| Orofacial Pain |
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American Academy of Orofacial Pain
HeadachesA complete medical history is taken as well as a history of the headache condition. Depending on what treatment has been tried in the past and what has been successful or unsuccessful, a determination will be made about how to treat the current problem. Often I will work in conjunction with a neurologist who specializes in headaches and a multi-disciplinary approach will be taken, which may include medication, physical therapy and home exercises, diet modification, behavioral changes, working with a pain psychologist, and other modalities of treatment. American Headache Society Neuropathic Painis characterized by a tingling, burning or electrical type of pain. Trigeminal Neuralgia, which has been described as the worst pain man can experience is a very sharp electrical shooting pain often stimulated by such normally innocuous things a teeth brushing, eating, hair brushing or even a breeze on the face. Other less severe forms of neuropathic pain exist and are diagnosed by a thorough history and examination and then frequently testing by anesthetizing the affected area with both topical and local anesthetic. Once a determination of the type of neuropathic pain has been made, a treatment plan will be developed that usually includes medication and sometimes the application of medicine directly on the site of the problem.Musculoskeletalpain is usually a deep aching pain but it can present in many different forms. Again, a thorough medical history is taken and an examination of the teeth, head and neck muscles and TM joints is performed. Sometimes it is necessary to have imaging done of the joints which can include CT scan or MRI. Once all the needed information is obtained, a diagnosis and plan of treatment is determined. This will often include home exercises and physical rehabilitation, diet modification, changes in behavior (such as not chewing gum or biting fingernails), and often an appliance that fits on the teeth is made to help control harmful habits, and in some instances injections into the sore muscles or joints.Snoring and Sleep ApneaSnoring is the noise that occurs from the vibrations of the tissues at the back of the mouth and the front of the throat. Usually the worst aspect of snoring is that is can be very annoying to the bed partner or others in the home. There is recent evidence, however, that snoring can often lead to sleep apnea which is a condition that has significant medical consequences such as high blood pressure, diabetes, stroke, heart attack, among other problems.
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The field of Orofacial Pain is made up of treating several different types of pain conditions: neurovascular pain (migraine headache, cluster headache, and other types of headache pain), neuropathic pain (pain that originates from a nerve problem such as Trigeminal Neuralgia) and musculoskeletal pain (which is main in the muscles of chewing and the neck and also includes the temporomandibular joint “TMJ”).
Obstructive sleep apnea is a condition in which the airway is blocking by the tongue and the tissues at the back of the mouth and the throat, causing a gasping or choking in order to get some air into the lungs. The individual is rarely if ever aware of this and it can occur many times throughout the night causing very poor qualitysleep. Signs of obstructive sleep apnea can include daytime drowsiness, inability to concentrate, changes in mood, weight gain, falling asleep at inappropriate times. It is diagnosed by a sleep study conducted at a sleep laboratory where many bodily activities are measured including brain activity and sleep levels, oxygen levels, muscle activity, respiration rate and the number of times one actually stops breathing. 
Obstructive sleep apnea is traditionally treated with a device called “CPAP” which stands for continuous positive air pressure. This is delivered through a mask worn over the nose and mouth and connected to a machine by a hose. The CPAP delivers a stream of air that pushes the airway open making it easier to breathe and get oxygen into the lungs. Many people have a difficult time using this device and an alternate way of treating obstructive sleep apnea is to use a device that fits onto the upper and lower teeth and repositions the jaw and tongue downward and forward thus also opening the airway. While these devices which come in many different forms take some getting used to, they are usually better tolerated than the CPAP. Obstructive sleep apnea is usually comanaged with your physician.