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Clinical Research Uncovers Missing Links in Resolving Migraine Headaches and Chronic Pain by Gerald H. Smith, D.D.S. ~ Langhorne, PA ~ USA An integrated chiropractic/dental approach has uncovered a major link in curing chronic pain. By merging craniosacral concepts of chiropractic with functional dental orthopedics, a more comprehensive system emerges which has the ability to orchestrate structural balance of the entire human frame. By applying the integrated system, chiropractors and dentists can now focus their treatments on correcting the underlying structural imbalances which are a major source for pain. The chiropractic treatment philosophy encompasses the paradigm of parallelism of the various planes of the body to establish total structural balance. The major parallel planes are represented by the eyes, ears, shoulders, and pelvis. The missing link which acts as the stabilizing keystone within this complex system of parallel planes is the transverse and sagittal planes of the maxillae. The maxillae represents the anterior two-thirds of the cranial base of the skull and provides the craniofacial fulcrum for balancing the skull, foramen magnum, atlas and dural membrane system. When the dental occlusion (upper and lower teeth alignment) is in balance 3-dimensionally (vertically, transversely, and sagittaly), it functions as the self-correcting mechanism for balancing the craniosacral system. This architecturally designed system comes into play every time an individual swallows and the teeth make contact. This process occurs two to three times per minute while one is awake and one to two times during sleep. One of the major underlying causes for the occurrence of pain, which has eluded mankind since the beginning of time, is the dural membrane tensions that occur within the cranial vault. These dural tensions can result from distortions either from the skull or pelvis. Newton's Third Law of Physics, "for every action there is an equal and opposite reaction", is played out via the dural tube which is the common connecting link for the craniosacral system. a slinky effect prevails which reflects imbalances from either the skull or pelvis. The sensation of pain results from stretching the dura which is innervated by sensory nerves from the three divisions of the trigeminal or fifth cranial nerve above the tentorium cerebelli and sensory branches from the second cervical nerve below its surface. As noted in the sixth edition (1981) of Guyton's Textbook of Medical Physiology (p.622), tugging on the venous sinuses or stretching the dura at the base of the brain can cause intense pain that is recognized as headaches. Almost any type of stretching stimulus to the blood vessels of the dura can also cause headaches. From a dentocranial perspective, distortions of the maxillae1, upper jaw, are one major direct cause for dural tensions and thus chronic pain which does not respond to conventional drug therapy.
Dental malocclusions are more prevalent than ever before owing their high incidence to the high consumption of a refined food diet (changes verified by Dr. Weston Price in his classic book, Nutrition and Physical Degeneration), cranial distortions from the birthing process, and iatrogenic dental procedures (improperly aligned denture teeth, crown and bridgework, removable partial dentures, and dental orthopedics and orthodontics). To help overcome this structural disharmony, dentistry now has several diagnostic techniques to guide the practitioner during treatment: Accu-Liner instrument, Dental Orthogonal radiographic Analysis and Four Cranial indicators. The Accu-Liner instrument is an ingenious device invented by a Seattle Washington dentist, Dr. James E. Carlson. This instrument positions the maxillae 3-dimensionally to enable proper analysis and correction. By utilizing the hammular notches and incisive papilla, the dental study cast is easily mounted within the functional range of Camper's Plane (hammular notch-incisive papilla- HIP). This horizontal plane parallels the occlusal plane and other major planes of the body. Rich2 observed a relationship between the HIP Plane and the occlusal plane which was confirmed by Karkazis and Polyzois's3 cephalometric study. The dentist now has an objective means of assessing the existing 3-dimensional disharmonies and formulating a treatment plane for their correction. Once the maxillary planes are reestablished within the framework of parallelisms, the chiropractor will be better able to structurally stabilize his patient.
The four cranial indicators have been established by this author to act as a guide for both dental and chiropractic treatment. Any structural change, whether from dental or chiropractic treatment, will directly affect the cranial and dural membrane systems. Orthopedic correction of the maxillae by means of a physiologically designed AlF (Advanced Lightwire Functional) or any other appliance, use of intra or inter dental arch elastics or various wire configurations to correct abnormal tooth position will all have a direct influence on changing the tensions within the dural membrane system. The four cranial indicators (sphenoid, temporals, amplitude and sphenobasilar symphysis) provide a working guide to assess the cranial mechanism before, during and at the completion of treatment. these palpatory indicators enable the clinician to assess the effect of their manipulative corrections on the cranial system. By making structural corrections that rebalance the cranial and dural systems, a state of homeostasis and stability will be more quickly achieved. Many factors combine to initiate and perpetuate the pain cycle. Of the myriad of factors causing pain, tensions within the cranial dural membrane system resulting from distortions of the maxillae are a dominant etiologic factor for the cause of migraines and tension headaches, facial, cervical and low back pain. Of greater significance than knowing the underlying cause, is the fact that these dural membrane tensions can now be corrected by means of dental orthopedics via the ALF appliance system and/or other restorative means of correcting the abnormal cants of the maxillary planes. Case 1. Twenty Year Migraines and Low back Pain J.G. is a 68 year-old female who has suffered severe migraine headaches and low back pain for 20 years. This patient received a multitude of therapies over the twenty year period that included various medications, manipulation and physical therapy. Unfortunately these approaches only provided temporary relief at best. The patient's underlying problem was an old set of dentures that were severely worn down creating a distorted horizontal maxillary plane. The structural imbalances set up by the misaligned denture was the direct cause for the upper cervical muscle spasms that entrapped the nerves and blood vessels to her head. Within several weeks after new full dentures were inserted that corrected the misaligned horizontal and vertical planes, the patients migraines and low back pain disappeared. Case 2. Ten Year Facial, Neck, Shoulder, Low Back Pain and Leg Weakness. A.C. is a 46 year-old female patient who was referred from Ottawa Canada by her orthodontist. This patient had suffered left side pain from the top of her head to her toes. Ten years of traditional therapy by medical and dental practitioners did not produce any lasting relief. The patient was presently undergoing orthodontic treatment for a poor bite and was wearing upper and lower removable appliances. The upper dental appliance and model of the patient's mouth were mounted on the Accu-Liner instrument to analyze the parallel planes. The upper appliance was corrected by grinding down the acrylic material to establish a horizontal plane parallel to the other major planes. Within five minutes after inserting the corrected appliance, 90% of the patient's left sided pain pattern disappeared. Additional nutritional and cranial manipulative treatment was provided during the next several days and increased the relief to a 98% level which the patient has maintained up to the present. Case 3. Four Years of Incapacitating Facial Pain. Mrs. B.G., a 44 year-old female, suffered severe incapacitating facial pain for a four year period. Mrs. G. was a registered nurse in Pittsburgh, PA. She had become gradually affected by facial pain to a point where she had to stop working. The pain affected not only the left side of her face but caused her left eye to completely close. The patient was treated by numerous medical doctors including a complete evaluation at the Cleveland Pain Clinic. As a last resort the patient was put on the new miracle drug Immitrex, for migraine headaches. At $40 per injection, this treatment brought only partial relief. An evaluation of the patient's problem revealed that her pain was caused by nerve entrapment from a spastic left external pterygoid muscle. The patient's 15 year-old ill fitting upper denture wore down to a point which reduced vertical support for the main chewing muscles. The resulting spasm put pressure on two branches of the trigeminal nerve causing facial pain and closure of her left eye. Resolving the muscle spasm and correcting the denture brought permanent relief within five minutes. Case 4. Fourteen Years of Cervical and Low back pain. Marc B. was a forty-six year old male who suffered chronic upper neck and low back pain. Marc's problem resulted from a two story fall through an elevator shaft which landed him onto a cement slab. As a result of numerous fractures in the spine he was placed into a body cast for over a year. Numerous therapies were sought out but nothing brought any lasting relief. The patient was evaluated cranially and with the DORA System. The radiographic analysis revealed compression of the atlas-axis on the right side. The patient had a slight cant of the maxillae that was high on the right. Treatment involved placement of over lay resins the thickness of two sheets of typing paper on the upper right first and second molars and second bicuspid tooth. This support corrected the slight discrepancy of the maxillae. Upon follow-up, the patient stated that his cervical pain dissipated completely within two days following treatment and that his low back pain reduced 75%. The before and after PA radiographs document the structural changes that occurred as a result of correcting the maxillae.
Non-Specific Medical Complaints As Related to Jaw Position. A twelve year study conducted by a fifteen member research group of Ph D's, physicians and dentists at the Children's Medical Center, Osaka Japan showed a high correlation between jaw imbalances and varied medical problems. Over 20,000 patients were studied for various medical complaints that had no definite diagnosis for the underlying cause. These maladies included headaches, asthma, allergies, postural problems (scoliosis), Parkinson's disease, respiratory problems, epilepsy, gynecological problems, eye problems, facial and neck pains, etc. Each patient was treated with a dental orthopedic appliance which reestablished a corrected jaw position. In 66.6% of the patients treated there was either a reduction in symptoms or total resolution of their problem. The neuroanatomy of the head and neck region is extremely complex and integrally related to one's maxillae and mandibular jaw position. Dentists trained in this specialized field and utilizing state of the art technology can now offer a non-invasive approach to resolving in part the age old riddle for the cause of pain. References
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