 20≦AI<40 40≦AI
%
Effect of template on lowest SpO2.AI<20:n=17, 20≦≦≦≦AI<40:n=5, 40≦≦≦≦AI: n=4.*p<0.05.
*
*
**
Effect of UPPP34%34%34%34%
27%27%27%27%
39%39%39%39%
13%13%13%13%
13%13%13%13%
74%74%74%74%
Effect of template
marked improvement
effective
stationary
SPORTS DENTISTRY
Clinical findings 3Clinical findings 3Clinical findings 3Clinical findings 37. Improvement of motor function and
skills: protect from sports injury,
acceleration of motor reflexes:
Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor reflexreflexreflexreflex
8. Improvement of TMJ disorder:
Clicking, can’t open mouth due to lock jaw, arthritis of TMJ and so on
9.9.9.9. Leads to proper occlusionLeads to proper occlusionLeads to proper occlusionLeads to proper occlusion
Reasons for the Effectiveness of Template Therapy
1. From the viewpoint of the physics:
Guzay’s Quadrant Theorem
2. From the viewpoint of the physiology:Masticatory muscles are stretched and controlled by the trigeminal nervous system(Controlled by brainstem directly)
We Are Looking For The Neuro-Dentistry
Dental treatment is same as brainstem treatment:
1. Reduce pain from oral area: stabilization of spinal tract of trigeminal
2. Improve the malocclusion: stabilization of the basal ganglia
3. Increase vertical of bite: stimulate to the mesencephalic nucleus, locus cereleus and gray matter of cerebral aqueduct of mid-brain
(Reduce the pain which is closely related to neuro system)
Conclusion
Mechanism of action is stabilization of the brain:
1. The muscles are no longer overactive from bite overclosure only stimulation to the trigeminal mesencephalon and gray matter of the mid aqueduct where pain is reduced
2. The teeth are important for chewing but also support ones head position and posture.
3..When teeth are missing and/or not replaced, the brain is going to overwork resulting in brain fatigue/ tiredness
WHEN WE BITE SOMETHING
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