Archive | TMD and Chronic Pain

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COMT (Catechol-O-methyl transferase) role in TMD – Wheaton dentist


New research has shown one of the genes that increases the likelihood of development of chronic pain.  COMT (Catechol-O-methyl transferase) enzyme degrades catecholamines such as dopamine, epinephrine, and norepinephrine in our brain and there are multiple variants of this enzyme.  COMT is associated with pain responsiveness and contains some combination of amino acids valine and […]

Placebo effect and why it works for some

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Chemical reason some are more prone to placebo Scientists don’t know all the details but we do know that placebo treatments work for some issues (especially those that involve brain chemicals like dopamine and endorphins).  Examples of health problems that are altered by those chemicals include chronic pain (in my field that means TMD) and […]

Temporomandibular disorder TMD

Classification of TMD

Temporomandibular disorder TMD Temporomandibular disorders (TMDs) are characterized by pain in the muscles of mastication, the temporomandibular joint (TMJ), and/or the muscles associated with mastication in the head and neck.  Patients typically experience pain, limited opening, and/or clicking/popping of the TMJ joint.  This condition is much more common in females.  The severity of TMD ranges […]

Occlusal Dysesthesia or Phantom Bite Syndrome


Occlusal Dysesthesia or Phantom Bite Syndrome Occlusal Dysesthesia, also known as Phantom Bite Syndrome and Occlusal Hyperawareness, is not that uncommon.  Until I learned of this diagnosis these were just the “crazy” people that I would struggle to try to appease, without success.  I can personally think of 3 of my  patients that exhibit all […]

NTI Information


The NTI is an FDA approved occlusal splint (nightguard) designed to reduce muscle tension headaches and migraines.  All the information one would ever be interested in can be found on their website here.  Here is some research These are the muscles that are most effected by clenching and grinding Chronic symptoms of the head and […]

Orofacial pain


Orofacial pain experts A newer sub-specialty that I have great respect for.  They treat chronic patients without the dental blinders and are more in line with how the medical field treats chronic pain. Chronic pain arises due to the nervous systems neuroplasticity (Greene JADA June 2009).  Neuroplasticity is what allows us to learn and adapt […]

Occlusal device night guard


Night Guard Types – Different classes of Night Guards Classification of the night guard or occlusal appliance is shown below. 1. Anterior midline stop device (AMPS) This appliance is a small one that only contacts in the anterior.  Care needs to be taken that in protrusive and excursives the posteriors never can hit and the […]

Jay Shah and MTrPs


MYOFASCIAL PAIN: INTEGRATING OBJECTIVE PHYSICAL FINDINGS WITH TREATMENT STRATEGIES Jay P. Shah, MD 8:00 AM–4:00 PM (Break: 10:30–10:45 AM, Lunch: 12:00–1:30 PM, Break: 2:45–3:00 PM) Chronic pain states are characterized by profound changes in neuronal excitability and architecture in the pain matrix. This workshop integrates emerging knowledge the pain sciences in a clinically accessible way. […]



There is a shift to treating TMD in terms of psychological factors and pain physiology. Occlusal role Long believed to be dominant cause now gradually being completely debunked. Information, reassurance, analgesics for pain relief, and jaw exercises will help majority of TMD patients. Placebo splint covering only hard palate is largely as effective as occlusal […]