Diagnosing Myofascial Pain Conditions
MKG- Computerized Mandibular Scan
The mkg was invented by Dr. Barney Jankelson, DR. J, and it is designed to measure mandibular movement in 3 dimensions and track the jaw to understand both function and dysfunction. The name actually means study of mandibular movement. The name was changed to differentiate between neuromuscular dentistry and kinesiology, the study of movement elsewhere in the body. The scanner works by tracking a small magnet to the lower front teeth and tracking the magnets movement by sensors that do not touch the lower jaw. This allows the study of mandibular motion free of any interfering forces. Dr Shapira has been using an MKG for 23 years starting with an early model that utilized an oscilloscope to today’s modern computerized scans. The understanding based on oscilloscope findings have been verified by today’s computers. Clinicians who learned rd on the oscilloscope usually have a deeper understanding than doctors learning on computers today. Today’s computers do give a wealth of information that was not available in the past.
EMG or electromyography is utilized in conjunction with the MKG or CMS to evaluate the physiologic state and function of the masticatory (jaw) muscles and neck postural muscles. The EMG can be used to evaluate bilateral symmetry of the muscles, the health during rest and function, and can be used for incredibly accurate adjustments to the bite.
Emg is also used to measure the effectiveness of TENS in relaxing muscles. Neuromuscular dentistry typically uses bipolar adhesive skin electrodes that measure activity only. There is no discomfort involved during EMG testing. Effectiveness of muscle relaxation can be determined by EMG following use of TENS.
TENS or transcutaneous electrical neural stimulation is at the heart of all neuromuscular dentistry. It is used to create a healthy relaxed state in unhealthy, diseased or spastic muscles. The Myomonitor is a specific type of TENS unit invented by Dr. Barney Jankelson that is used to relax masticatory and cervical musculature. The unit uses a very small electrical impulse to gently stimulate the muscles through a single synapse reflex (similar to the knee jerk done by physicians) repeatedly over an extended time. This action naturally relaxes the muscles. While some people don’t think the process sounds natural I describe it as such because the repeated pulsing and relaxation pumps metabolic wastes out of the muscle cells and brings in blood with oxygen and nutrition, and the muscle relaxes as it heals versus the unnatural relaxation occurring by dumping chemicals or drugs into the system.
The pulses occur every 1.5 seconds and last only a 500th of a second. This time is set because it is the length of time it takes the cellular membrane to return to normal after stimulation. It is for this reason the muscles can be pulsed for an extended time without fatigue.
Borer associates have a similar TENS unit that is used for the same purposes but is slightly different in design. The slight differences usually do not matter, but for difficult long-term patients, each unit has its own peculiar advantages usually only appreciated by the very skilled and adept neuromuscular practitioner.
Both types of TENS are used in conjunction with the MKG and EMG to evaluate changes in mandibular position and function as the muscles are made healthier. Most problems are associated with long term accommodation pf muscle to less than ideal conditions. This results in a repetitive strain injury as the muscles must overcompensate for long periods of time.
The best way is to look at the diagnostic information gathered with these devices as aids that help the doctor make a more accurate diagnosis and plan effective treatment. If you go to the mall and look for a store, you will look up the store on the map and then look for the you are here arrow to figure out where you are in relation to where you are going. This information is vital to prevent treatment going in the wrong direction.
Transcranial neural transmitter modulation is a very unique type of TENS unit that is designed to stimulate the brain and create neurotransmitter changes in the brain similar to potent antidepressants without the chemical side effects.
Dr. Ira Shapira has been using this instrument as part of a diagnostic protocol to help understand and differentiate between peripheral disorders and problems arising from the CNS or central nervous system.
TENSing (Transcutaneous Electrical Neuromuscular Stimulation) muscles works out the lactic acid in your jaw muscles while working in fresh blood, oxygen, and nourishment for your jaw muscles. This helps relax your muscles and helps neuromuscular dentist Dr. Shapira to re-align your jaw to its relaxed neuromuscular rest position and establish an occlusion that lets the patients muscles return to a healthy state after use. The corrective alignment is usually done by a diagnostic orthotic. This allows initial treatment that is reversible until accurate diagnosis and successful phase 1 treatment is accomplished.
Phase 1 treatment is designed to find a functional position that stabilizes the jaw and allows healthy function in which the muscles naturally return to their relaxed state. Phase 2 treatment is long term stabilization with a more permanent orthotic cosmetic reconstruction orthodontic or surgical intervention. Avoidance of surgery is a top concern of Dr. shapira because there are so many complications related to surgery.
Neuromuscular dentist, Dr. Shapira, has been working with chronic head and neck pain patients for 23 years. His practice is dedicated to non-surgical alternatives to Temporomandibular Joint Dysfunction and drug-free pain management. He is certified to treat sleep apnea with FDA approved appliances as non-surgical alternatives to UP3 and Tracheotomy. He understands the relation of jaw position and sleep apnea to all of the physical and biochemical disorder patients deal with. He has successfully treated hundreds of patients with a multitude of TM Joint problems, TMD and the myriad of related conditions. As a former sufferer of chronic pain, Dr Shapira made it a personal crusade to not only relieve his pain but to give patients a quality of life they never thought was possible.
Dr Shapira trained with Dr Janet Travell, the world’s expert on myofascial pain and dysfunction and uses the techniques he learned from her to alleviate pain and restore normal function to his patients. Many experts consider fibromyalgia and myofascial dysfunction to be different subsets of the same disorder.
Note: Neuromuscular dentistry typically use non-invasive bipolar adhesive skin electrode
Many patients may remember Dr Shapira from his time at the Pain Relif Center in Racine Wisconsin, a multidisciplinary practice in pain medicine as well as from the TMJ center and oral facial pain center of Chicago where he practiced with a Diplomat Oral Surgeon as well as his dual tenures at Rush Medical School where he was involved in research and treatment of sleep apnea and snoring as a visiting assistant professor in the late 1980′s and early 1990′s and again as an assistant professor in the late 1990′s and early 2000.
If you demonstrate any symptoms of TMJ and TMD disorder, you should immediately contact neuromuscular dentist, Dr. Ira Shapira and neuromuscular dentist, Dr. Amidei in Chicago, Illinois. Email us or call 847-623-5530 for a TMD treatment or TMJ treatment consultation. His practice is located in Gurnee, Illinois.