Dental Treatment of Headache and Force

Continuing Education
Course Number: 166
Dental Treatment of
Headache and Force-Related
Problems
Authored by
Robert L. Harrell, DDS
Upon successful completion of this CE activity 2 CE credit hours may be awarded
A Peer-Reviewed CE Activity by
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in indentifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it
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Approved PACE Program Provider
FAGD/MAGD Credit Approval does
not imply acceptance by a state or
provincial board of dentistry or
AGD endorsement. June 1, 2012 to
May 31, 2015 AGD PACE approval
number: 309062
Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of
specific product names does not infer endorsement by Dentistry Today. Information contained in CE articles and
courses is not a substitute for sound clinical judgment and accepted standards of care. Participants are urged to
contact their state dental boards for continuing education requirements.
Continuing Education
Dental Treatment of Headache
and Force-Related Problems
Effective Date: 10/1/2013
system (TruDenta [Dental Resource Systems]) for providing
comprehensive assessment, treatment, and management
protocol to achieve consistent, long-lasting, and effective
relief from pain and dental foundation rehabilitation.
For millions of Americans affected by DMSD, pain is
part of their daily lives. Dentomandibular sensorimotor
dysfunction—a disorder of the head and neck, TMJs, jaw
function, dental forces, and neurology of these structures
and functions resulting from imbalanced or improper
forces—lies at the root of many conditions. These include,
but are not limited to: chronic headaches, migraines, TMJ
disorders, and numerous other symptoms, such as TMJ
sounds or vibrations (eg, clicking and popping of the jaw),
and pain in the head, neck, face, or jaw.1,2
The scope and negative impact of these conditions are
significant. According to the National Headache Foundation,
an estimated 90% of the population suffers from headaches,
with migrane sufferers losing more than 157 million work and
school days a year because of heachace pain.3 More than 29
million Americans suffer from migraines.4 Additionally, the
National Institute of Dental and Craniofacial Research
indicates that anywhere from 10 to 45 million Americans
suffer from some type of TMJ issue.5
Finding little or no relief from over-the-counter
medications or nonpharmacological techniques, thousands
of patients look to different healthcare professionals for
treatment solutions to their often debilitating pain. Dentists,
trained and knowledgeable in assessing and treating the
anatomical areas affected by these conditions, are uniquely
suited to offer such patients dental headache care, pain
resolution, and treatment of force-related problems.6-8
Expiration Date: 10/1/2016
LEARNING OBJECTIVES
After participating in this CE activity, the individual will learn:
• To describe how force related dental disease affects the
head, orofacial, and dentomandibular areas.
• To identify the assessment and treatment modalities in a
systematic approach to treating dental headache pain.
ABOUT THE AUTHOR
Dr. Harrell is a practicing dentist in
Charlotte, NC. His practice focuses on
treating advanced restorative and TMD
cases with the latest digital technologies.
He has also pioneered the concept of the
dental-based headache center for treatment of patients with chronic headaches, TMD, and facial pain.
He can be reached at [email protected].
Disclosure: Dr. Harrell is a paid consultant for Dental
Resource Systems, Inc.
INTRODUCTION
Dentomandibular sensorimotor dysfunction (DMSD) is
associated with such conditions as chronic headaches,
migraines, temporomandibular joint (TMJ) disorders, and
numerous other symptoms. When no definitive pathology
exists, more emphasis has been devoted to the masticatory
muscles, soft tissues in the head and neck area, and
altered central nervous system pain processing in the
trigeminal area. Dentists are trained and experts in
assessing and treating the anatomical areas affected by
these conditions and can provide patients with dental
headache care, pain resolution, and treatment of force
related problems.
This article reviews the need for providing care to
patients with chronic and unresolved headache pain. It also
demonstrates the typical use of a complete, proprietary
ASSESSMENT TOOLS AND TREATMENTS FROM
OTHER DISCIPLINES
Dentistry has applied many technological and material
science innovations to assess and treat oral-based
problems. High-strength ceramics or in-office CAD/CAM
systems address the need to restoratively correct the
destructive effects of wear, bruxism, and tooth decay.9,10
The development of such enhanced materials has been
based on clinical and research knowledge of the effects of
the oral environment on restoration longevity, natural teeth
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
opposition, and the masticatory system.11
Cervical range of motion (CROM) devices or occlusal
analysis equipment (T-Scan) have helped shed light on
possible functional and physiological issues influencing the
dentomandibular area and/or contributing to related health
problems.12-16 Dentists have applied these technologies to
implant procedures and restorative rehabilitations centering on
occlusal adjustments. For instance, electronic axiographic
tracers are used to resolve the movements of the condyles,
magnetic resonance tomography imaging can be utilized to
analyze the anatomical relation of joint surfaces to the disc,14
and pressure sensitive foils in conjunction with time resolution
enable an accurate analysis of masticatory forces.11-13
These assessment and restorative approaches have
contributed to greater comprehension of the interrelationship
between force overload and disease/dysfunction within the
oral environment and the masticatory system. In restorative
dentistry, awareness of the symptoms of malocclusion has
been key to offering predictable, consistent, and durable
dental treatments.11,17
When malocclusion (ie, abnormal forces between some
or all of the dentition resulting in pain and/or damage to the
tooth anatomy or periodontal interface) is present,
alterations and adaptations may occur to the masticatory
musculature, the TMJ, and the function of the condyle.18-22
These adaptations sometimes may contribute to acute or
chronic pain in the head and neck region served by the
trigeminal cervical nucleus. Subsequently, this can lead to
additional neurochemical adaptations and compensatory
muscle activity that can limit range of motion (eg, cervical
or mandibular) and/or result in trigger point muscle
spasms.20,21,23-25
When the occlusion is force balanced, a person is
comfortable at rest and in full closure exhibits mandibular
range of motion within normal limits, and is free from acute
or chronic pain. The person demonstrates normal tooth
anatomy and mobility, normal posture and work abilities,
and has no dietary restrictions due to dental function
limitations.11,26-29
Practical measuring instruments have successfully
identified occlusal interferences and heavier forces, as well
as muscle responses and pain symptoms during
masticatory function.26-28 Technology has helped to
accurately show significant discrepancies in jaw position
and muscle function that contribute to chronic daily
headaches.30 Such objective data concerning pain stimuli,
in conjunction with masticatory function combined with
research on TMJ, orofacial, headache, and other systemic
pain responses related to muscle forces, have shifted how
dentistry deals with patients experiencing debilitating
discomfort issues.
When there is no definitive tissue pathology, more
emphasis has been devoted to understanding that pain in
some patients may arise from altered central nervous system
pain processing, especially in the masticatory muscles and
soft tissues in the head and neck area.31 Heightened muscle
tension and force—as related to parafunctional habits and
stress—signal the likelihood of jaw and facial pain.32 Many
types of headaches are now understood to be referred pain
from myofacial trigger points in the posterior cervical, head,
and shoulder muscles.33
Reversing parafunctional habits (eg, bruxing, clenching,
and grinding) through behavior modification has proven
effective in minimizing pain from TMJ disorders and
myofacial issues.34,35 Deprogrammers have played a role
in “retraining” the masticatory muscles, recognizing the
muscles’ role in the forces contributing to pain, as well as
the fact that controlling the perpetuating factors (ie, force)
can help control, reduce, or eliminate pain.35,36
For years, sports medicine technologies (eg, low-level
laser therapy, therapeutic ultrasound, and microcurrent
nerve stimulation) have been used successfully to enhance,
accelerate, and improve athletes’ recovery from
musculoskeletal and force related injuries.37 Such
treatment methods—when combined with neuroscience
and systematic and objective assessment/monitoring—now
are being increasingly applied in dental practices.38-42
A COMPREHENSIVE AND INNOVATIVE SYSTEM
The availability of a patented, proprietary system
(TruDenta) enables dentists to provide comprehensive
assessment, treatment, and management protocol to
achieve consistent, long-lasting, and effective relief from
pain and dental foundation rehabilitation for patients
suffering from the symptoms of DMSD. The system
incorporates proven combinations of sports medicine
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
rehabilitation and advanced dentistry techniques, as well as
well-developed and tested equipment, technology,
software, and therapeutic protocols (Figure 1). These have
been cleared by the US FDA. They also have been shown
to objectively measure and visually illustrate the cause of
patient symptoms relating to DMSDs, as well as contribute
to predictable outcomes when combined with conservative
care.38-45
The system uses T-Scan technology (TruDentaScan
digital force measurement) for evaluating the amount and
balance of forces at closure and while chewing, and a
computerized ROM assessment tool (TruDentaROM), which
measures the CROM as expressed in the patient’s head
movements. A CROM disability can be correlated with
mandibular ROM disability and/or an imbalance in the
dental foundation. The system’s rehabilitation technology
features therapeutic ultrasound, transcutaneous electrical
stimulation (ie, subthreshold microcurrent), low-level laser
therapy, and intraoral orthotics.
The following case demonstrates the typical TruDenta
assessment and treatment protocol for individuals
presenting with chronic headache pain and other
discomfort resulting from DMSD.
Figure 1. View of the
complete TruDenta
System (Dental
Resource Systems) that
can be used to assess
and treat dental force
related problems
associated with
dentomandibular
sensorimotor
dysfunction.
CASE REPORT
talking, and at rest, she noted jaw clicking, teeth clenching,
and grinding, as well as recurring eye pain, pressure behind
the eyes, and shoulder pain and stiffness.
The patient was allergic to codeine and reported taking
over-the-counter pain medications (eg, Tylenol [McNeil
Consumer Healthcare]; Advil [Wyeth]; and Aleve [Bayer]),
which did not provide relief. She also reported taking a
prescription antihistamine medication (Allegra [Perrigo]) for
seasonal allergies. Additionally, she reported seeking the care
of an oral surgeon after awakening one morning with a locked
jaw. The oral surgeon had recommended joint surgery.
Upon muscle palpation examination, the patient showed
tenderness of the anterior and middle bands of the temporalis
muscle. In addition, bilaterally, the masseter, occipital, and
trapezius
neck/shoulder
area,
pterygoids,
and
sternocleidomastoid (SCM) were severely sensitive. The
patient rated the pain a 10 on a pain scale of one to 10, with
10 being the worst. Severe tenderness also was detected upon
palpation of the posterior and lateral capsules of the TMJ. In
Diagnosis and Treatment Planning
A 36-year-old woman presented, complaining of various
symptoms of DMSD. As with any assessment and clinical
treatment protocol, the first step was determining the
condition(s) that may be amenable to treatment. Therefore,
the patient completed—and the dentist reviewed—
comprehensive head health, medical, and headache history.
A review of the patient’s pharmacological treatments also
was undertaken prior to the clinical evaluation. Dental,
periodontal, airway, orthodontic, and occlusal examinations
also were undertaken. Additionally, a computed tomography
scan had been done recently by her neurologist to rule out
the existence of any underlying organic condition.
The patient showed symptoms of bilateral frontal
headaches. She experienced occipital and temporal head
pain, jaw pain bilaterally with opening and closing, and
limited mandibular ROM with limited vertical opening. In
addition to frequently experiencing jaw pain when chewing,
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
brief, all of the muscles of mastication, TMJ ligaments, and the
jaw position produced stark myalgia, which negatively altered
her normal daily living and social habits.
Crucial to establishing the severity of sensorimotor
dysfunction, any abnormal, excessive, or imbalanced forces were identified objectively using mandibular ROM
disability, cervical range of motion disability (digitally), and
digital force analysis (TruDentaScan). These technologies
were combined with panoramic radiographs. It is important
to note that the ROM portion of the diagnostic process
provides objective data conforming to AMA guidelines.
The patient’s T-Scan testing showed that 38.5% of the
pressure from her bite was localized to the left side of her
mouth; the right side of her mouth received 61.5% of biting
pressure (Figure 2). This demonstrated an imbalance of
the stomatognathic system, which adversely impacted the
patient’s overall well-being.
Clinical examination revealed bilateral crepitus upon
opening and closing. Cervical ROM measurements showed
pain on extension and limited extension. The patient
presented with forward head posture, a back sleeping
position, and a sitting and standing work position. A digital
ROM study revealed extension of the neck limited to 50°
(60° is the normal ROM). The patient’s left lateral rotation
was at 37° (45° is the normal neck stretch) (Figure 3).
These findings were thought to likely account for the severe
pain at the occipital, trapezius, and SCM muscles.
Based on assessment codes that are in agreement with
the AMA insurance codes, it was determined that the
patient suffered from the following: atypical face pain,
cervicalgia, eye pain/pressure, headache, limited
mandibular ROM, TMJ pain, muscle spasms, and myalgia.
Figure 2. The
assessment T-Scan
showed that 38.5% of
the pressure from the
patient’s bite was
localized to the left
side of her mouth;
the right side of her
mouth received 61.5%
of biting pressure.
involve therapeutic in-office appointments consisting of
applied electrical stimulation, manual muscle therapy, cold
laser therapy, and therapeutic ultrasound. Additional
components of the weeks-long therapy to be incorporated
would be therapeutic exercises, an occlusal orthopedic
device, and self-care home management training, based on
periodic occlusal analysis.
Stabilization goals were directed toward maintaining
muscle comfort, joint stability, and orthopedic stabilization
of the mandible. This normal function restoration was
achieved through an occlusal orthopedic device or
rehabilitation orthotic. The rehabilitation orthotic helps to
balance, stabilize, and support the mandible. At the time
she presented, the patient experienced symptoms from an
injured TMJ from excessive clenching and grinding, and
longstanding occlusal force imbalances. This overuse
typically results in spasms and pain/sensitivity in the
muscles of mastication.
Treatment Protocol
Treatment was directed toward conservative therapy in an
attempt to avoid surgery, establish orthopedic realignment
of the mandible, improve myalgia, reduce inflammation,
strengthen the musculoskeletal system, and alleviate
headaches as well as pain, pressure, and sensitivity in the
eyes. First steps in the treatment process would involve
assessment conforming to AMA insurance codes, would
include manual muscle testing, TMJ ultrasound, and ROM
testing. Then, an individualized treatment plan would
Figure 3. Digital
cervical range of motion
(ROM) measurements
revealed extension of
the patient’s neck
limited to 50º (60º is
the normal ROM). The
patient’s left lateral
rotation was at 37º
(45º is the normal
neck stretch).
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
It was important to ensure that the orthotic was
fabricated in a manner that stabilized the jaw position to a
healthy placement to minimize muscle activity and the
patient’s pain and symptoms. The patient was taught
therapeutic exercises by the dental team. These exercises
first were done in-office, and then continued by the patient
at home. The importance of continuing the regimen at home
was emphasized to the patient. If treatment did not continue
after the patient left the office, she would not progress in her
care. By purchasing—and correctly and regularly using—
the home care kit, including the Alpha-Stim AID
(Electromedical Products), the patient learned and
benefited from the proper preventative measures and
methods to stabilize and maintain her jaw health.
Figure 4. Following 6
weeks of treatment, the
patient’s health and
stability were confirmed
with a digital ROM test.
Treatment Outcome
The patient underwent in-office therapeutic rehabilitation as
previously described for 6 weeks. In addition to fabricating
a custom rehabilitation orthotic for the mouth, 3 sequential
occlusal equilibrations, or bite adjustments, were performed
to correct bite imbalances.
At 6 weeks, the patient’s health and stability were
confirmed with a digital ROM test. Range of motion values
were found to be equal to or above physiologic norms
(Figures 4 and 5). Dental bite force balance also was
confirmed with the T-Scan analysis, which revealed left/right
balance at 52%/48%, well within physiologic norms and
tooth force readings at normal levels (Figure 6).
Figure 5. The digital
ROM test at 6 weeks
showed the patient’s
ROM to be equal to or
above physiologic
norms.
CONCLUSION
Figure 6. At 6 weeks, a
T-Scan analysis
revealed the patient’s
dental bite force
balance had also
improved to well within
physiologic norms and
tooth force readings at
normal levels, with
left/right balance at
52%/48%.
Dentists can create a pathway of care that offers
predictable, reliable, and long-lasting relief from pain and
restored function to patients suffering from the symptoms of
DMSD. These include chronic headaches and force-related
dental conditions. Using a systematic approach to
assessing and treating these conditions that incorporates
technologies used for years in sports medicine (TruDenta),
they can confidently provide much needed care to
individuals who haven’t yet found the relief they’ve been
seeking. Additionally, as in the case presented here,
restoring balance, function, and overall well-being to the
lives of long-suffering patients provides dentists and their
teams with pride and professional satisfaction.
5
Continuing Education
Dental Treatment of Headache and Force-Related Problems
17. Francisconi LF, Graeff MS, Martins Lde M, et al. The
effects of occlusal loading on the margins of cervical
restorations. J Am Dent Assoc. 2009;140:1275-1282.
18. Hess LA. The relevance of occlusion in the golden
age of esthetics. Inside Dentistry. 2008;4:38-44.
19. McNeill C. Occlusion: what it is and what it is not.
J Calif Dent Assoc. 2000;28:748-758.
20. Mackie A, Lyons K. The role of occlusion in
temporomandibular disorders—a review of the
literature. N Z Dent J. 2008;104:54-59.
21. Frisardi G, Chessa G, Sau G, et al. Trigeminal
electrophysiology: a 2 x 2 matrix model for differential
diagnosis between temporomandibular disorders and
orofacial pain. BMC Musculoskelet Disord.
2010;11:141.
22. Hegarty AM, Zakrzewska JM. Differential diagnosis for
orofacial pain, including sinusitis, TMD, trigeminal
neuralgia. Dent Update. 2011;38:396-406.
23. Kampe T. Function and dysfunction of the masticatory
system in individuals with intact and restored
dentitions. A clinical, psychological and physiological
study. Swed Dent J Suppl. 1987;42:1-68.
24. Lodetti G, Mapelli A, Musto F, et al. EMG spectral
characteristics of masticatory muscles and upper
trapezius during maximum voluntary teeth clenching.
J Electromyogr Kinesiol. 2012;22:103-109.
25. Ohrbach R, Fillingim RB, Mulkey F, et al. Clinical
findings and pain symptoms as potential risk factors
for chronic TMD: descriptive data and empirically
identified domains from the OPPERA case-control
study. J Pain. 2011;12(suppl 11):T27-T45.
26. Velly AM, Look JO, Carlson C, et al. The effect of
catastrophizing and depression on chronic pain—a
prospective cohort study of temporomandibular muscle
and joint pain disorders. Pain. 2011;152:2377-2383.
27. Ackerman JL, Ackerman MB, Kean MR. A
Philadelphia fable: how ideal occlusion became the
philosopher’s stone of orthodontics. Angle Orthod.
2007;77:192-194.
28. Maness WL. Force movie. A time and force view of
occlusion. Compend Contin Educ Dent. 1989;10:404-408.
29. Kerstein RB. Treatment of myofascial pain dysfunction
syndrome with occlusal therapy to reduce lengthy
disclusion time—a recall evaluation. Cranio.
1995;13:105-115.
30. Wright EF. Manual of Temporomandibular Disorders.
2nd ed. Ames, IA: Wiley-Blackwell; 2009.
31. Didier H, Marchetti C, Borromeo G, et al. Chronic
REFERENCES
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MO: Medico Dental Media International; 1998.
2. Okeson JP. Management of Temporomandibular
Disorders and Occlusion. 6th ed. St. Louis, MO:
Mosby Elsevier; 2008.
3. National Headache Foundation. Migraine.
headaches.org/education/Headache_Topic_Sheets
/Migraine. Accessed July 10, 2013.
4. Sessle BJ. Mechanisms of oral somatosensory and
motor functions and their clinical correlates. J Oral
Rehabil. 2006;33:243-261.
5. US News and World Report. Headache. 2006.
health.usnews.com/health-conditions/brainhealth/headache. Accessed July 10, 2013.
6. American Dental Association. Dentists: doctors of oral
health. ada.org/4504.aspx. Accessed July 10, 2013.
7. Kerstein RB. Reducing chronic masseter and
temporalis muscular hyperactivity with computerguided occlusal adjustments. Compend Contin Educ
Dent. 2010;31:530-538.
8. Bogduk N. The neck and headaches. Neurol Clin.
2004;22:151-171, vii.
9. Tysowsky GW. The science behind lithium disilicate: a
metal-free alternative. Dent Today. 2009;28:112-113.
10. Strub JR, Rekow ED, Witkowski S. Computer-aided
design and fabrication of dental restorations: current
systems and future possibilities. J Am Dent Assoc.
2006;137:1289-1296.
11. Kugel G. Materials continue to expand dentistry’s
options. Compend Contin Educ Dent. 2012;33:80.
12. Dawson PE. Functional Occlusion: From TMJ to Smile
Design. St. Louis, MO: Mosby Elsevier; 2007.
13. Ogince M, Hall T, Robinson K, et al. The diagnostic
validity of the cervical flexion-rotation test in C1/2related cervicogenic headache. Man Ther.
2007;12:256-262.
14. Garg AK. Analyzing dental occlusion for implants:
Tekscan’s TScan III. Dent Implantol Update.
2007;18:65-70.
15. Koos B, Godt A, Schille C, et al. Precision of an
instrumentation-based method of analyzing occlusion
and its resulting distribution of forces in the dental
arch. J Orofac Orthop. 2010;71:403-410.
16. Koos B, Höller J, Schille C, et al. Time-dependent
analysis and representation of force distribution and
occlusion contact in the masticatory cycle. J Orofac
Orthop. 2012;73:204-214.
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
32.
33.
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40.
41.
daily headache: suggestion for the neuromuscular oral
therapy. Neurol Sci. 2011;32(suppl 1):S161-S164.
Cairns BE. Pathophysiology of TMD pain—basic
mechanisms and their implications for
pharmacotherapy. J Oral Rehabil. 2010;37:391-410.
Glaros AG, Williams K, Lausten L. The role of
parafunctions, emotions and stress in predicting facial
pain. J Am Dent Assoc. 2005;136:451-458.
Fernández-de-las-Peñas C, Cuadrado ML, ArendtNielson L, et al. Myofascial trigger points and
sensitization: an updated pain model for tension-type
headache. Cephalalgia. 2007;27:383-393.
Glaros AG. Temporomandibular disorders and facial
pain: a psychophysiological perspective. Appl
Psychophysiol Biofeedback. 2008;33:161-171.
Okeson JP, de Leeuw R. Differential diagnosis of
temporomandibular disorders and other orofacial pain
disorders. Dent Clin North Am. 2011;55:105-120.
Cameron MH. Physical Agents in Rehabilitation: From
Research to Practice. 3rd ed. St. Louis, MO: Saunders
Elsevier; 2009.
Öz S, Gökçen-Röhlig B, Saruhanoglu A, et al.
Management of myofascial pain: low-level laser
therapy versus occlusal splints. J Craniofac Surg.
2010;21:1722-1728.
Marini I, Gatto MR, Bonetti GA. Effects of superpulsed
low-level laser therapy on temporomandibular joint
pain. Clin J Pain. 2010;26: 611-616.
Srbely JZ, Dickey JP. Randomized controlled study of
the antinociceptive effect of ultrasound on trigger point
sensitivity: novel applications in myofascial therapy?
Clin Rehabil. 2007;21:411-417.
Aguilera FJ, Martín DP, Masanet RA, et al. Immediate
effect of ultrasound and ischemic compression
techniques for the treatment of trapezius latent
myofascial trigger points in healthy subjects: a
randomized controlled study. J Manipulative Physiol
Ther. 2009;32:515-520.
42. Zuim PR, Garcia AR, Turcio KH, et al. Evaluation of
microcurrent electrical nerve stimulation (MENS)
effectiveness on muscle pain in temporomandibular
disorders patients. J Appl Oral Sci. 2006;14: 61-66.
43. Morphett AL, Crawford CM, Lee D. The use of
electromagnetic tracking technology for measurement
of passive cervical range of motion: a pilot study. J
Manipulative Physiol Ther. 2003;26:152-159.
44. Kerstein RB. Combining technologies: a computerized
occlusal analysis system synchronized with a
computerized electromyography system. Cranio.
2004;22:96-109.
45. Kerstein RB. Current applications of computerized
occlusal analysis in dental medicine. Gen Dent.
2001;49:521-530.
SUPPLEMENTAL READING LIST
DiMatteo AM, Montgomery MW. Understanding,
Assessing & Treating Dentomandibular Sensorimotor
Dysfunction. Fort Lauderdale, FL: Dental Resource
Systems; 2012.
Forssell H, Kirveskari P, Kangasniemi P. Effect of occlusal
adjustment on mandibular dysfunction. A double-blind
study. Acta Odontol Scand. 1986;44:63-69.
Karppinen K, Eklund S, Suoninen E, et al. Adjustment of
dental occlusion in treatment of chronic cervicobrachial
pain and headache. J Oral Rehabil. 1999;26:715-721.
Silverman MM. Headache from pathology-producing
occlusion of the teeth. Headache. 1971;11:35-46.
7
Continuing Education
Dental Treatment of Headache and Force-Related Problems
2. Technologies that provide insight into possible
functional and physiological influences that
contribute to health problems are which of the
following?
POST EXAMINATION INFORMATION
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this educational activity you must complete the program
post examination and receive a score of 70% or better.
a.
b.
c.
d.
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to the address provided.
3. Pain and headache pain in some patients may arise
from which of the following?
a.
b.
c.
d.
Altered central nervous system pain processing.
Heightened muscle tension and force.
Myofacial trigger points.
All of the above.
4. Which technology can be used to evaluate the
amount and balance of dental forces at closure and
while chewing?
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a.
b.
c.
d.
TruDenta Scan/T-Scan.
Computerized ROM assessment tool.
Transcutaneous electrical stimulation.
All of the above.
5. What can a cervical range of motion disability be
correlated with?
a.
b.
c.
d.
Mandibular ROM disability.
Imbalance in the dental foundation.
Both a and b.
None of the above.
6. Objectively identifying abnormal, excessive, or
imbalanced forces is crucial to determining what?
a.
b.
c.
d.
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POST EXAMINATION QUESTIONS
The severity of sensorimotor dysfunction.
Tenderness of the anterior temporalis bands.
Sensitivity of the pterygoids.
All of the above.
7. Rehabilitation for DMSD includes which of the
following technologies?
1. Dentomandibular sensorimotor dysfunction (DMSD)
is associated with which of the following?
a.
b.
c.
d.
In-office CAD/CAM systems.
Cervical range of motion devices (CROM).
Occlusal analysis equipment.
Both b and c.
a.
b.
c.
d.
Chronic headaches.
Temporomandibular joint disorders (TMJ).
Migraines.
All of the above.
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Therapeutic ultrasound.
Transcutaneous electrical stimulation.
Low-level laser therapy.
All of the above.
Continuing Education
Dental Treatment of Headache and Force-Related Problems
8. Symptoms of DMSD that can be assessed and
treated with a proprietary system include which of
the following?
a.
b.
c.
d.
Chronic headaches.
Force-related dental conditions.
Both a and b.
None of the above.
9. What may be achieved through the use of an
occlusal orthopedic device or rehabilitation orthotic?
a.
b.
c.
d.
Restoration of normal function.
Stabilization and balancing of the mandible.
Both a and b.
None of the above.
10. How are bite imbalances corrected?
a. Fabrication of a custom rehabilitation orthotic for the
mouth alone.
b. Sequential occlusal equilibrations or bite adjustments
alone.
c. Low-level laser, ultrasound, and low-level electrical
stimulation therapy alone.
d. A combination of low-level laser, ultrasound, low-level
electrical stimulation therapy, orthotic wear, and bite
adjustments.
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Continuing Education
Dental Treatment of Headache and Force-Related Problems
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endorsement. June 1, 2012 to
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number: 309062
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What topics interest you for future Dentistry Today CE courses?
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