AMERICAN ASSOCIATION ofORTHOPEDIC MEDICINE

December 7 & 8, 2007

WORKSHOP

Pain Management and Healing in the 21st Century

Jointly Sponsored by American Association ofOrthopedic Medicine AAOM and the University

of California, San Diego School of Medicine

Contribution from dental to medical

Template Therapy and Irregular Output of the Trigeminal Nervous System

David L. Burns D.D.S.December 7&8 2007

Fort Wayne, Indiana

Dental Occlusion and Health

Dr. David L. BurnsAcademy of Physiological Dentistry

American Dental AssociationIndiana Dental Association

American Academy of Functional OrthodonticsAmerican Academy of Pain Management

International College of Craniomandibular Orthopedics

American Academy of Craniofacial Pain

drdlburns@comcast.netwww.davidlburnsdds.com

260-432-8596

HOW DO WE KNOW IF OCCLUSION IS GOOD OR BAD?

HOW DO WE TREAT TMD?

ANIMAL RESEARCH

CLINICAL CASES

SPORTS DENTISTRY

CONTENTS

HOW DO WE KNOW IF

OCCLUSION IS GOOD

OR BAD?

OCCLUSION

GOOD ----------------- EUSTRESSBAD -------------------DISTRESS

FOR WHOLE BODY

POSTUREPHYSIOLOGY

DYNAMIC FUNCTIONS

WHY DOES OCCLUSION CAUSE EUSTRESS

ORDISTRESS?

A. MECHANICAL FACTORS

B. PHYSIOLOGICAL FACTORS

PHYSIOLOGICAL FACTORS

1. MUSCLES

2. SENSORY- AFFERENT

MUSCLE SPINDLES

GOLGI TENDONS EXTEROCEPTORS

3. CENTRAL NERVOUS SYSTEM

CORTEX BRAINSTEM

4. MOTOR- EFFERENT

ALPHA- GAMMA

AUTONOMIC N.S.

5. PSYCHOSOMATICS

MECHANICAL FACTORS

1. BITE2. GUZAY’S QUADRANT THEOREM

FORCESAXIS-- X&YLEVERS

3. DISCDISPLACEDRUPTURED

4. COMPRESSIONPYRAMUS BONECERVICAL VERTEBRAE

OCCLUSION

GOOD ----------------- EUSTRESSBAD -------------------DISTRESS

FOR WHOLE BODY

POSTUREPHYSIOLOGY

DYNAMIC FUNCTIONS

Quadrant Theorem

Established by

Casey M.Guzay1973:Chicago, USA

Kiyoshi Maehara1985: Osaka, Japan

Center of jawmovement is inthe Sub-Atlas .

In order to masticate or speak properly, the cranium has to keep a stable position.

The posterior cervical muscles and the masticatory muscles always co-work with each other. It is suggested that the length of the posterior cervical muscles goes along with the length of the masticatory muscles.

In case of deep bite or mal occlusion, neuro motor system is activated more than before. This action causes the posterior muscles to constrict more. Cervical vertebrae then receive the force to cause the compression.

Ia and II are proprioception fibers and go into the mesencephalic nucleus, locus cereleus and gray matter of aqueduct of mid-brain. These places act as first ganglia of the trigeminal nerve.

IaII

HOW DO WE TREAT TMD?

What is a Template & Therapy?

1. Kind of mouth piece

2. Stretch of the Masticatory M.

3. Stabilization of the Head Position

4. Improve the diseases and non-specific complaints

5. Connect the medicine and dentistry

How to use the stick in medical care?Template or stick is not a drug

This work stabilizes the brain by cutting off the output signals to the masticatory muscles .

1. During the hospitalization patients should bite stick

2. Never take the dentures out during the sleeping time

3. Ease to pain control when bite the Stick or TP.

4. While under anesthesia bite block is necessary in

order for the stabilization of blood pressure

5. In case of incurable diseases, stick or Tp help for patients

ANIMAL RESEARCH AND THINKING

Conclusion of Animal Experiments

Vertical height loss led to1. Whole body muscle tension changes

2. Imbalance of Autonomic nervous

system.

3. No changes of blood and urine tests

Reference of Animal Experiments

1. Rats : Dr. Tatsuya Ueda Dr. Kiyoshi Maehara

2. Guinea Pigs: Dr. Yukio Azuma, Dr. Hitoshi Taga, Dr. Masaharu Hashimoto Dr. Kiyoshi Maehara

3. Beagle Dogs: Dr. Masaharu Hashimoto, Dr. Kiyoshi Maehara, Dr. Teruaki Sumioka

4. Rhesus Monkeys: Dr. David Burns, Dr. Masaharu Hashimoto, Dr. Keiichi Tamaki, Dr. Kiyoshi Maehara

1-2 Asahi University School of Dentistry Department of Pharmacology

3-4 Fujisawa Pharmaceutical Company Limited

CLINICAL CASES

Clinical Findings 1Clinical Findings 1Clinical Findings 1Clinical Findings 1

1.1.1.1.．．．．Posture: Malposture,Humpback and Malposture,Humpback and Malposture,Humpback and Malposture,Humpback and

Scoliosis etc.Scoliosis etc.Scoliosis etc.Scoliosis etc.

2.2.2.2. Stabilization of cervical vertebra:

Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Cervical spondylosis deformans, Headache, Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness Shoulder/Neck stiffness, Glaucoma and Numbness of finger/armsof finger/armsof finger/armsof finger/arms

3. Analgesic action : All kind of pain caused All kind of pain caused All kind of pain caused All kind of pain caused from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which from inflammation or neuralgia below the pons which is a trigeminal pathway.is a trigeminal pathway.is a trigeminal pathway.is a trigeminal pathway.

Clinical findings 2Clinical findings 2Clinical findings 2Clinical findings 24.．Improvement of blood flow to brain

from vertebral arteries :

Consequence of the cerebral infarction, Consequence of the cerebral infarction, Consequence of the cerebral infarction, Consequence of the cerebral infarction, Epilepsy, ParkinsonEpilepsy, ParkinsonEpilepsy, ParkinsonEpilepsy, Parkinson’’’’s disease and Dementias disease and Dementias disease and Dementias disease and Dementia5.．Stabilization of autonomic nervous system:

HyperHyperHyperHyper・・・・Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Hypotension, Diarrhea, Fatigue,Diabetes and Anxiety neurosisDiabetes and Anxiety neurosisDiabetes and Anxiety neurosisDiabetes and Anxiety neurosis6.．Stabilization of immune system:

AsthmaAsthmaAsthmaAsthma、、、、Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease Atopic dermatitis, Collagen disease and Myasthenia gravisand Myasthenia gravisand Myasthenia gravisand Myasthenia gravis

Clinical findings 3Clinical findings 3Clinical findings 3Clinical findings 37. Improvement of motor function and

skills: protect from sports injury,

acceleration of motor reflexes:

Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor reflexreflexreflexreflex

8. Improvement of TMJ disorder:

Clicking, can’t open mouth due to lock jaw, arthritis of TMJ and so on

9.9.9.9. Leads to proper occlusionLeads to proper occlusionLeads to proper occlusionLeads to proper occlusion

An actress suffered from whiplash by traffic accident and could not remember her script. She was cured within a week by the template wearing.

Effect of the template therapy with sleep apnea syndrome patients.

Hitoshi TAGA 1) , Teruaki TOMARU1)

Satoshi NAITOH2) , Kiyoshi MAEHARA 3)

1)Showa Univ. Med. Fujigaoka Hosp. Dept. of Anesthesiology

2)Showa Univ. Med. Fujigaoka Hosp. Dept. of Otolaryngology

3)Hamamatsu Med. Univ. Dept. of Oral Surgery

UPPP Template Nosedrops

Septoplasty

Reduceweight

Tonsillectomy

0000

10101010

20202020

30303030

Choice of treatment for the SAS patients.

%

93

93.5

94

94.5

95

95.5

96

96.5

97

AI<20 20≦AI<40 40≦AI

%

before

after

Effect of template on mean SpO2.AI<20:n=17, 20≦≦≦≦AI<40:n=5, 40≦≦≦≦AI:n=4. *p<0.05, **p<0.01.

50

55

60

65

70

75

80

85

90

AI<20 20≦AI<40 40≦AI

%

Effect of template on lowest SpO2.AI<20:n=17, 20≦≦≦≦AI<40:n=5, 40≦≦≦≦AI: n=4.*p<0.05.

＊

＊

＊＊

Effect of UPPP34%34%34%34%

27%27%27%27%

39%39%39%39%

13%13%13%13%

13%13%13%13%

74%74%74%74%

Effect of template

marked improvement

effective

stationary

SPORTS DENTISTRY

Clinical findings 3Clinical findings 3Clinical findings 3Clinical findings 37. Improvement of motor function and

skills: protect from sports injury,

acceleration of motor reflexes:

Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor Strength of the muscles and light and motor reflexreflexreflexreflex

8. Improvement of TMJ disorder:

Clicking, can’t open mouth due to lock jaw, arthritis of TMJ and so on

9.9.9.9. Leads to proper occlusionLeads to proper occlusionLeads to proper occlusionLeads to proper occlusion

Reasons for the Effectiveness of Template Therapy

1. From the viewpoint of the physics:

Guzay’s Quadrant Theorem

2. From the viewpoint of the physiology:Masticatory muscles are stretched and controlled by the trigeminal nervous system(Controlled by brainstem directly)

We Are Looking For The Neuro-Dentistry

Dental treatment is same as brainstem treatment:

1. Reduce pain from oral area: stabilization of spinal tract of trigeminal

2. Improve the malocclusion: stabilization of the basal ganglia

3. Increase vertical of bite: stimulate to the mesencephalic nucleus, locus cereleus and gray matter of cerebral aqueduct of mid-brain

(Reduce the pain which is closely related to neuro system)

Conclusion

Mechanism of action is stabilization of the brain:

1. The muscles are no longer overactive from bite overclosure only stimulation to the trigeminal mesencephalon and gray matter of the mid aqueduct where pain is reduced

2. The teeth are important for chewing but also support ones head position and posture.

3.．When teeth are missing and/or not replaced, the brain is going to overwork resulting in brain fatigue/ tiredness

WHEN WE BITE SOMETHING