THE SYNDROME
Typically, CCS patients wake up with a headache. Most of the time the headache is focused in the temporal region and often extends to the forehead. Occasionally, the headache comes from the back of the neck, at the base of the skull (some patients get only this kind, which I'll explain later). They may have visited a chiropractor several times, with limited improvement. In addition to their headaches, CCS patients typically suffer from other symptoms. Their teeth are sensitive to cold and they occasionally experience 'phantom' toothaches (their dentist cannot find a reason for the pain). Many have experienced episodes at a dental office in which a tooth wouldn't get numb after several injections. Their necks are stiff and sore. Their ears sometimes itch, tingle, ring, or feel stuffy, plugged, or clogged. Some patients are constantly trying to clean their ears, or at least they're sticking something into their ears, just to scratch. Their jaws may be stiff and sore, and fatigue easily after a chewy meal. Some patients have recurring 'sinus' headaches, although their physicians have assured them that their sinuses are within normal limits.
When I was in dental school, students practiced doing novocaine injections on each other. Unlike most everybody else, I never seemed to get very numb when I was the target for the lower molar teeth. In fact, I've had only one filling done on a lower back molar as an adult, and that was performed by a fellow dental student. I remember being able to sense the drilling, even though I was not supposed to. I thought, "Well, no wonder people get the creeps when you drill on them, if it feels like this!" The typical chronic headache patient may have few fond memories of dental treatment.
One of the more frequent ways Chronic Clenching Syndrome can be diagnosed is when a patient goes to their dentist with a toothache. Typically, the tooth is very sensitive to cold; however, the patient cannot always pinpoint the exact tooth. Instead, the patient will point through their cheek, instead of directly on a specific tooth. The patient is convinced there are 'cavities' due to several toothaches, usually on the same side, some on top, some on the bottom. An x-ray rarely shows any need for fillings or crowns, and the teeth look normal. I'm afraid to guess how many fillings, crowns, and root canals have been done unnecessarily by dentists because the patient requested something be done, even though no reason for the pain could be found. My mother-in-law is a good example. Before I knew her, she had been complaining for over a year of a toothache located in an upper, back molar. First, a filling was done. Later, a crown (sometimes called a cap) was placed over the tooth. When she still had a toothache, a root canal was done. Her tooth actually hurt more after the root canal was done, so the tooth was extracted. Guess what? When I met her, she told me of this weird toothache she was still having. (Ever notice that you tell a dentist your worst dental nightmare when you first meet him?) We were in her living room at the time, so I asked her to open up and let me peek. I said to her, "Hey, there's no tooth in there!" Then she told me her horror story and she concluded that some part of the tooth must have been left behind after the extraction. I announced that I'd like to do a little test on her. I put my finger on the side of her face and gently pushed under her cheekbone. She hit the roof. All that time, it had been a painful jaw muscle (the one I had just pushed on) giving her all the problems, a result of clenching!
What's going on? Teeth are not designed to be temperature sensors. If they were, nobody would ever get a pizza burn on the roof of their mouth! The teeth would touch the hot cheese and warn you to stop. Teeth do sense temperature when they are in distress, however. For example, if decay is deep enough into a tooth, the nerve can easily sense temperatures and acidic foods while eating. The dentist easily detects this type of decay. Although I never had any tooth decay, I used to have to drink icy drinks out of a straw and keep my cheeks sucked in a little to protect my teeth from hurting from the cold. So why do they hurt? Here's the deal. The intense pressure and compaction that an individual tooth experiences from clenching is tremendous. The root of each tooth is coated with a shock-absorbing nerve and ligament liner that becomes strained and bruised. This is very distressing to the teeth and they respond by being temperature sensitive. They are trying to tell you something is wrong, even though an x-ray of that tooth will look normal. To demonstrate, imagine grabbing a molar with a pair f pliers and twisting the tooth from side to side for a few minutes. Hours later, that tooth would still be aching and sensitive to cold. This is exactly what happens when intense clenching occurs. Instead of the pliers applying the pressure, an opposing tooth is applying the pressure. Of course, it's the muscle that is really supplying the force. This is why many patients feel that they have two toothaches. It takes a lower tooth to push on an upper tooth, so sometimes both hurt. Typically, these patients have been having headaches, simultaneously, with their toothaches, but never make the connection.
What does clenching have to do with a stiff and sore neck? Muscles generally work in teams. It's difficult to have one muscle (like the temporalis) tighten up without having muscles from the supporting 'team' tighten also. When a patient's jaws are squeezed together, the neck muscles that support the entire skull assume a tightened posture at the same time. These muscles are primarily located in the back of the neck; therefore, the habitual intense jaw-clencher practically always experiences a stiff and sore neck.
HEADACHE AT THE BACK OF THE NECK
Some patients' headaches originate primarily from the back of their necks. There is a certain type of jaw-clenching activity that particularly involves and engages these neck muscles. Instead of pressing the back teeth together, patients with these symptoms will have their lower jaw positioned slightly forward, pressing the lower front teeth into the backside of the upper front teeth. This type of activity doesn't fatigue the temporalis as much because the back teeth are not squeezed together as efficiently, yet still puts a tremendous strain on the neck muscles. Why? The neck muscles are trying to pull the head back to keep it erect because the forward jaw-thrusting makes the head want to tilt forward. The constant strain on the neck muscles results in the headache felt at the back of the neck radiating up the back of the skull.
UNSUCCESSFUL CHIROPRACTIC CARE
The clenching patient with chronic temporal tension headaches or back of the neck headaches is the chiropractor's worst nightmare. My chiropractor assured me that he could get rid of my headaches. He had shown me an x-ray of my neck and pointed out how my neck bones were lining up to form a straight line, instead of the curve that they were supposed to be in. Through chiropractic adjustments, he attempted to realign my neck bones to regain the proper curve. This should, I was told, relieve me of my headaches. Since I was actually there to have him fix my lower back (which I periodically mess up), I figured what the heck, as long as I'm coming here, go ahead and take a crack at it (sorry). After a few visits, my back was good as new, but my headaches hadn't changed. I went twice a week, and each time I needed the same adjustment as before, as though nothing had been accomplished. Maybe by now you've figured out what was happening. I'd go home from my visit feeling pretty good, but during the night, I'd clench my jaws together, which would re-establish my headache. This would tighten my neck muscles and pull my neck bones back into a straight line. My clenching habit kept goofing up everything the chiropractor had just done!
I remember going to the ear doctor during the time when I was having amazing headaches. I was concerned that there was blood on the Q-tip after I had cleaned my ears. "A-ha!" I figured. "This must have something to do with my headaches!" The ear doctor looked into my ear and asked me, "What are you doing in there? There's a scab deep in your ear canal!" I told him that something had been bugging me deep in my ear, and I had been trying to clean it out. He announced that I had rubbed right through the skin.
O.k., so how come our ears feel so weird? Put your little finger in your ear while opening and closing your mouth. Now move your jaw from side to side. You can feel a lot of action in there! The over-activity of your jaw makes your ear canal somewhat sensitive. In many cases excess wax is produced, as if some little bug were in your ear canal, and your body was trying to protect itself.
The are two other muscles associtated with jaw function (that is, muscles innervated by the mandibular division of the trigeminal nerve) call the tensor tympani (it attaches to the ear drum, and stabilizes it from the excess vibration caused by loud sounds) and the tensor levi palatini (it attaches to the eustacian tube, and helps to open and close the tube, thereby equilizing pressure withing the inner ear...it is what "unplugs" your ears as you chew gum in an airplane). Over activity of these muscle can sometimes cause a ringing sensation, called tinnitus. It is not unusual for the patient with CCS to complain of ringing in their ears, or vertigo. The tensor tympani and tensor levi palatini are tensed when ever the jaw-closing muscles are tensed, i.e., when ever the jaw is clenched. Although at first they might seem unrelated, you can now see how chronic jaw-clenchers ofter times complain of tinnitus.
The lateral pterygoid muscles attaches at the top of the jaw bone, just in front of the ear canal, and inserts at a wall of the sinuses (the pteygoid plate). The lateral pterygoid can become dysfunctional by pulling the jaw to one side (while your teeth are together), too much and/or too hard. Clenching your teeth on only one side requires the temporalis and lateral pterygoid to work at the same time. The temporalis is closing your jaw enough so that your teeth can touch, while one of the lateral pterygoids is pulling your jaw to the side. This is called a unilateral or one-sided clench. When clenching occurs from side-to-side-to-side, it is called grinding (or bruxing). As the lateral pterygoid becomes dysfunctional from all this over-activity, the pressure and strain that that is created is focused in the jaw joint space. The jaw joint is designed to deal with the forces and strains that are put upon it during normal chewing; however, the intense strain put on the jaw joint during unilateral clenching is very damaging. Given enough time, the strain from unilateral clenching can cause such damage that even constant rest can not reverse. For the most part thought, most peoples with a jaw joint problem who use an NTI-tss appliances for a couple of weeks (daytime included) experience a significant improvement. For the patient whose jaw joint(s) have not shown significant improvement (less painful and considerably less tender) are usually referred to an oral surgeon to have their jaw joints evaluated. This occurs in about 5% of cases.
If you simply had your teeth pressed together, and neither lateral pterygoid
was working, you'd be clenching your teeth; but, if your mouth was closed
just enough so that your teeth could touch (a function of the temporalis),
and each lateral pterygoid started working, alternately pulling your jaw
to the left and then to the right, you'd be grinding your teeth (a right
and left motion while the teeth are touching). Clenching the teeth and
grinding the teeth are two separate activities. People whom exclusively
grind their teeth (and don't clench), rarely get headaches. In order to
grind your teeth, the temporalis must relax enough to let the jaw move
around so that the teeth aren't locked together, but must contract slightly
to keep the teeth touching. The temporalis is relaxed enough to keep it
from hurting, but it still becomes fatigued (which is important to remember
for later in the book). Some people do a little of both. After a clenching
episode, they'll have a headache. If they've been grinding only, however,
they won't have a headache. Unfortunately, dentistry seems to combine the
terms 'clenching' and 'grinding', as though they were interchangeable.
They're not. If a patient reports that she is having headaches, and a dentist
sees that the patient has tell-tale wear facets on their teeth, the
dentist may mistakenly assume that grinding has caused the headaches
(which it hasn't, that's clenching). Then he attempts to protect the teeth
from the grinding with the traditional splint, believing that the headaches
will be relieved. This gets him nowhere because it's the clenching
that causes the headaches (remember, some people can clench harder with
a splint).
Medicine and dentistry have yet to fully acknowledge that grinding
is a dynamic form of clenching and that addressing grinding alone may serve
to accentuate clenching. I'm convinced that this lack of acknowledgement
has kept headache and jaw dysfunction
prevention research at a standstill. Treating and preventing grinding
of the teeth is a piece of cake, but it has little to do with headaches
and jaw joint strain and damage. Suppressing clenching intensity is a whole
different matter, requiring a totally different approach (which is what
we're addressing).
The NTI Tension Suppression System simply provides an 'air space' between the teeth and keeps them from touching when they're not supposed to be touching. In other words, the NTI-tss prevents the temporalis and lateral pterygoid muscles from contracting with intensity when they're not supposed to be. By doing so, the myofascial dysfunction of the temporalis' and lateral pterygoids and strain on the jaw joint is prevented, thereby preventing headaches, toothaches, neck pain, ear conditions, and jaw pain.
No wonder headache sufferers are accused of being hypochondriacs! They visit neurologists for headaches, dentists for tooth and jaw aches, chiropractors and P.T.'s for their stiff and sore necks, and E.N.T.'s for their ringing, itchy ears. But you've got sinus headaches? No problem, let's talk about that in the next chapter.
"Today I am free of throbbing head pain, and a painfully stiff neck (I can now turn my head, not my body, while backing my vehicle out of the garage). No more Imitrex shots in the wee hours of the morning. My eyes are not at half-mast (due to pain and medication). I now have energy, I can exercise, and I feel like a new person!" Suzanne Hubbard, Clarkston, MI