Caring for Face Pain and Sleep Apnea
Rich Hirschinger, DDS, MBA
Diplomate American Board of Orofacial Pain
9615 Brighton Way, Suite 323
Beverly Hills, CA 90210
888.981.8981
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Posts Tagged ‘muscle pain’

TMJ or Simply Muscle Pain?

Posted on: July 30th, 2017 by Dr. Rich Hirschinger No Comments

Overuse of muscles typically leads to pain.

I am a Board-certified orofacial pain specialist. It is a unique specialty of dentistry, which I learned during a two-year residency at the UCLA School of Dentistry Orofacial Pain and Dental Sleep Medicine program. I am now a clinic-co-Director of the UCLA residency one day a week and I have a private practice in Beverly Hills, CA the other four days of the week. I have been treating patients who complain of “TMJ” for the past 7 years and I never need to touch teeth since my training proved to me that the pain patients complain about are not related to occlusion, which is how teeth meet. If it is not related to the bite, what is it related to? I would say the 98% of the patients who think they have pain related to their TMJ, are actually suffering mainly from muscle pain. The pain is mainly due to overuse of the muscles from daytime clenching and/or bad oral habits during the day such as chewing gum, nail biting, and nighttime habits such as clenching and/or grinding during sleep. Any muscle that gets over used needs a break. If the muscles do not get a rest, they will start causing pain.

There are four muscles that close the jaw. These muscles are the superficial masseter, deep masseter, temporalis, and medial pterygoid. The superficial masseter, when measured on a pounds per square inch basis, is the strongest muscle in the human body. When patients come into my office I always have them point with one finger where their main pain is and they almost always point to the angle of the jaw, which is the superficial masseter. When your teeth are touching, the closing muscles of the jaw are contracted. As humans, we do not walk around with our teeth together. If you find yourself clenching your teeth during the day, you need to stop. Your teeth should be apart during the day in the “N-Rest” position, which you can learn about at this page on my website. The graphic below is from a slide I give to dentists and other specialists that want to learn what I do.

Beverly Hills TMJ Muscle Pain

You don’t have to just take my word for it. My training is evidence-based. A fantastic paper by Dr. James Fricton showed that a placebo equilibration is slightly better than an occlusal equilibration. What does this mean? An occlusal equilibration is an irreversible surgical procedure where a dentist grinds a small amount of enamel off your teeth or material off your crowns, fillings, etc. to get your teeth to meet more evenly. However, Dr. Fricton’s paper showed the when you do a placebo equilibration that patients report more improvement. A placebo equilibration is when the patient thinks their bite was adjusted when in reality nothing was done. This is accomplished by “adjusting” the teeth with the smooth end of a dental bur. The patient thinks something was done since they felt the vibration of the drill on their teeth but in reality, nothing was adjusted.

Beverly Hills TMJ Muscle Pain

The bottom line is this. It is incumbent upon all health care providers to try all non-surgical and reversible procedures first before doing surgery. Cutting healthy teeth or existing crowns or fillings is surgery and it is not reversible. If you suffer from what you think is TMJ, try softening your diet, keep your teeth apart during the day, stretch your jaw muscles several times a day, and during sleep wear a hard, full coverage night guard preferably over your lower teeth. I never have patients wear an appliance 24 hours a day, I never have patients wear an appliance during the day, and I never have patients wear an appliance for “TMJ” that is designed to change their bite. If your dentist ever uses the terms “Phase 1 and phase 2,” I would highly encourage you to get a second opinion from a Board Certified specialist in orofacial pain. Here is a link to the American Board of Orofacial Pain member directory. I would be happy to see you at my office in Beverly Hills if you are in the Los Angeles area. Remember, it is not about the bite. It is about keeping your teeth apart.

References:

Fricton J. Current Evidence Providing Clarity in Management of Temporomandibular Disorders: A Systemized Review of Randomized Clinical Trials for Intra-oral Appliances and Occlusal Therapies. Journal of Evidence Based Dentistry March issue Volume 6 Issue 1 pp. 48-62 2006

Occlusal adjustment for treating and preventing temporomandibular joint disorders – Koh Journal of Oral Rehabilitation 2004

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? – Journal of Oral Rehabilitation Volume 44, Issue 11, pages 908–923, November 2017

What is OFP – Orofacial Pain

Posted on: October 6th, 2013 by Dr. Rich Hirschinger 4 Comments

What is Orofacial Pain?

OFP, which stands for orofacial pain, is a unique branch of dentistry practiced by Dr. Rich Hirschinger at his office in Beverly Hills, California that involves the diagnosis, and management of chronic head and neck pain using very conservative treatment methods. The types of conditions that OFP doctors treat include primary headaches such as episodic or chronic migraines, tension-type headaches, and cluster headaches, myofascial pain, which is a fancy way of saying pain caused by muscles, neuropathic pain such as trigeminal neuralgia, which is pain caused by damage or irritation of a nerve, TMJ, which stands for temporomandibular joint, and obstructive sleep apnea. What OFP does not involve is the treatment of teeth since evidenced-based research shows that chronic head and neck pain is not related to the occlusion, which is how the teeth come together.

Beverly Hills TMJ Migraine Heacaches

Woman suffering from chronic head and neck pain

There are dentists who practice what they call neuromuscular dentistry, which is not taught in any accredited dental school in the United States, who argue that a lot of the chronic pain patients report is caused by the “bite.” They claim that teeth touch about 2,000 times a day when we swallow, and when we chew food. I agree teeth touch when we swallow but it is a light touch that does not involve a full contraction of the muscles that close the jaw and cause the teeth to meet, and teeth rarely touch when chewing since there is food between the teeth. Additionally, we should not walk around with our teeth clenched during the day so we teach patients the “n rest position” so that addresses the issue of any daytime pain being caused by how teeth meet. Both OFP doctors and neuromuscular dentists agree that patients clench and/or grind their teeth at night but this can be addressed by covering the teeth at night with a nightguard, which should be a hard appliance that covers all of the teeth, is not designed to change the bite, and it only worn at night. This addresses the issue of any nighttime chronic pain being caused by how teeth meet since the teeth contact the appliance instead of other teeth. Lastly, Dr. Hirschinger and most orofacial pain colleagues do not use a dental drill to alter or adjust the teeth. That begs the question that if OFP doctors can treat patients with chronic head and neck pain without touching or drilling teeth, why wouldn’t every doctor try treating patients using the same conservative, reversible procedures before trying any other approach?

The goal of this blog will be to educate doctors as well as the public about orofacial pain by discussing the treatment approach I use as well as posting some very interesting cases. Since very few doctors are aware of OFP, very few patients are aware of it. However, orofacial pain is getting more recognition because starting in 2011, the Commission on Dental Accreditation of the American Dental Association has accredited ten post graduate programs in orofacial pain. The first two in 2011 were UCLA, where orofacial pain was founded by Dr. James Fricton, and Kentucky. Dr. Hirschinger was the first graduate from UCLA’s Orofacial Pain and Dental Sleep Medicine residency after it received CODA recognition.

The key part of treating anyone with chronic pain is getting a diagnosis before treatment is started. For the patients I see, headache and TMJ are not considered enough of a diagnosis to initiate treatment. What type of headache is it, and what is causing the pain? If your doctor does not know, then I would suggest that you find someone who can give you a diagnosis.

Please spread the word about this blog by telling your colleagues and friends to sign up to receive notifications of new posts. I look forward to answering any questions you have about any chronic head and neck pain you are personally experiencing, or if you have a question about a patient of yours.

Rich Hirschinger, DDS, MBA
Diplomate, American Board of Orofacial Pain
Member American Academy of Orofacial Pain
Lecturer, UCLA Orofacial Pain and Dental Sleep Medicine
www.LoveOFP.com
888.981.8981