Dr. Stan Farrell - AZ TMJ

Psychologic implications of surgical-orthodontic treatment in patients with anterior open bite

2012-03-09T11:26:00.000-08:00

Key Words: TMJ Surgery, Orthodontics, Bite, surgical-orthodontic treatment

Hoppenreijs/Hakman/van't Hof/Stoelinga/Tuinzing/Freihofer

International Journal of Adult Orthodontics and Orthognathic Surgery

Aims: Two hundred eighty-two patients who received surgical-orthodontic treatment to correct anterior open bite were retrospectively evaluated by interview and questionnaires to determine the motivation and expectations before treatment, experience during treatment, psychosocial impact, functional and esthetic results, and satisfaction.

Methods: All patients underwent a Le Fort I osteotomy, and 126 patients also received a bilateral sagittal split advancement osteotomy. The mean follow-up was 6 years. The most important reasons for treatment, as cited by the patients, were biting and chewing problems (28%), dissatisfaction with facial appearance (26%), and symptoms of temporomandibular joint (TMJ) dysfunction (21%). Patients with anterior open bite had a critical attitude toward facial appearance; therefore, esthetic aspects should be taken seriously.

Results: The expectations on chewing ability, phonetics, nasal passage, and facial appearance were met by the treatment; however, expectations on TMJ function, interincisal relationship, and biting ability were not completely fulfilled. There was a subjective improvement of TMJ sounds in 27% and a worsening in 14% of the patients. Dysesthesia of the infraorbital nerve was noticed in 4% of patients and of the mental or inferior alveolar nerve in 23% of the patients. Chewing and biting abilities improved in 54% and 73%, respectively. Facial appearance, self-confidence, and social interaction had improved. Patients had expected more information before and psychologic support after treatment. Despite the relapse of open bite in 20% of the patients, 75% were satisfied with the dental and 85% with the facial appearance.

As this research has indicated, surgical-orthodontic procedures for TMJ Dysfunction are not always guaranteed to be successful. Only 27% showed improvement in popping/clicking sounds and 14% actually got worse. Additionally, 20% of the patients surveyed had a relapse of their open bite. There are many non-surgical, conservative options available for the treatment of TMJ Dysfunction. Here at AZ TMJ, we focus on conservative types of treatments that have been proven to be successful and are backed by research. Dr. Stan Farrell is Board Certified in Orofacial Pain, making him one of the best options in the Phoenix area to treat a wide variety of head pain and TMJ disorders. Call and schedule a consultation at 480-945-3629. www.az-tmj.com

Self-Efficacy Is Associated with Pain, Functioning, and Coping in Patients with Chronic Temporomandibular Disorder Pain

2012-03-02T09:50:00.000-08:00

Key Words: TMJ, TMD, Headaches, Facial Pain, Chronic Pain, Chronic Headaches, Migraines

Heather Brister, BS / Judith A. Turner, PhD / Leslie A. Aaron, PhD, MPH / Lloyd Mancl, PhD

Aims: To examine the psychometric characteristics of a measure of self-efficacy for managing temporomandibular disorders (TMD) and to determine whether scores on this measure were related to pain, disability, and psychological distress in patients with chronic TMD pain.

Methods: Patients seeking treatment for chronic TMD pain (n = 156, 87% female, mean age = 37 years) completed measures assessing pain, disability, mental health, pain-coping strategies, and self-efficacy for managing their pain.

Results: The self-efficacy measure, which was adapted from arthritis research, demonstrated good psychometric characteristics (Cronbach’s alpha = 0.91, minimal floor and ceiling effects, and validity). Greater self-efficacy was associated with significantly (P < .05) lower levels of pain, disability, and psychological distress. Self-efficacy remained significantly associated with disability and mental health measures even after controlling for demographic variables and pain intensity. In addition, patients with higher self-efficacy reported significantly (P < .05) greater use of an active, adaptive chronic pain-coping strategy (task persistence) and less use of a passive, maladaptive chronic pain-coping strategy (rest).

Conclusion: Self-efficacy for managing pain appears to be important in the adjustment of patients with chronic TMD pain. Research is needed to determine whether treatments designed to increase self-efficacy improve TMD patient outcomes. J OROFAC PAIN 2006;20:115–124

Patients with greater self-efficacy have shown significantly lower levels of pain and worked better with pain coping strategies associated with TMD and its discomfort. Dr. Stan Farrell works with many patients that feel they have no-where else to turn. He provides numerous non-surgical treatment options for TMJ and associated headaches that are proven to alleviate pain without the use of narcotics. If you feel like you’ve exhausted all options or have just lived with the pain, call and schedule a consultation with Dr. Farrell at AZ TMJ, 480-945-3629. www.aztmj.com

Antidepressant Drugs and Bruxism

2012-02-10T12:50:00.000-08:00

Key Words: Antidepressant Medication, Bruxism, Clenching, Grinding, TMJ, Headache

Ephraim Winocur, DMD, Anat Gavish, DMD, Michal Voikovitch, MSc, Alona Emodi-Perlman, DMD, Ilana Eli, DMD

Aims: Bruxism associated with drugs can be destructive, resulting in severe consequences to health that include destruction of tooth structure, irreversible harm to the temporomandibular joint, severe myofascial pain, and muscle contraction headache. However, reports concerning a possible association between bruxism and various pharmacologic drugs are scarce and mostly anecdotal. The purpose of this article was to review the existing literature concerning the exacerbating or ameliorating effect of drugs on bruxism in humans.

Methods: A search of the MEDLINE, EMBASE, and PsicINFO databases from 1982 to 2001 was conducted, and the term bruxism and one of the following terms were used: drugs, medicine(s), pharmaceutical, movement disorders, akathisia, dyskinesia, dystonia, central or autonomic nervous system, dopamine, serotonin, and GABA. Furthermore, a search using the term bruxism was carried out on the weekly journal Reactions, which deals with side effects of drugs. Several chemical terms were searched separately (eg, caffeine, nicotine). Relevant information was also derived from reference lists of the retrieved publications.

Results: The search yielded complex information referring to the association between bruxism and dopaminerelated drugs, antidepressant drugs, sedative and anxiolytic drugs, and drugs of abuse.

Conclusion: There is insufficient evidencebased data to draw definite conclusions concerning the effects of various drugs on bruxism. Although certain substances related to the dopaminergic, serotonergic, and adrenergic systems suppress or exacerbate bruxist activity in humans and animals, the literature is still controversial, and based mostly on anecdotal case reports. More controlled, evidence-based research on this underexplored subject is needed. J OROFAC PAIN 2003;17:99–111.

Summary: Bruxism or clenching/grinding has been associated with the use of antidepressant drugs. If you are suffering from TMJ/TMD or headaches associated with bruxism and are taking an antidepressant, Dr. Stan Farrell can work with you to alleviate your symptoms while managing the effects of your medication. Dr. Farrell is Board Certified in Orofacial pain and has extensive training in medication management. Contact Dr. Farrell to find out more about his state of the art treatments proven to assist in alleviating Orofacial Pain and headaches associated with this pain at 480-945-3629. www.az-tmj.com

Clinical Signs of Temporomandibular Disorders and Various Pain Conditions Among Children...

2012-01-20T13:01:00.000-08:00

Key words: children, headache, pain, temporomandibular disorders, widespread pain

Anu Vierola, DDS/Anna Liisa Suominen, DDS, PhD/Tiina Ikävalko, DDS/Niina Lintu, MSc/Virpi Lindi, PhD/Hanna-Maaria Lakka, MD, PhD/Jari Kellokoski, DDS, PhD/Matti Närhi, DDS, PhD/Timo A. Lakka, MD, PhD

Aims: To examine the prevalence and significance of clinically determined signs of temporomandibular disorders (TMD) and pain in different parts of the body as well as the frequency, intensity, and other features of pain in children.

Methods: The subjects were a population-based sample of children 6 to 8 years of age. Complete data on clinical signs of TMD were available for 483 children. Data on pain during the past 3 months, assessed by a questionnaire administered by parents, were available for 424 children. Differences between the prevalence of at least one sign of TMD and the location or frequency of pain were evaluated using the chi-square test, as well as the associations between the prevalence, frequency, and location of pain and gender, the use of medication, and visits to a physician. The relationship of various pain conditions with the risk of having clinical signs of TMD was analyzed using logistic regression.

Results: Of the 483 children, 171 (35%) had at least one clinical sign of TMD. Of the 424 children, 226 (53%) had experienced pain during the past 3 months. Pain was most prevalent in the lower limbs (35%) and head (32%). Of the 226 children with pain, 119 (53%) had experienced frequent pain (≥ once a week). No gender differences were found. The risk of having at least one clinical sign of TMD was 3.0 (95% confidence intervals [CI]: 1.1–8.5, P < .05) times higher in children with back pain, 2.7 (95% CI: 1.2–6.0, P < .05) times higher in children with neck-shoulder pain, and 1.6 (95% CI: 1.1–2.5, P < .05) times higher in children with headache compared to children without these pain symptoms. The risk of having at least one clinical sign of TMD was 12.2 (95% CI: 1.4–101.8, P < .01) times higher among children with palpation tenderness in trapezius muscles than among those without it.

Conclusion: Clinical signs of TMD and pain symptoms are common in children. The relationship of back pain, neck-shoulder muscle palpation tenderness, and headache with clinical signs of TMD suggests that more attention should be paid to stomatognathic function in children with such pain problems. J OROFAC PAIN 2012;26:17–25

As this research has indicated, a high percentage of children have at least one clinical sign of TMJ disorder. There are many conservative ways to treat TMJ in order to provide pain relief as children go through these growth stages. AZ TMJ focuses on treatment methods that are safe and non-surgical. Dr. Stan Farrell is Board Certified in Orofacial Pain and is well versed in treating children of all ages for TMJ, migraine headache, neck and facial muscle pain. If your child is complaining of migraine headache, jaw or muscle pain, call and schedule an appointment with Dr. Farrell at 480-945-3629. http://www.az-tmj.com/

Are Sleep Difficulties Associated With Migraine Attributable to Anxiety and Depression?

2012-01-13T14:02:00.000-08:00

Keywords: sleep; migraine; anxiety; depression

Objective.— To examine whether sleep complaints reported by migraineurs can be attributed to comorbid anxiety and/or depression.

Background.— A consistent association between migraine and sleep complaints has been reported in community and clinical studies. However, anxiety and depression are often comorbid with migraine. Thus, it may be possible that the increased prevalence of sleep problems in migraineurs is attributable to comorbid anxiety and depression. To our knowledge, no previous studies have demonstrated that the associations are not solely attributed to comorbid anxiety and depression.

Design and Methods.— Controlled family study of anxiety disorders and substance use disorders in a community in New Haven County, CT. The sample included 221 probands (41 migraineurs) and their 261 directly interviewed first-degree relatives (39 migrainuers), including parents, siblings, and offspring over age 18. A lifetime history of migraine was obtained using the Diagnostic Interview for Headache Syndromes. A lifetime history of psychiatric disorders was obtained using the semi-structured Schedule for Affective Disorders and Schizophrenia which was modified to incorporate Diagnostic and Statistical Manual diagnostic criteria. Several sleep items on current and lifetime sleep complaints were included as a subset of the interview.

Results.— There was a significant association between migraine and the number of sleep problems as well as several specific sleep symptoms among probands and their adult relatives. Adults with migraine reported having significantly more lifetime sleep problems (OR [CI] = 2.3 [1.1-4.6]), and more current sleep difficulties, specifically, inadequate sleep (2.5 [1.2-5.0]), difficulty falling asleep (3.0 [1.5-6.3]), and persistent nightmares of childhood onset (4.3 [1.8-9.9]) than those without migraine. The associations between sleep problems and migraine persisted after controlling for both lifetime and current anxiety and mood disorders.

Conclusions.— The association between sleep problems and migraine that is not solely explained by comorbid anxiety disorders or depression suggests that sleep problems should be evaluated among people with migraine.

Vgontzas, A., Cui, L. and Merikangas, K. R. (2008), Are Sleep Difficulties Associated With Migraine Attributable to Anxiety and Depression?. Headache: The Journal of Head and Face Pain, 48: 1451–1459. doi: 10.1111/j.1526-4610.2008.01175.x

In short, this study suggests that there are other contributing factors to sleep problems and migraine that is not explained by present anxiety or depression. Here at AZ TMJ, we treat many of these “other” contributing factors like, TMJ and Sleep Apnea. Both of which, can lead to migraines and sleep problems. There is this vicious cycle of symptoms where someone’s TMJ disorder can lead to migraines, which can lead to depression or anxiety, which can ultimately affect sleep. Dr. Stan Farrell is Board Certified in Orofacial Pain and a member of the American Academy of Dental Sleep Medicine. He is well versed in identifying and treating many of the symptoms related to TMJ disorders and Sleep Apnea. If you have migraines and sleep problems, you owe it to yourself to see Dr. Farrell. Call today, 480-945-3629. www.az-tmj.com

Patterns of Dental Care Utilization Among Patients with Temporomandibular Disorders

2012-01-06T11:37:00.000-08:00

Key words: dental care, dental utilization, temporomandibular disorders

Kara A. Hobson, DDS, MS/Greg J. Huang, DMD, MSD, MPH/David A. Covell Jr, PhD, DDS

Aims: To use data from a large health maintenance organization to specifically investigate dental utilization rates among patients with and without temporomandibular disorders (TMD).

Methods: Subjects were enrolled in Kaiser Permanente Northwest between 1998 and 2003. Two age- and gender-matched controls were selected for each subject who had a TMD diagnosis during the study period. Dental treatment was categorized using Current Dental Terminology (CDT) codes. Overall dental utilization rates were calculated, as well as rates based on age, gender, categories of treatment, and periods before and after TMD diagnoses. These rates were analyzed with t tests.

Results: TMD subjects utilized significantly more dental services than comparison subjects overall and for several dental categories. The difference was between 10% to 20%, or about 1 additional dental procedure per year. A positive linear relationship existed between dental utilization rates and age, with a significant increase in utilization for each ascending age cohort. Females had higher dental utilization rates than males in TMD and non-TMD groups and in all categories of dentistry. After a TMD diagnosis, major differences in utilization were not found when compared to patterns of treatment prior to the diagnosis.

Conclusion: TMD subjects utilized 10% to 20% more dental services than non-TMD subjects. Gender and age were important factors with increased utilization in females and older patients. TMD diagnoses did not affect dental utilization patterns, indicating that most TMD patients continue to seek routine dental care. J OROFAC PAIN 2008;22:108–114

This research really shows the importance of treating your TMJ/TMD disorder. As it indicated, many people with TMD are going to their dentist more often and ultimately spending more money. This is consistent with what we see here at AZ TMJ; many of our patients have seen numerous doctors and dentists and have been bounced around looking for answers to their facial pain. Dr. Stan Farrell has extensive education and training in identifying TMJ related pain and headaches. Dr. Farrell is Board Certified in Orofacial Pain and uses a non-surgical and non-narcotic approach to treating your TMJ disorder. If you’ve been looking for answers to your TMJ problems, schedule an appointment with Dr. Farrell at 480-945-3629. www.az-tmj.com

Headaches and Academic Performance in University Students: A Cross-Sectional Study

2011-11-18T11:59:00.000-08:00

Keywords: headache; prevalence; educational measurement; study performance; student

Hugo R. Souza-e-Silva MSc, Pedro A. S. Rocha-Filho MD, PhD

Article first published online: 14 NOV 2011

DOI: 10.1111/j.1526-4610.2011.02012.x
Objectives.— To estimate the 1-year prevalence of headache, its repercussion and its association with the academic performance of university students.

Methods.— Cross-sectional study. Three hundred eighty students were randomly selected out of the 1718, 90.5% of them were interviewed. A semi-structured interview, the Headache Impact Test (HIT-6) and the Hospital Anxiety and Depression Scale were used. The variables related to academic performance: absenteeism, performance coefficient and number of failures in disciplines, were obtained by consulting the academic records.

Results.— Three hundred forty-four students were interviewed. The headache prevalence was 87.2%. Migraine prevalence was 48.5%. Tension-type headache prevalence was 42.4%. During the 3 months prior to the interview, 8.7% sought emergency services, 30.8% missed class, and 30.8% had a reduction in their productive capacity because of headache. HIT-6: substantial/severe impact = 49%. Multiple linear regressions have shown that serious/very serious-impact headaches are significantly related to greater number of discipline failure and absenteeism. There was no association between student grades and headaches.

Conclusion.— A high prevalence of headache in the studied population was verified. A high headache impact on a student's life was associated with worse academic performance.

As this research indicated, 87% of the students had headache prevalence and 30% missed class and 30% had a reduction in their productive capacity because of headaches. If this sounds very similar to your situation, Dr. Stan Farrell can help. Dr. Farrell is well versed in all types of headaches and is a member of the American Headache Society and Board Certified in Orofacial Pain. Many headaches are caused by some sort of trigger, whether it is a muscle, joint or nerve; Dr. Farrell can map these triggers and provide numerous treatment options based off the type of trigger. If you suffer from headaches, don’t let them affect your productivity. Schedule an appointment today at 480-945-3629. http://www.az-tmj.com/

Nighttime Blood Pressure in Cluster Headache

2011-11-04T09:19:00.000-07:00

Keywords: cluster headache; sleep apnea; blood pressure dip; 24-hour blood pressure; circadian pattern; hypertension

Sonia Santos Lasaosa MD, Jorge Navarro Calzada MD, Alba Velázquez Benito MD, Cristina Pérez Lázaro MD

Article first published online: 29 AUG 2011

DOI: 10.1111/j.1526-4610.2011.01991.x

Background.— It has been proposed that desaturation of oxygen during an apnea event is the trigger for cluster headache. Obstructive sleep apnea has been associated with a higher than normal cardiovascular morbidity and mortality. Some obstructive sleep apnea syndrome patients lack the sleep-related, nocturnal decrease, or “dip” in blood pressure, which is seen in normal individuals.

Objective.— The aim of this study is to assess whether this non-dipper pattern is present in cluster headache patients.

Design and Methods.— A total of 30 normotensive cluster headache patients underwent an ambulatory blood pressure monitoring. “Non dippers” were defined as patients with a nighttime mean blood pressure fall <10%.

Results.— Fifteen cluster headache patients (50%) were non-dippers, a frequency higher than expected. The pattern of nocturnal non-dipping is associated with a higher body mass index. Non-dipper patients displayed higher mean nighttime systolic and diastolic blood pressure. No significant difference was observed in the mean 24-hour and daytime blood pressure.

Conclusions.— The high incidence (50%) of non-dipper pattern in both processes, cluster headache and obstructive sleep apnea syndrome, provides support for the hypothesis of a relationship between theses 2 disorders.

As indicated in this study, sleep apnea, high blood pressure and headache can all be interrelated. Treating your obstructive sleep apnea can help lower your blood pressure and relieve related headaches. AZ TMJ’s, Dr. Stan Farrell, offers an alternative to the CPAP machine by using an oral sleep appliance for the treatment of obstructive sleep apnea. Dr. Farrell is a member of the American Academy of Dental Sleep Medicine and Board Certified in Orofacial Pain. The type of appliance used and the skill of the practitioner fabricating, fitting and adjusting the appliance ultimately determine its success. If you have been diagnosed with sleep apnea or are non- compliant with the CPAP machine, call and schedule an appointment with Dr. Farrell at 480-945-3629. www.az-tmj.com

Effectiveness of Low-Level Laser Therapy in Temporomandibular Disorders

2011-10-28T10:48:00.000-07:00

Key Words: TMJ, TMD, Laser Therapy, Temporomandibular Joint Disorder

Ambra Petrucci, DDS/Fabrizio Sgolastra, DDS/Roberto Gatto, MD, DMD/Antonella Mattei, ScD/Annalisa Monaco, DDS

Aim: To assess the scientific evidence on the efficacy of low-level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD).

Methods: The databases of PubMed, Science Direct, Cochrane Clinical Trials Register, and PEDro were manually and electronically searched up to February 2010. Two independent reviewers screened, extracted, and assessed the quality of the publications. A meta-analysis- was performed to quantify the pooled effect of LLLT on pain and function in patients with chronic TMD.

Results: The literature search identified 323 papers without overlap between selected databases, but after the two-phase study selection, only six randomized clinical trials (RCT) were included in the systematic review. The primary outcome of interest was the change in pain from baseline to endpoint. The pooled effect of LLLT on pain, measured through a visual analog scale with a mean difference of 7.77 mm (95% confidence interval [CI]: –2.49 to 18.02), was not statistically significant from placebo. Change from baseline to endpoint of secondary outcomes was 4.04 mm (95% CI 3.06 to 5.02) for mandibular maximum vertical opening; 1.64 mm (95% CI 0.10 to 3.17) for right lateral excursion and 1.90 mm (95% CI: –4.08 to 7.88) for left lateral excursion.

Conclusion: Currently, there is no evidence to support the effectiveness of LLLT in the treatment of TMD. J Orofac Pain 2011;25:298–307

AZ TMJ focuses on treatment methods for TMJ and migraine headache that have been proven to be effective through research. Dr. Stan Farrell does not use laser therapy for the treatment of TMJ disorders, due to the lack of evidence and research behind their effectiveness. Dr. Farrell focuses his treatment on non-surgical methods like custom splints, medication management and trigger point injections. All of which have been proven to be effective. Additionally, Dr. Farrell does not prescribe the use of narcotics. Our goal is to treat the root problem of your pain and not just medicate it. If you suffer from TMJ pain, call and schedule an appointment with Dr. Farrell and know that you’re getting the best treatment available by a Board Certified Doctor in Orofacial Pain. www.az-tmj.com

Botulinum Toxin Type A (Botox) as a Migraine Preventive Treatment

2011-10-14T08:25:00.000-07:00

Key Words: migraine headache treatment, Botox

Stephen Silberstein MD1,5, Ninan Mathew MD2,6, Joel Saper MD3,7, Stephen Jenkins MD4,8, for the BOTOX Migraine Clinical Research GroupArticle first published online: 25 DEC 2001

DOI: 10.1046/j.1526-4610.2000.00066.x

Objective.—To assess the safety and efficacy of botulinum toxin type A (BOTOX; Allergan, Inc) in the prevention of migraine.

Background.—Current migraine preventive therapies are often unsatisfactory because of their limited efficacy, adverse effects, and drug interactions. Botulinum toxin type A injections often reduce the pain associated with conditions such as cervical dystonia, achalasia, rectal fissures, and myofascial pain syndrome. An open-label, noncontrolled study of botulinum toxin type A suggested benefits for patients with migraine.

Design and Methods.—This was a double-blind, vehicle-controlled study of 123 subjects with a history of two to eight moderate-to-severe migraine attacks per month, with or without aura. Participants were randomized to receive single administrations of vehicle or botulinum toxin type A, 25 U or 75 U, injected into multiple sites of pericranial muscles at the same visit. During a 1-month baseline period and for 3 months following injection, subjects kept daily diaries in which they recorded migraine frequency, migraine severity, and the occurrence of migraine-associated symptoms.

Results.—Compared with vehicle treatment, subjects in the 25-U botulinum toxin type A treatment group showed significantly fewer migraine attacks per month, a reduced maximum severity of migraines, a reduced number of days using acute migraine medications, and reduced incidence of migraine-associated vomiting. Both the 25-U and 75-U botulinum toxin type A groups were significantly better than the vehicle group on subject global assessment. Botulinum toxin A treatment was well tolerated, with only the 75-U treatment group exhibiting a significantly higher rate of treatment-related adverse events than vehicle.

Conclusions.—Pericranial injection of botulinum toxin type A, 25 U, was found to be a safe treatment that significantly reduced migraine frequency, migraine severity, acute medication usage, and associated vomiting.

AZ TMJ focuses on the treatment of all types of headaches. Dr. Stan Farrell is a member of the American Headache Society and a Diplomate with the American Board of Orofacial Pain, making him one of the best choices for your migraine headache treatment. As the research has indicated, Botox has been found to be safe and effective in reducing the symptoms of migraine headaches. Our patients are experiencing similar results as found in this study. If you’ve tried numerous treatment options for your headaches and haven’t found relief, this may be an option for you. Schedule an appointment with Dr. Farrell today at 480-945-3629. www.az-tmj.com

Elongated Styloid Process: An Unusual Cause of Neck Pain and Difficulty in Swallowing

2011-10-07T14:10:00.000-07:00

Key Words: Eagle Syndrome, neck pain, TMJ / TMD, styloid process

Deshraj Jain, MDS/Jaideep Singh Chauhan, MDS/Sandhya Jain, MDS/Gaurav Goel, MDS

An elongated styloid process is an unusual source of craniofacial and cervical pain. This condition is characterized by a dull, nagging pharyngeal pain and a palpatory finding in the tonsillar fossa. Eagle described it for the first time in 1937 as Eagle’s Syndrome and divided it into two subtypes: the “classic syndrome” and the “stylo-carotid syndrome.” The syndrome generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings. Palpation of the styloid process in the tonsillar fossa and infiltration with anesthetic are also used for making a diagnosis. This article presents a case report of a patient with a history of throat pain that was relieved after surgical treatment. J Orofac Pain 2011;25:269–271

As this study indicated, Eagle's Syndrome is an unusual source of craniofacial pain and may manifest itself as TMJ / TMD pain or neck pain. Here at AZ TMJ, we’re able to diagnose this syndrome with the use of our imaging equipment and Dr. Stan Farrell’s expertise with these types of disorders. Dr. Farrell is Board Certified in Orofacial Pain making him one of the best choices for your treatment. Call and schedule an appointment at 480-945-3629. www.az-tmj.com

Differences in the Personality Profile of Medication-Overuse Headache Sufferers and Drug Addict Patients

2011-09-30T10:13:00.000-07:00

Keywords: drug addiction; dependence; personality; medication-overuse headache

(Headache 2011;51:1212-1227)

Background.— Medication-overuse headache (MOH) refers to headache attributed to excessive use of acute medications. The role of personality needs studies to explain the shifting from drug use to drug abuse. The main aim of this study is to study personality, according to Minnesota Multiphasic Personality Inventory, comparing MOH, episodic headache, substance addicts (SA) vs healthy controls.

Methods.— Eighty-two MOH patients (mean age 44.5; 20 M, 62 F) and 35 episodic headache (mean age 40.2; 8 M, 27 F), were compared to 37 SA (mean age 32.5; 29 M, 8 F) and 37 healthy controls (mean age: 32.49; 20 M, 17 F). International Classification of Headache Disorders 2nd Edition criteria were employed. Chi-square test, Kruskal-Wallis test, and post hoc comparisons were used for statistics.

Results.— MOH patients scored higher on Hypochondriasis, Depression (only females), Hysteria (only females) (P < .000). MOH did not show higher scores than episodic headache or healthy controls in dependency scales, while SA did.

Conclusion.— The data obtained show that MOH and SA do not share common personality characteristics linked to dependence. Although further studies are needed to understand if such a difference is related to instrumental characteristics or to yet undiscovered psychobiological characteristics of MOH patients; however, we hypothesize that the detected difference may rely on the fact that drug dependence in the 2 groups is promoted by entirely different needs: pleasure seeking in the SA group, pain avoidance in the MOH group.

Medication-overuse headaches are very common. As pain becomes more chronic, many patients begin to take too much medication in order to relieve the pain. It may be as simple as changing the type of medication you’re being prescribed, or better yet, treat the root problem and not just the symptoms. At AZ TMJ, we do just that. Dr. Stan Farrell has extensive training in medication management and the treatment of all types of headaches and facial pain. We focus on non-invasive, non-narcotic treatment methods that have proven to work without the danger of addiction to medication. If you've been prescribed medication for your head, neck or facial pain and are continuing to suffer from headaches, we can help! Call and schedule an appointment with Dr. Farrell at 480-945-3629. www.az-tmj.com

Head and Cervical Posture in Patients with Temporomandibular Disorders

2011-09-23T14:15:00.000-07:00

Key words: cervical posture, head posture, temporomandibular disorders, TMJ, TMD

Publication:
Summer 2011
Volume 25 , Issue 3

Head and Cervical Posture in Patients with Temporomandibular Disorders

Susan Armijo-Olivo, PT, BSc PT, MSc PT, PhD/Karen Rappoport, DDS, Cert Ortho/Jorge Fuentes, PT, BSc PT, MSc PT/Inae Caroline Gadotti, PT, BSc PT, MSc PT, PhD /Paul W. Major, DDS, MSc, FRCD(c)/Sharon Warren, PhD/Norman M.R. Thie, BSc, MSc, DDS, MSc/David J. Magee, PhD, BPT

Aim: To determine whether patients with myogenous or mixed (ie, myogeneous plus arthrogeneous) temporomandibular disorders (TMD) had different head and cervical posture measured through angles commonly used in clinical research settings when compared to healthy individuals.

Methods: One hundred fifty-four persons participated in this study. Of these, 50 subjects were healthy, 55 subjects had myogenous TMD, and 49 subjects had mixed TMD (ie, arthrogenous plus myogenous TMD). A lateral photograph was taken with the head in the self-balanced position. Four angles were measured in the photographs: (1) Eye-Tragus-Horizontal, (2) Tragus-C7-Horizontal, (3) Pogonion-Tragus-C7, and (4) Tragus-C7-Shoulder. Alcimagen software specially designed to measure angles was used in this study. All of the measurements were performed by a single trained rater, a dental specialist in orthodontics, blinded to each subject’s group status.

Results: The only angle that reached statistical significance among groups was the Eye-Tragus-Horizontal (F = 3.03, P = .040). Pairwise comparisons determined that a mean difference of 3.3 degrees (95% confidence intervals [CI]: 0.15, 6.41) existed when comparing subjects with myogenous TMD and healthy subjects (P = .036). Postural angles were not significantly related to neck disability, jaw disability, or pain intensity. Intrarater and interrater reliability of the measurements were excellent, with intraclass correlation coefficient (ICC) values ranging between 0.996–0.998.

Conclusion: The only statistically significant difference in craniocervical posture between patients with myogenous TMD and healthy subjects was for the Eye-Tragus-Horizontal angle, indicating a more extended position of the head. However, the difference was very small (3.3 degrees) and was judged not to be clinically significant. J Orofac Pain 2011;25:199–209

This is very interesting research. It’s important for people seeking treatment for their TMJ to understand the various options that they may encounter when seeking a physician. There are some physicians that believe treating your posture and cervical position will heal many of your facial and neck pain, but as we can see from research, this is not the case. At AZ TMJ, we focus on using treatment methods that have been clinically tested and are backed by research. Dr. Stan Farrell is Board Certified in Orofacial Pain and utilizes many proven non-surgical treatment methods for your TMJ/TMD and migraine headaches. Schedule a consultation at 480-945-3629. http://www.az-tmj.com/

Medicare to Cover Sleep Apnea Testing At Home

2011-09-16T11:07:00.000-07:00

Key Words: Sleep Apnea, Home Sleep Testing, CPAP Alternative, Oral Sleep Appliance

http://www.msnbc.msn.com/id/22542232/ns/health-sleep/t/medicare-cover-sleep-apena-testing-home/

Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.

A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea — letting people snooze in their own beds instead of spending the night in a sleep laboratory.

It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.

"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," says Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.

Today, Medicare pays for sleep apnea treatment only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. The public may comment on the proposal until next week; final approval is expected in March.

While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.

Sleep apnea doesn't just deprive family members of their own zzzz's. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.

Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.

Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.

Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways, and apnea in the family.

Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring — or until daytime sleepiness gets so bad they can't function.

Only then comes the test debate.

There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.

But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles' drive.

Only tests for apnea, not other disorders

For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and doctor checks the recordings later.

"It certainly is possible to diagnose severe apnea at home," adds Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"

Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.

Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients — but should be administered by sleep specialists.

Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.

Lack of support for some

In fact, Medicare concluded a sleep-lab test isn't perfect, either. Only if their doctors certify they're being helped would treatment continue.

That's important, because about half of apnea patients prescribed CPAP struggle to use it, says Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent. What he calls tricks of the trade — trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils — early could keep more of them in care.

Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.

Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.

"There's a different level of comfort being at home," Miles says of the testing.

AZ TMJ is now offering convenient home sleep testing for our sleep apnea patients. Dr. Stan Farrell is a member of the American Academy of Dental Sleep Medicine and has extensive training in the treatment of sleep apnea with an oral sleep appliance. Our sleep appliance is a great alternative to the CPAP, but can also be used with one to improve its performance. If you are unable to tolerate a CPAP, your health is still at risk for many of the symptoms of your sleep disorder. Treatment with an oral sleep appliance may be right for you. Call 480-945-3629 and schedule a consultation with Dr. Farrell today. http://www.az-tmj.com/

Lack of Sleep Can be Deadly

2011-05-20T10:10:00.000-07:00

A Wake-Up Call to Sleepy Workers

Marietta Bibbs, BA, RPSGT, Manager, Sleep Disorders Center

Did you know that lack of sleep can be deadly? The loss of sleep can often be related to several issues, but the various causes of sleepiness can have a cumulative effect. Any combination of these causes can greatly increase one’s risk for a fatigue-related workplace accident or an automobile accident. The cause of sleepiness is most often related to undiagnosed or untreated sleep disorders, but there are other causes that are less often thought about. These include sleep loss from restriction or too little sleep, interrupted or fragmented sleep, chronic sleep debt, circadian rhythm factors associated with driving patterns, work schedules, time spent on a task, using sedating medications and consuming alcohol when one is already tired.

Loss of sleep leads to daytime fatigue and poor functioning during the day. Fatigue has a great impact not only in our workplace, but also in our daily lives. The impact of fatigue leads to impaired reaction time, poor judgment and decision making, problems with information processing and short-term memory, decreased performance, vigilance and motivation and increased moodiness and aggressive behaviors. Many hours of productivity are lost at work because of a chronically-sleepy population.

All of us are at risk for daytime fatigue and sleepiness since we require adequate sleep in order to function at peak. Once we succumb to fatigue, we are at greater risk of having a microsleep–an unintentional episode of sleep that usually lasts 2-3 seconds but can last up to 30 seconds or more. The most frightening thing about microsleep is that it can occur without your knowledge. Only a few seconds of sleep is sufficient time for you to fall asleep at your desk, run off the road while driving or drift into another lane.

The population at greatest risk for fatigue and chronic sleep deprivation is those with undiagnosed and untreated sleep disorders like obstructive sleep apnea. Other at-risk populations include young people under the age of 25, shift workers—particularly those working the night shift, and people who work long hours. Commercial drivers (especially long-haul drivers) and business travelers who spend time driving or flying across time zones may be jet-lagged and have a greater tendency to fall asleep at inappropriate times.

Several tragedies and work-place accidents have been related to chronic fatigue and sleepiness—the Exxon Valdez accident, Three-Mile Island Accident, the ConAir Plane Crash and the Continental Connection Crash near Buffalo, New York in 2009 when pilot error lead to the death of 50 people. Later investigations by the NTSB concluded that the pilots’ performance was likely impaired because of fatigue. On the day of the flight, the captain commuted hundreds of miles and the first officer commuted from the other side of the country prior to reporting for duty. The NTSB concluded that both pilots used an inappropriate facility during their last rest period before the accident flight.

New Jersey was the first state to enact a law (Maggie’s Law) that addresses drowsy driving.

The law was enacted in memory of 20-year-old Maggie McDonnell who was killed by a driver who fell asleep while driving and hit Maggie’s car head-on. The driver admitted that he had been awake for 30 hours and had been using drugs. Maggie’s Law states that a sleep-deprived driver qualifies as a reckless driver who can be convicted of vehicular homicide. Several states now have similar laws in which drowsy driving can be a criminal offense. Driving drowsy also significantly increases the legal risks employers face from extended hours of operation.

Dr. Stan Farrell, with AZ TMJ, can accurately diagnose and treat your Obstructive Sleep Apnea. We offer treatment with an oral sleep appliance as an alternative to using a CPAP. Research has shown that 50-80% of people using a CPAP are non compliant, meaning they're not using them and are still at risk. Oral sleep appliances have been proven to be effective at treating mild to moderate cases of sleep apnea. If you suffer from daytime fatigue, snoring or sleep apnea, you owe it to yourself to schedule an appointment with Dr. Farrell. For more information visit us at, http://www.az-tmj.com/.

Decreased Quality of Life For Facial Pain Patients

2011-05-06T11:28:00.000-07:00

Key words: masticatory muscle pain, neuropathic pain, orofacial pain, psychosocial, sleep quality, TMJ, TMD, migraine headache, sleep apnea

Publication:

Journal of Orofacial Pain
Spring 2011
Volume 25 , Issue 2

Differences in Psychosocial Functioning and Sleep Quality Between Idiopathic Continuous Orofacial Neuropathic Pain Patients and Chronic Masticatory Muscle Pain Patients

Felipe Porto, DDS/Reny de Leeuw, DDS, PhD/Daniel R. Evans, MS/Charles R. Carlson, PhD/Juan F. Yepes, DDS, MD, MPH/Adam Branscum, PhD/Jeffrey P. Okeson, DMD

Aim: To examine differences between idiopathic continuous orofacial neuropathic pain (ICONP) patients and chronic masticatory muscle pain (MMP) patients for psychosocial functioning and sleep quality.

Methods: Archival data were used to compare 81 ICONP patients to 81 age- and sex-matched chronic MMP patients on pain severity, life interference, life control, and affective distress measures from the Multidimensional Pain Inventory (MPI), a global severity index of psychological symptoms from the Symptom Checklist-90-R (SCL-90-R), Posttraumatic Stress Disorder Checklist–Civilian (PCL-C), and overall sleep quality from the Pittsburgh Sleep Quality Index (PSQI). MANOVA, MANCOVA, and chi-square analysis were used to investigate differences between the two groups in the psychosocial and sleep variables.

Results: The ICONP group reported greater pain severity (P = .013) and more life interference (P = .032) than the MMP group, while the MMP group reported higher levels of global psychological symptoms (P = .005) than the ICONP group. After controlling for pain severity, however, the MMP group demonstrated greater affective distress (P = .014) than the ICONP group, and life interference was no longer significantly different between the groups. ICONP patients were more likely to report a traumatic life event (P = .007).

Conclusion: Although ICONP patients are likely to present more intense pain and report that their pain causes more interference in their lives, MMP patients are more likely to present with higher levels of overall psychological symptoms. The greater levels of pain severity reported by ICONP patients appear to be partially responsible for their higher levels of reported life interference. J OROFAC PAIN 2011;25:117–124

This study continues to show the daily effects of facial pain and it's ability to lower one's quality of life. We can see that patients suffering from jaw pain and facial nerve pain report interferences in their daily lives and higher levels of overall psychological symptoms, including lowered sleep quality. Dr. Stan Farrell is Board Certified in Orofacial pain, making him one of the best qualified doctors at treating a wide variety of causes of head and facial pain, TMJ / TMD, migraine headache and trigeminal neuralgia. Visit http://www.az-tmj.com/ for more information.

Adolescents with TMD/TMJ Temporomandibular Disorder Pain

2011-04-29T10:59:00.000-07:00

Publication:

Journal of Orofacial Pain
Spring 2011
Volume 25 , Issue 2

Adolescents with Temporomandibular Disorder Pain—The Living with TMD Pain Phenomenon

Ing-Marie Nilsson, DDS, Odont dr/ Thomas List, DDS, Odont dr/ Ania Willman, RN, PhD

Aims: To acquire a deeper understanding of adolescents’ experiences of living with temporomandibular disorder (TMD) pain.

Methods: Twenty-one adolescents with TMD pain, aged 15 to 19, were strategically selected from a group of patients referred to an orofacial pain clinic. The patients were examined and received diagnoses per the Research Diagnostic Criteria for TMD. One-on-one interviews that followed a semistructured protocol focused on the patient’s experiences of living with TMD pain. The interviews were recorded and transcribed verbatim, followed by content analysis to obtain a deeper understanding of adolescents’ experiences living with TMD pain.

Results: Content analysis led to the overall theme “Adolescents with TMD live with recurrent pain; physical problems and daily demands form a vicious circle that causes adolescents to oscillate between hope and despondency.” The latent content forming the theme is grounded in three categories that evolved from 13 subcategories. For instance, five subcategories—headache; headache on awakening; jaw and tooth pain; constant thoughts of pain; and popping, cracking, clicking, and locking—formed the category that was labeled TMD pain is recurrent. The latent interpretation, ie, the meaning, of this category was that adolescents with TMD pain constantly thought about the pain, even when it was absent.

Conclusion: TMD pain is a substantial problem for affected adolescents and has consequences for all aspects of their lives. In this study, the adolescents were able to talk openly and introduce issues outside of the interview protocol. Qualitative analysis deepens our understanding of the adolescent patient with TMD pain. J OROFAC PAIN 2011;25:107–116

Key words: adolescents, content analysis, headache, interview, TMD pain

TMD/TMJ problems not only effect adults, but are a real common problem among adolescent adults. If your child has complained of headache; headache on awakening; jaw and tooth pain; constant thoughts of pain; and popping, cracking, clicking, and locking, you should seek immediate medical attention. Dr. Stan Farrell has extensive training in the treatment of TMJ/TMD and the many comorbities that go along with these problems. Dr. Farrell is Board Certified with the American Board of Orofacial Pain and is the sole practitioner at his practice AZ TMJ, meaning that your child will only be treated by him. He focuses on non-invasive, conservative treatment methods without the use of narcotics. Visit http://www.az-tmj.com/ for more information about our practice.

Suffering from a Headache? Your Body May Be Telling You Something

2011-04-22T11:13:00.000-07:00

By Dennis Thompson

HealthDay Reporter

TUESDAY, Dec. 21 (HealthDay News) — Headaches are truly miserable things. There’s little good to be said about throbbing, crushing, skull-pounding pain that makes you wince and moan.

Yet headaches can tell a lot about a person. They can indicate things you’re doing that aren’t good for you. They also can warn of serious illness.

“A headache can be a symptom of a simple organic disorder, a serious or complicated disorder, or it can be individually characteristic, like a tension headache or a migraine,” said Dr. Seymour Diamond, director of the Diamond Headache Clinic and director of the inpatient headache unit at Saint Joseph Hospital in Chicago. “There are multiple causes or variations of headaches.”

Dr. Ellen Beck, a family physician and clinical professor in family and preventive medicine at the University of California, San Diego, said that people normally have one of two types of headaches: those that result from muscle tension or strain, known as tension headaches; or headaches that result from swelling of the blood vessels in the tissues surrounding the head, called vascular headaches.

These headaches can be a clue that you’re doing something in your daily life that is causing stress or harm to your body, Beck said. Lifestyle causes of a headache can include:

•Not eating enough
•Dehydration
•Poor posture at a work station
•Eyestrain

“The headache can be a message from your body,” Beck said. “You don’t want to just treat the headache with medicine. You want to play detective and figure out what is causing the headache.”

Beck gave the example of a college student who came to her complaining of frequent and terrible headaches. She asked a few questions and found there was a simple explanation for his pain.

“It turned out he was studying and working so hard that he had forgotten to eat,” she said. The student wouldn’t eat all day long and would then consume a single meal late at night. When he began eating more regularly throughout the day, she said, his headaches largely went away.

One dreaded form of vascular headache is the migraine headache. People who have migraines often find the headache pain to be debilitating. Untreated attacks can last anywhere from four hours to three days, according to the U.S. National Institute of Neurological Disorders and Stroke.

Migraine pain differs significantly from tension headache pain. “Tension headaches tend to feel like a tight band around the head,” Beck said, and they are often accompanied by fatigue.

Migraines are not at all similar, Beck said. “Migraines are more like a hammering, pounding type of headache,” she said. Migraines usually are on one side of the head and sometimes are accompanied by nausea.

The detective work people need to do with migraines is to figure out their warning signs and headache triggers. By learning the telltale signs of an oncoming migraine attack, they can take medicine to stop the headache before it gets started. And, if they can figure out what triggers their migraines, they may be able to put a halt to them by avoiding the triggers.

Warning signs that a migraine may be developing, according to the U.S. National Institute of Neurological Disorders and Stroke, can (but do not always) include:

•An aura in your field of vision
•Difficulty speaking
•Smelling something that’s not there, such as oranges
•Confusion
•Nausea
•Loss of appetite
•Increased sensitivity to bright light or loud noise

Migraine triggers, on the other hand, vary greatly from person to person. Common ones, though, include:

•Certain foods
•Strong odors or fumes
•Mood problems, such as depression or anxiety
•Missed medication doses
•Low blood sugar
•Sudden changes in weather
•Bright or flashing lights
•Menstruation and other hormonal changes

Avoiding these triggers can be as simple as wearing a hat and sunglasses when you’re outside, or ingesting some medication or caffeine just before your period, Beck said.

And then there are signs that a headache might be indicative of a more serious medical condition, such as a tumor or aneurysm, Beck said. Red flags include:

•A type of severe headache pain you’ve never felt before
•Headache pain that won’t respond to medication or other treatment
•Headaches that wake you from your sleep
•Fever accompanying a headache
•Confusion or nerve symptoms along with a headache

“These dangerous headaches are rare, but we physicians want to be able to identify them as soon as possible,” Beck said. “If there’s something that worries you, it’s better to see your physician.”

Diamond agrees. “If you’re getting more than three or four headaches a week, or you’re taking excessive amounts of analgesics on a daily or almost daily basis, you should seek out care,” he said.

More information

The American Academy of Family physicians has more about headache symptoms and diagnosis.

For more on living with migraines, read about one woman’s story.

SOURCES: Ellen Beck, M.D., family physician, San Diego, and clinical professor, division of family and preventative medicine, University of California, San Diego; Seymour Diamond, M.D., director and founder, Diamond Headache Clinic, director, inpatient headache unit, Saint Joseph Hospital, Chicago, and clinical professor, family medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago
Last Updated: Dec. 21, 2010
Copyright © 2010 HealthDay. All rights reserved.

Here at AZ TMJ, Dr. Stan Farrell has extensive training in the treatment of migraine headaches, tension type headaches, and headaches associated with various known triggers, eg. TMJ or muscle spasms. If you suffer from chronic or daily headaches, there is definitely an underlying, more serious problem that should be looked at by an experienced Board Certified doctor. Visit us at www.az-tmj.com for more information on our practice and don't live another day in pain!

BOTOX® Treatments Continue to Produce Immediate Relief from the Pain & Discomfort of TMJ Syndrome

2011-04-15T11:14:00.000-07:00

Published: Wednesday, Mar. 30, 2011
Updated: Wednesday, Mar. 30, 2011

AZ-TMJ BOTOX® Treatments Continue to Produce Immediate Relief from the Pain & Discomfort of TMJ Syndrome

Dr. Stan Farrell’s Expectations for Success Far Surpassed

AZ-TMJ is continuing to lead the way in innovative and effective treatments for severe cases of TMJ. AZ-TMJ has developed treatment methods using BOTOX® to ease painful muscle cramping and spasms, a side effect of clenching and grinding of patients' teeth, which are often symptoms associated with TMJ/TMD. Patients who receive this treatment are consistently obtaining relief from their discomfort and often instantaneously.

“I have found this treatment to be highly effective in a substantial number of cases where the effects of other treatments are often mitigated by the presence of muscle spasms,” said Dr. Stan Farrell. “The BOTOX® treatment I have developed allows other noninvasive treatments to work much more effectively in these instances.”

BOTOX® is a mild neurotoxin that has become a popular beauty treatment but is seldom used in more serious medical applications. However, its ability to relax muscles has been found to aid in the treatment of TMJ cases where the patient is suffering from severe muscle spasms. In many cases the BOTOX® has provided immediate relief from the muscle spasms, reducing pain and allowing for other nonsurgical treatments to take place.

AZ-TMJ’s treatment is a simple, nonsurgical procedure where the BOTOX® is injected into the jaw muscle. The procedure is not time-consuming and only needs an ice pack to help with any possible inflammation. Only the areas injected with BOTOX® will be relaxed. BOTOX® treatment for TMJ therapy will not negatively affect the patient’s body. Furthermore, the FDA has approved BOTOX® for the treatment of several other migraine headache trigger points.

About AZ-TMJ

AZ-TMJ is a clinic focused on the treatment of TMJ, Severe Headaches and Sleep Apnea all of which can be symptoms of an issue with the Temporomandibular Joint, which is where the jaw connects to the cranium. The clinic is lead by Stan Farrell, DDS, FAAOP who received his training in Orofacial Pain at UCLA. He graduated from the School of Dental and Oral Surgery at Columbia University. He is a Diplomate with the American Board of Orofacial Pain. Services provided by an Arizona licensed general dentist. For information regarding TMJ relief, visit the AZ-TMJ website at http://www.az-tmj.com or call AZ-TMJ at (480) 945-3629.

Read more: http://www.bradenton.com/2011/03/30/v-print/3074477/az-tmj-botox-treatments-continue.html#ixzz1JcIhwgDP

Negative Effects of Episodic Migraines on Quality of Life

2011-04-01T09:58:00.000-07:00

Negative Impact of Episodic Migraine on a University Population: Quality of Life, Functional Impairment, and Comorbid Psychiatric Symptoms

Todd A. Smitherman PhD, Michael J. McDermott BA, Erin M. Buchanan PhDArticle first published online: 1 APR 2011
DOI: 10.1111/j.1526-4610.2011.01857.x
(Headache 2011;51:581-589)

Background.— Migraine is associated with significant negative impact, including reduced quality of life, impaired functioning, and comorbid psychiatric disorders. However, the impact of migraine on university students is understudied, despite their high prevalence of migraine and psychiatric disorders and their frequent use in research studies.

Objectives.— The aim of this cross-sectional study was to evaluate the impact of migraine among college students on quality of life, functional impairment, and comorbid psychiatric symptoms.

Methods.— Three hundred and ninety-one students (76.73% female, mean age = 19.43 ± 2.80 years) completed well-validated measures of migraine and migraine-related disability, quality of life, and comorbid psychiatric symptoms. They also quantified impairment in school attendance and home functioning and reported the number of medical visits during the preceding 3 months.

Results.— One hundred and one (25.83%) met conservative screening criteria for episodic migraine; their mean score on the Migraine Disability Assessment Questionnaire was 9.98 ± 12.10. Compared to those not screening positive for migraine, the migraine-positive group reported reduced quality of life on 5 of 6 domains, as well as a higher frequency of missed school days (2.74 vs 1.36), impaired functioning at home (2.84 vs 1.21 days), and medical visits (1.86 vs 0.95). They also reported more symptoms of both depression and anxiety than controls, although differences in functional impairment remained after controlling for these comorbid psychiatric symptoms. These differences were highly statistically significant and corroborated by evidence of clinically significant impairment; the corresponding effect sizes were modest but non-trivial.

Conclusions.— Episodic migraine is associated with negative impact in numerous domains among university students. These findings replicate and extend those of studies on other samples and have implications for future research studies with this population.

If you feel you're suffering from episodic migraines, you owe it to yourself to visit Dr. Stan Farrell at AZ-TMJ. He is Board Certified with the American Board of Orofacial Pain and has extensive training in the treatment of migraine headaches. He uses the latest technology to not only accurately diagnose many migraine headache trigger points, but to treat them as well. As the research concluded, treating your migraine headaches could greatly improve your quality of life. Visit us at http://www.az-tmj.com/

Unnecessary Tooth Extractions in Patients

2011-03-04T09:12:00.000-08:00

Publication:

Journal of Orofacial Pain
Fall 2010
Volume 24 , Issue 4
E-mail Abstract Back

Unnecessary Extractions in Patients with Hemicrania Continua: Case Reports and Implication for Dentistry

Sanjay Prakash, DM/Nilima D. Shah, MD/Bhavna V. Chavda, MD

Headache and facial pain are both very high in the general population. Headache has been identified as one of the associated conditions in patients with chronic orofacial pain. The interrelation between the two has not been explored in the literature. Patients with facial pain often initially seek the care of a dentist. Misdiagnosis and multiple failed treatments (including invasive procedures) are very common in this population. This case report describes four patients whose condition fulfilled the International Headache Society’s criteria for hemicrania continua but whose teeth were extracted because their pain was suspected to be of odontogenic origin. Each patient’s records and the literature were reviewed for possible reasons for the unnecessary extractions. The findings suggest that initial treatment with drugs specific for primary headache disorders should be instituted before subjecting patients to invasive procedures.

J OROFAC PAIN 2010;24:408–411

Dr. Stan Farrell has extensive training in the treatment of TMJ and Migraine Headaches. At AZ TMJ, we focus on conservative treatment methods that have been proven to be successful. TMJ disorders, tooth pain, facial pain and headaches can all be inter-related, meaning an issue with your TMJ could trigger pain in a tooth or manifest itself as a headache. This is why it's important to see a doctor who has extensive training in evaluating not only the teeth, but your joints, muscles and nerves, as well. www.az-tmj.com

Effect of Chewing Upon Disc Reduction in the Temporomandibular Joint

2011-02-25T12:32:00.000-08:00

Publication: Journal of Orofacial Pain
Winter 2011
Volume 25 , Issue 1

Effect of Chewing Upon Disc Reduction in the Temporomandibular Joint

Stanimira Kalaykova, DDS/Frank Lobbezoo, DDS, PhD/Machiel Naeije, PhD

Aims: To test whether an intensive chewing exercise influences the moment of disc reduction in subjects with or without reports of intermittent locking of the jaw.

Methods: This experimental study included 15 subjects with a reducing anteriorly displaced disc (ADD) and with symptoms of intermittent locking and 15 subjects with a reducing ADD without such symptoms. The moment of disc reduction (MDR), quantified using mandibular movement recordings, was recorded at baseline, and after maximally 60 minutes of chewing. Thereafter, MDR was recorded again after 20 minutes of rest, and if necessary after 72 hours, in order to document return of MDR to baseline values.

Results: In subjects without intermittent locking, the MDR after chewing was not different from baseline (P = .25). However, in the subjects with intermittent locking, the MDR value had increased significantly after chewing (P = .008); two subjects showed a later moment of disc reduction, and four showed a temporary loss of disc reduction.

Conclusion: While intensive chewing did not influence disc reduction in subjects without intermittent locking, it caused a delay or even hampered disc reduction in approximately half of the subjects reporting intermittent locking.

This suggests that increased TMJ loading may influence the moment of disc reduction during mouth opening and may also facilitate the development of an anterior disc displacement with out reduction (ADDRWoR).

J OROFAC PAIN 2011;25:49–55

Dr. Stan Farrell focuses on the treatment of TMJ disorders and has developed many innovative treatments that can limit the effects of chewing on the Temporomandibular Joint and disc. Many of our patients find immediate relief from their myofacial pain and pain associated with a displaced disc (locked jaw), after visiting AZ TMJ. http://www.az-tmj.com/

Giant cell arteritis misdiagnosed as temporomandibular disorder

2011-02-18T12:34:00.000-08:00

Here is an interesting abstract on research found regarding the misdiagnosis of TMJ/TMD:

J Orofac Pain. 2009 Fall;23(4):360-5.

Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature.

Reiter S, Winocur E, Goldsmith C, Emodi-Perlman A, Gorsky M.
Deparment of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv Unversity, Tel Aviv, Israel. shosh5@bezeqint.net

Abstract

Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large-sized arteries, most commonly the extracranial branches of the carotid artery. Early diagnosis and treatment are essential to avoid severe complications. This article reports on a GCA case and discusses how the orofacial manifestations of GCA can lead to misdiagnosis of GCA as temporomandibular disorder. GCA should be included in the differential diagnosis of orofacial pain in the elderly based on the knowledge of related signs and symptoms, mainly jaw claudication, hard end-feel limitation of range of motion, and temporal headache.

Dr. Stan Farrell is Board Certified and has extensive training in the treatment of TMJ disorders and migraine headaches. His education and training allows him to be able to accurately diagnose if a patient has GCA and not a TMJ disorder. Here at AZ TMJ, we use the latest technology in imaging and treatment methods, to give our patients the best quality care they deserve. www.az-tmj.com

Stress & TMJ Syndrome: Is Your Stressful Life Taking a Physical Toll on Your Body?

2011-02-08T07:23:00.000-08:00

Follow the link to see Dr. Stan Farrell's article on CNBC.

Stress & TMJ Syndrome: Is Your Stressful Life Taking a Physical Toll on Your Body?

Treatment of temporomandibular disorders by stabilising splints in general dental practice: results after initial treatment

2011-02-04T13:15:00.000-08:00

British Dental Journal 197, 35 - 41 (2004)
Published online: 10 July 2004
doi:10.1038/sj.bdj.4811420
Subject Category: TMD disorders

Treatment of temporomandibular disorders by stabilising splints in general dental practice: results after initial treatment

R W Wassell1, N Adams2 & P J Kelly3

•During the first six weeks of treatment, the occlusal surface of the splint made no significant contribution to any of the outcomes measured suggesting that the occlusion is a relatively unimportant factor influencing recovery in the majority of TMD patients seen in practice.

•A small proportion of patients needed treatment for up to five months to obtain a satisfactory response. These were the patients who crossed over from the non-occluding control splint to the stabilising splint. They tended to be older with TMJ clicking.

•Clicking was not especially responsive to treatment with the stabilising splint, but discomfort was reduced in three quarters of patients with clicking TMJs. It was difficult to make a reliable diagnosis of disc displacement with reduction using the trial criteria.

•Suitably trained practitioners can manage four out of five TMD patients; a link with specialist services is recommended to deal with non-responding patients.

Dr. Stan Farrell, at AZ TMJ, has dedicated his practice to the treatment of TMJ Disorders and has developed custom stabilizing splints, that minimize the effect on occlusion and allow the Temporomandibular Joint (TMJ) to heal and find a natural resting place. Dr. Farrell's conservative treatment approach has been highly successful; with many patients experiencing immediate relief. www.az-tmj.com

Diagnosis and Treatment of Snoring in Adults

2011-01-28T09:47:00.000-08:00

Sleep Breath. 2010 Dec;14(4):317-21. Epub 2010 Jul 18.

Diagnosis and treatment of snoring in adults--S1 guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery.

Stuck BA, Abrams J, de la Chaux R, Dreher A, Heiser C, Hohenhorst W, Kühnel T, Maurer JT, Pirsig W, Steffen A, Verse T.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.

Abstract

INTRODUCTION: Snoring has received increased attention over the last years. Given its high prevalence and its impact on quality of life, diagnosis and treatment of snoring are of major importance.

AIM OF THE GUIDELINE: This guideline aims to promote high-quality care by medical specialists for adults who snore.

DIAGNOSTIC MEASURES: Before every intervention, a medical history, clinical examination and sleep test need to be performed.

INTERVENTIONS: There is no need to treat snoring unless requested by the snorer. Invasive treatments should be selected with care; for surgical treatment, minimally invasive procedures are preferred. Weight reduction; the avoidance of sleeping pills, alcohol and nicotine; and a regular sleep-wake cycle can be recommended, although convincing evidence is lacking. Since currently, there is not enough evidence to confirm the effectiveness of muscle stimulation or other forms of muscle training, these treatments cannot be recommended. Snoring can be treated successfully with intraoral devices, but it is essential to select suitable subjects. Devices preventing sleep in the supine position can also be helpful in selected cases. The data on the success rates of surgical intervention are often limited to short-term follow-up studies, and not all interventions have been sufficiently evaluated. The techniques used to treat nasal obstruction in snorers are identical to those used for general nasal obstruction. Nasal surgery is only indicated when subjects complain about nasal obstruction. A significant amount of data is available for laser-assisted resection of excessive mucosa; however, resections can be performed with other tools. The efficacy of radiofrequency surgery at the soft palate has been documented in placebo-controlled trials. Soft palate implants can reduce snoring. Tonsillectomy or uvulopalatopharyngoplasty should be selected with care, especially as less invasive alternatives are available.

INTRAORAL DEVICES: Enlarge the pharynx in the anterior-posterior dimension. A significant improvement in snoring can be expected if subjects are assessed and appropriately selected with regard to individual anatomy (e.g. jaw mobility, dental status and body mass index). Regular follow up visits are necessary for early detection of potential dental side effects. Close collaboration with a dentist is recommended for indication, adjustment and follow up with an intraoral device.

Dr. Stan Farrell has extensive training in Sleep Medicine. Patients at AZ TMJ / AZ Sleep can expect a thorough evaluation of their individual cases to see if an intraoral device is right for them. Dr. Farrell can make a custom device and perform all the necessary follow up to ensure maximum effectiveness. http://www.az-tmj.com/treatment-sleep.php

Temporomandibular Disorders and Associated Clinical Comorbidities

2011-01-21T11:40:00.000-08:00

Clinical Journal of Pain:

POST AUTHOR CORRECTIONS, 20 December 2010

doi: 10.1097/AJP.0b013e31820215f5

Temporomandibular Disorders and Associated Clinical Comorbidities

Abstract Objective: Temporomandibular joint and muscle disorders (TMJD) are ill-defined, painful debilitating disorders. This study was undertaken to identify the spectrum of clinical manifestations based on self-report from affected patients.

Methods: A total of 1511 TMJD-affected individuals were recruited through the web-based registry of patients maintained by The TMJ Association, Ltd, a patient advocacy organization, and participated in the survey as well as 57 of their nonaffected friends. Results were also compared with US population for questions in common with the National Health and Nutrition Examination Survey.

Results: The TMJD-affected individuals were on average 41 years of age and predominantly female (90%). Nearly 60% of both men and women reported recent pain of moderate-to-severe intensity with a quarter of them indicating interference or termination of work-related activities. In the case-control comparison, a higher frequency of headaches, allergies, depression, fatigue, degenerative arthritis, fibromyalgia, autoimmune disorders, sleep apnea, and gastrointestinal complaints were prevalent among those affected with TMJD. Many of the associated comorbid conditions were over 6 times more likely to occur after TMJD was diagnosed. Among a wide array of treatments used (46 listed), the most effective relief for most affected individuals (91%) was the use of thermal therapies-hot/cold packs to the jaw area or hot baths. Nearly 40% of individuals affected with TMJD patients reported one or more surgical procedures and nearly all were treated with one or many different medications. Results of these treatments were generally equivocal. Although potentially limited to the most severe TMJD affected individuals, the survey results provide a comprehensive dataset describing the clinical manifestations of TMJD.

Discussion: The data provide evidence that TMJD represent a spectrum of disorders with varying pathophysiologies, clinical manifestations, and associated comorbid conditions. The findings underscore the complex nature of TMJD, the need for more extensive interdisciplinary basic and clinical research, and the development of outcome-based strategies to more effectively diagnose, prevent, and treat these chronic, debilitating conditions.

(C) 2010 Lippincott Williams & Wilkins, Inc.

Also, according to an article posted at www.Fibromyalgia-Symptoms.org, 75% of fibromyalgia sufferers also have TMJ / TMD, or Temporal Mandibular Joint Dysfunction.

In May of 2007, the Orofacial Pain Center of the University of Kentucky in Lexington (rbalasub@dental.upenn.edu) published the results of a study comparing the prevalence of temporomandibular disorders in fibromyalgia and “failed back syndrome” patients. 53% of the Fibromyalgia patients reported having face pain compared with 11% of the FBS patients. Of those Fibromyalgia patients who reported face pain, 71% fulfilled the criteria for a diagnosable TMD.

Dr. Stan Farrell, AZ TMJ and his sister Dr. Estelle Farrell, Arizona PM&R are working closely together to help patients find relief for many of these comorbidities. Dr. Farrell focuses on conservative treatments, without the use of narcotics or surgical procedures. www.az-tmj.com

TMJ Treatment Using Botulinum Toxin A - Botox (Allergen)

2011-01-14T13:17:00.000-08:00

British Dental Journal 183, 415 - 417 (1997)

Published online: 13 December 1997
doi:10.1038/sj.bdj.4809523

Medical treatment of recurrent temporomandibular joint dislocation using botulinum toxin A

A P Moore & G D Wood

Abstract

This paper describes a new technique for prophylactic treatment of recurrent mandibular dislocation using injection of botulinum toxin A (BtA) into the lateral pterygoid muscles. BtA temporarily weakens muscles by blocking acetylcholine release, and thus operates through a principle different from established treatments such as joint sclerosant therapy, eminectomy or Dautry's procedure. The patient suffered recurrent mandibular dislocations caused by tardive dystonia. We injected 75 mu BtA percutaneously into each lateral pterygoid muscle under electromyographic guidance. No further dislocations occurred over the subsequent 10 months, and follow-up continues. There were no immediate or delayed side effects. More experience is required before this becomes an established treatment. BtA is usually given in outpatients, and is less invasive or destructive than previous options. It may not be suitable if dislocation is due to lax ligaments or weak muscles. Operators must be aware that other BtA preparations require a different dose

Dr. Stan Farrell is now utilizing the use of botulinum toxin A (Botox, Allergen Brand) in the treatment of TMJ / TMD, headaches and migraines at AZ TMJ. http://www.az-tmj.com/

Narcotic Painkillers May Pose Danger to Elderly Patients

2010-12-17T11:06:00.000-08:00

December 13, 2010

The New York Times

Narcotic Painkillers May Pose Danger to Elderly Patients, Study Says By BARRY MEIER

Older patients with arthritis who take narcotic-based drugs to relieve pain face a higher risk of bone fracture, heart attack and death when compared to those taking non-narcotic drugs, according to a government-financed study published Monday.

The study, in The Archives of Internal Medicine, appears to be the first large-scale effort to look at the comparative safety risks for the elderly taking different classes of painkillers. The use of narcotic painkillers has increased in recent years because of a prevailing belief that such drugs were safer for older patients than non-narcotic drugs like Advil and Motrin.

The review, financed by the federal Agency for Healthcare Quality and Research, appears to undercut that assumption. The report, which was based on an analysis of patient health care records, was conducted by researchers at Brigham and Womens Hospital in Boston.

“Doctors should not assume that opioids are a safer alternative,” to other painkillers, said Daniel H. Solomon, the study’s researcher, said in a telephone interview on Monday. “They seem to carry profound risks to cardiovascular system as well as increased risk fractures and appear to be associated with increased risk of death.”

The study does not raise questions about the use of powerful narcotics like OxyContin to treat severe pain resulting from cancer or other conditions.

To conduct the study, Dr. Solomon reviewed the experience of Medicare recipients in both New Jersey and Pennsylvania who were found during a six-year period to have osteoarthritis or rheumatoid arthritis. Using statistical methods, researchers divided those patients, predominantly women with a mean age of 80 years, into three groups based on their pain medications.

Patients in one group received a narcotic-based painkiller. The second group took a non steroidal anti-inflammatory drug like Advil or Aleve. The third group took another class of pain drugs called coxibs, which include Celebrex and Vioxx, a drug that is no longer on the market.

Because the study was based on records, it could not identify all factors that might have contributed to a patient’s problems. But researchers found that the overall risk of death was twice as high for patients taking a narcotic painkiller when compared to those taking a non steroidal anti-inflammatory drug.

More specifically, patients in the narcotic group were four times more likely to experience a compound bone fracture, apparently as a result of a fall, and they were twice as likely to have a heart attack. The cardiovascular risks posed by narcotics were the same as for drugs like Celebrex and Vioxx, which have come under scrutiny for that hazard.

The review also found that the rate of gastrointestinal bleeding among patients taking narcotics was about the same as those taking drugs like Advil and Aleve. A principal reason that medical experts have advocated narcotics in older patients is the belief that they reduce such problems.

In an commentary accompanying the new report, two physicians at Yale University Medical School, Dr. William C. Becker and Dr. Patrick G. O’Connor, wrote that the study’s findings, like those regarding bleeding ulcers, could be skewed by undocumented patient use of over-the-counter painkillers. They added, however, that the high incidence of bone fractures, which often lead to fatal complications in the elderly, were troublesome.

In a related study that was also published Monday in The Archives of Internal Medicine, Dr. Solomon and other researchers looked at the comparative risks posed by different narcotics.

Using the same patient records, they reported that cardiovascular risks were highest for codeine and that codeine and oxycodone, the active ingredient in drugs like OxyContin, posed higher mortality-related risks than hydrocodone, the active ingredient in drugs like Vicodin.

The Food and Drug Administration recently moved to stop sales of one narcotic painkiller, proproxyphene, citing its heart risks. The drug was used in both Darvon and Darvocet.

Dr. Stan Farrell, AZ TMJ, focuses on using treatment methods for headache, migraine and TMJ / TMD pain that provide relief without the use of narcotics. http://www.az-tmj.com/

The Stress and Migraine Interaction

2010-12-10T09:24:00.000-08:00

Khara M. Sauro MSc, Werner J. Becker MD, FRCPCArticle first published online: 8 JUL 2009 DOI: 10.1111/j.1526-4610.2009.01486.x
© 2009 the Authors. Journal compilation © 2009 American Headache Society

There are several ways in which stress may interact with migraine in those predisposed to migraine attacks. These interactions may result from biochemical changes related to the physiological stress response, as, for example, the release of corticotrophin releasing hormone, or from changes induced by the psychological response to stressors. Stress is the factor listed most often by migraine sufferers as a trigger for their attacks, but in addition there is evidence that stress can help initiate migraine in those predisposed to the disorder, and may also contribute to migraine chronification. Migraine attacks themselves can act as a stressor, thereby potentially leading to a vicious circle of increasing migraine frequency. Since the important factor in the stress–migraine interaction is likely the individual's responses to stressors, rather than the stressors themselves, the acquisition of effective stress management skills has the potential to reduce the impact of stressors on those with migraine.

Dr. Stan Farrell, AZ TMJ, focuses on providing our patients with headache relief during their times of increased stress related migraine attacks. Dr. Farrell has many proven treatments that can often provide immediate migraine relief. http://www.az-tmj.com/

Stress and the Holidays

2010-11-24T12:02:00.000-08:00

Title: Stress, depression and the holidays: 10 tips for coping
Author: By Mayo Clinic Staff
Publication: MayoClinic.com
Publisher: Mayo Foundation for Medical Education and Research
Date: Oct 20, 2009
© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

Stress, depression and the holidays: 10 tips for coping

Stress and depression can ruin your holidays and hurt your health. Being realistic, planning ahead and seeking support can help ward off stress and depression.

By Mayo Clinic staff

The holiday season, which begins for most Americans with Thanksgiving and continues through New Year's Day, often brings unwelcome guests — stress and depression. And it's no wonder. In an effort to pull off a perfect holiday, you might find yourself facing a dizzying array of demands — parties, shopping, baking, cleaning and entertaining, to name a few. So much for peace and joy, right?

Actually, with some practical tips, you can minimize the stress and depression that often accompany the holidays. You may even end up enjoying the holidays more than you thought you would.

Recognize holiday triggers

Learn to recognize common holiday triggers, so you can disarm them before they lead to a meltdown:

Relationships. Relationships can cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you're thrust together for several days. On the other hand, facing the holidays without a loved one can be tough and leave you feeling lonely and sad.
Finances. With the added expenses of gifts, travel, food and entertainment, the holidays can put a strain on your budget — and your peace of mind. Not to mention that overspending now can mean financial worries for months to come.
Physical demands. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burning the wick at both ends makes you more susceptible to colds and other unwelcome guests.

Tips to prevent holiday stress and depression

When stress is at its peak, it's hard to stop and regroup. Try to prevent stress and depression in the first place, especially if the holidays have taken an emotional toll on you in the past.

Acknowledge your feelings. If someone close to you has recently died or you can't be with loved ones, realize that it's normal to feel sadness and grief. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.
Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.
Be realistic. The holidays don't have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can't come to your house, find new ways to celebrate together, such as sharing pictures, emails or videotapes.
Set aside differences. Try to accept family members and friends as they are, even if they don't live up to all your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they're feeling the effects of holiday stress and depression too.
Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someones name, give homemade gifts or start a family gift exchange.
Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That will help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.
Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can't participate in every project or activity. If it's not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.
Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

Take control of the holidays

Don't let the holidays become something you dread. Instead, take steps to prevent the stress and depression that can descend during the holidays. With a little planning and some positive thinking, you may find that you enjoy the holidays this year more than you thought you could.

Here at AZ TMJ (Dr. Stan Farrell), we want you to have the most enjoyable holiday season as possible. We typically see an increase in TMJ / TMD, headache and migraine symptoms during this time of year due to increased stress levels. Hopefully there was some useful information in this article to help you get through this busy time of year stress free! If you feel your symptoms are severe don't hesitate to contact us or your health care provider. http://www.az-tmj.com/

Headache and Symptoms of Temporomandibular Disorder

2010-11-19T09:55:00.000-08:00

Gonçalves, D. A., Bigal, M. E., Jales, L. C., Camparis, C. M. and Speciali, J. G. (2010), Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study. Headache: The Journal of Head and Face Pain, 50: 231–241. doi: 10.1111/j.1526-4610.2009.01511.x

Objectives.— A population-based cross-sectional study was conducted to estimate the prevalence of migraine, episodic tension-type headaches (ETTH), and chronic daily headaches (CDH), as well as the presence of symptoms of temporomandibular disorders (TMD) in the adult population.

Background.— The potential comorbidity of headache syndromes and TMD has been established mostly based on clinic-based studies.

Methods.— A representative sample of 1230 inhabitants (51.5% women) was interviewed by a validated phone survey. TMD symptoms were assessed through 5 questions, as recommended by the American Academy of Orofacial Pain, in an attempt to classify possible TMD. Primary headaches were diagnosed based on the International Classification of Headache Disorders.

Results.— When at least 1 TMD symptom was reported, any headache happened in 56.5% vs 31.9% (P < .0001) in those with no symptoms. For 2 symptoms, figures were 65.1% vs 36.3% (P < .0001); for 3 or more symptoms, the difference was even more pronounced: 72.8% vs 37.9%. (P < .0001). Taking individuals without headache as the reference, the prevalence of at least 1 TMD symptom was increased in ETTH (prevalence ratio = 1.48, 95% confidence interval = 1.20-1.79), migraine (2.10, 1.80-2.47) and CDH (2.41, 1.84-3.17). At least 2 TMD symptoms also happened more frequently in migraine (4.4, 3.0-6.3), CDH (3.4; 1.5-7.6), and ETTH (2.1; 1.3-3.2), relative to individuals with no headaches. Finally, 3 or more TMD symptoms were also more common in migraine (6.2; 3.8-10.2) than in no headaches. Differences were significant for ETTH (2.7 1.5-4.8), and were numerically but not significant for CDH (2.3; 0.66-8.04).

Conclusion.— Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine.

This study, once again, confirms what we have seen in numerous studies, that there is a relationship between TMJ disorders and chronic migraine or chronic daily headaches. Dr. Stan Farrell has developed "The Farrell Splint" to help patients with severe TMD disorders, CDH, ETTH and Chronic Migraines at his Scottsdale, AZ practice. http://www.az-tmj.com/

TMJ Disorders a Leading Source of Migraine Headaches, Innovative Treatments Found at AZ-TMJ Dr. Stan Farrell's Practice a Leading Center for Effective Migraine Treatments - CNBC

2010-11-17T15:42:00.000-08:00

TMJ Disorders a Leading Source of Migraine Headaches, Innovative Treatments Found at AZ-TMJ Dr. Stan Farrell's Practice a Leading Center for Effective Migraine Treatments - CNBC

2010-11-12T10:32:00.000-08:00

Headache. 2010 Sep 1;50(8):1306-1312. Epub 2010 Feb 12.

Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study.

da Silva Jr A, Costa EC, Gomes JB, Leite FM, Gomez RS, Vasconcelos LP, Krymchantowski A, Moreira P, Teixeira AL.

From the UFMG - Headache Clinic, Belo Horizonte, Brazil (A. da Silva Jr, E.C. Costa, J.B. Gomes, and F.M. Leite); University Hospital, Federal University of Minas Gerais - Headache Clinic, Neurology Division, Belo Horizonte, Brazil (R.S. Gomez); Federal University of Minas Gerais (UFMG) - Internal Medicine, Belo Horizonte, Brazil (L.P. Vasconcelos and A.L. Teixeira); Universidade Federal Fluminense - Neurology, Rio de Janeiro, Brazil (A. Krymchantowski); Universidade Federal Fluminense - Headache Clinic, University Hospital, Rio de Janeiro, Brazil (P. Moreira); Federal University of Minas Gerais (UFMG) - Laboratory of Immunopharmacology, Belo Horizonte, Brazil (A.L. Teixeira).

Abstract

Background.- Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking.
Objectives.- To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil.
Methods.- This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively.
Results.- A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1%) of them.
Conclusions.- The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers. (Headache 2010;50:1306-1312).

As for the individuals with TMD, trigger points were detected in the masticatory or accessory system (myofacial pain) and 36% had also articular dysfunctions.

Through much of our research here at AZ TMJ, we have found that once our patients TMD symptoms are treated, many find relief of their Chronic Daily Headache / Migraines and psychiatric disorders. Future studies are needed to clarify the nature of these relationships. Dr. Stan Farrell is focused on finding new and innovative ways to treat CDH, CM, Headache and TMD disorders. http://www.az-tmj.com/

Signs of Temporomandibular Disorders in Migraine Patients

2010-11-05T12:40:00.000-07:00

Clinical Journal of Pain:
June 2010 - Volume 26 - Issue 5 - pp 418-421

by Stuginski-Barbosa, Juliana DDS

Objectives: To identify signs of temporomandibular disorders and cervical pain in individuals with episodic and chronic (transformed) migraine (CM), relative to controls without headaches.

Methods: In this prospective, controlled, double-blind study, we examined 93 individuals divided in 3 groups: episodic migraine EM, (n=31), CM chronic migraine (n=34), and controls without migraine (n=28). We recorded signs of temporomandibular disorders, and of pain in the neck, after the protocol of Helkimo (1974). We calculated the odds ratio (OR) and confidence intervals (CI) of symptoms as a function of headache status. Data from all groups were paired and compared using the χ2 test. The level of significance was 5% in 2-tailed tests.

Results: Relative to controls, participants with EM and CM were significantly more likely to have tenderness in the masticatory muscles [controls=28%, migraine=54%, (OR=3.0, 95% CI=1.1-8.9), CM=73% (OR=6.9, 95% CI=2.3-21.2)], and in the temporomandibular joint [controls=25%, migraine=61%, (OR=4.7, 95% CI=1.5-14.5), CM=61% (OR=4.8, 95% CI=1.6-14.5)]. They were numerically (but nonsignificantly) more likely to have limited lateral jaw movements (CM=34%; EM=26%; NP=18%), joint sounds (CM=44%; EM=29%; NP=28%), and tenderness in neck muscles (CM=64%; EM=51%; NP=35%).

Conclusion: In a tertiary care population, individuals with EM and CM are more likely to have tenderness at the temporomandibular joint and on the masticatory muscles, relative to controls. Studies are needed to investigate whether treatment of 1 disorder will improve the other.

As you can see in the studies results, there is a relationship between Chronic Migraine and Temporomandibular Joint Disorders (TMD) in many cases. Here at AZ TMJ, we have found that when we treat a patients' TMJ problems they have significant relief from their Chronic Migraine symptoms. Dr. Stan Farrell is continuing to research this relationship and develop further non-surgical treatments. Visit our website for more information, http://www.aztmj.com/.

Temporomandibular Disorder and Ear Symptoms

2010-10-29T12:17:00.000-07:00

In a study written by Kent W. Cox, MD, PhD, "Temporomandibular Disorder and New Aural Symptoms", Arch Otolaryngol Head Neck Surg. 2008:134 (4): 389-393, it was found that 10% of all new otolaryngology (ENT) clinic patients were diagnosed as having Temporomandibular Disorder (TMD). Of the studied patients with TMD, 35% listed the ear as one of their sites of pain.

The prevelance of each of the 8 aural symptoms assessed was significantly higher in TMD patients compared with controls (P<.001). A warm and/or fluid sensation in the ear and a stuffed cotton sensation in the ear were the most indicative symptoms of TMD because they had the highest relative risk ratios in TMD patients. Aural symptoms of loud noise sensitivity and cold air/wind sensitivity are also relevant and were approximately 5 times more frequent in TMD subjects than in controls. (Cox, “Temporomandibular,” p. 389-393.)

In conclusion,

Patients with TMD are a significant component to an otolaryngology practice. There are previously uninvestigated aural symptoms that occur much more frequently in TMD patients than in patients without TMD. (Cox, “Temporomandibular,” p. 389-393.)

This study is consistent with the findings of Dr. Stan Farrell, in that, 90% of the patients treated in our practice (AZ TMJ) who express some sort of ear pain and dizziness have significant relief of these symptoms after their TMD issues have been treated. Additionally, over 50% of patients who express that they have ringing in the ear have significant relief of these symptoms after their TMD issues have been treated. http://www.aztmj.com/.

Method of Injection of Botox for Chronic Migraine is Safe and Effective Treatment

2010-10-22T14:09:00.000-07:00

Chronic migraines are a disabling neurological disorder that affects 1.4 to 2.2% of the general population, according to the Headache Journal of Head and Face Pain. These are patients who experience headaches more than 15 days per month, lasting longer than a 3 month period. The overuse of headache medications can be a real problem for these types of patients. OnabotulinumtoxinA (Botox; Allergan Brand) has now been FDA approved for the treatment of migraine headaches. OnabotulinumtoxinA (Botox) has been reported to relieve pain in a variety of conditions, including migraine headaches. In a recent study in Headache Journal of Head and Face Pain, 89% of patients with episodic migraine who were treated with OnabotulinumtoxinA had complete or partial response of their migraine symptoms, including headache. The conclusion of the study was that OnabotulinumtoxinA (Botox) has been found to be effective, safe, and well-tolerated for the prophylaxis of headache in adults with chronic migraines at doses ranging from 155 to 195 units administered across 7 head and neck muscles (corrugators, procerus, frontalis, temporalis, occipitalis, cervical paraspinal and trapezius) every 12 weeks for up to 5 treatment cycles. Dr. Stan Farrell is now using Botox for the treatment of chronic migraines, headaches and TMJ disorders at his Scottsdale practice, AZ-TMJ. www.aztmj.com

Side Effects of Boil and Bite Type Oral Appliance Therapy in Sleep Apnea Patients

2010-09-24T09:31:00.000-07:00

In the September 2010 Journal of Sleep and Breathing, an interesting study was conducted regarding the side effects of boil and bite type oral appliance therapy for sleep apnea. It was concluded that:

Nonusers complained more about ill-fitting appliances when compared to users, and "uncomfortable" was the main reason given to discontinue therapy. Even though we did not have PSG results for every patient, TheraSnore does appear to be less effective than a custom-made appliance. Since the TheraSnore is a ready-made appliance available in only one standard size, by design, it may result in a less than optimal fit and subsequently decrease overall compliance when compared to custom-made appliances. This study suggests that boil and bite appliances may not be always the alternative for custom-made appliances.

Dr. Stan Farrell is providing his patients with a custom-made oral appliance for the treatment of sleep apnea in his practice, AZ-Sleep (www.azsleep.net), located in Scottsdale, AZ.

Prevalence of TMD in Obstructive Sleep Apnea Patients

2010-09-10T09:55:00.000-07:00

In a recent study in The Journal of Orofacial Pain, it was concluded that the prevalence of pain associated with TMD (Temporomandibular Disorders) and the impact of this dysfunctional pain were high in OSAS (Obstructive Sleep Apnea Syndrome) patients referred for oral appliance therapy.

The findings suggest that standardized criteria for TMD diagnosis should be part of the examination procedure for OSAS patients referred for oral appliance treatment. They also suggest that support therapy for TMD should be used by OSAS patients undergoing oral appliance therapy, and by patients with preexisting TMD symptoms. Support therapy could prevent or reduce pain associated with TMD.

Further studies are needed to understand the connection between sleep quality and the incidence of TMD.

Testosterone Replacement in Chronic Pain Patients

2010-08-27T10:01:00.000-07:00

In the latest issue of Practical Pain Management, there's research that shows that chronic pain contributes to lower testosterone in both males and females. If you increase the testosterone levels to a normal level, pain improves and becomes more manageable. Dr. Farrell is going to investigate this type of treatment and look at possibly incorporating the management of testosterone levels as part of many patients' treatments. Since we have a portion of our patient base on HCG for weight loss and HCG increases testosterone, we can observe whether or not these patients exhibit better pain control.

In-Home Sleep Diagnostic Equipment

2010-08-13T11:43:00.000-07:00

In the latest issue of Sleep and Breathing Journal, a recent study of the diagnostic performance of an in-home sleep diagnostic unit was found to be an accurate screening tool for sleep apnea in a population with high prevalence of the disorder. Dr. Farrell is now using in-home sleep diagnostic equipment to accurately screen and treat sleep apnea disorders. Sleep apnea causes non-restorative sleep and excessive daytime sleepiness and is associated with hypertension, heart disease, stroke, congestive heart failure. Sleep apnea is a considerable health concern.

Dr. Farrell's "Sonoran Living" segment on Channel 15

2010-08-02T14:09:00.000-07:00

Follow the link to watch Dr. Farrell's latest TV Segment on Channel 15, "Sonoran Living"

http://www.abc15.com/dpp/lifestyle/sonoran_living/sl_sponsors/jaw-pain-and-headaches%3F-head-to-az-tmj-%28sponsor-of-sonoran-living-live%29

Phoenix Magazine (August 2010) Q&A Feature

2010-07-23T10:57:00.000-07:00

See Dr. Farrell's attached Q&A feature in the latest issue of Phoenix Magazine. The issue is dedicated to the Best Schools and Top Dentists in the valley.

Are headache and temporomandibular disorders related? A blind Study.

2010-07-12T14:58:00.000-07:00

Cephalalgia. 2008 Aug;28(8):832-41. Epub 2008 May 21.

Are headache and temporomandibular disorders related? A blinded study.

Ballegaard V, Thede-Schmidt-Hansen P, Svensson P, Jensen R.
Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. vibececilie@gmail.com

Abstract

To investigate overlaps between headache and temporomandibular disorders (TMD) in a clinical headache population and to describe the prevalence of TMD in headache patients, 99 patients referred to a specialized headache centre were diagnosed according to Research Diagnostic Criteria for TMD (RDC/TMD) and classified in headache groups according to the International Classification of Headache Disorders, second edition for headache diagnoses in a blinded design. The prevalence of TMD in the headache population was 56.1%. Psychosocial dysfunction caused by TMD pain was observed in 40.4%. No significant differences in TMD prevalence were revealed between headache groups, although TMD prevalence tended to be higher in patients with combined migraine and tension-type headache. Moderate to severe depression was experienced by 54.5% of patients. Patients with coexistent TMD had a significantly higher prevalence of depression-most markedly in patients with combined migraine and tension-type headache. Our studies indicate that a high proportion of headache patients have significant disability because of ongoing chronic TMD pain. The trend to a higher prevalence of TMD in patients with combined migraine and tension-type headache suggests that this could be a risk factor for TMD development. A need for screening procedures and treatment strategies concerning depression in headache patients with coexistent TMD is underlined by the overrepresentation of depression in this group. Our findings emphasize the importance of examination of the masticatory system in headache sufferers and underline the necessity of a multidimensional approach in chronic headache patients.

PMID: 18498400 [PubMed - indexed for MEDLINE]

Your Life A to Z - Dr. Stan Farrell

2010-07-12T14:49:00.000-07:00

Link to Dr. Stan Farrell's segment on "Your Life A to Z"

2010-06-04T12:00:00.000-07:00

Follow the youtube link to watch Dr. Stan Farrell's segment on Sleep Apnea and Snoring that aired May 24th, 2010 on Channel 3: http://www.youtube.com/watch?v=g8MezAh82v4

"Your Life A to Z" Channel 3

2010-05-21T14:41:00.000-07:00

Tune in Monday, May 24th, 2010 at 10:00AM to see Dr. Stan Farrell on "Your Life A to Z" on local Channel 3. Dr. Farrell will be discussing Sleep Apnea and how to treat it. If you miss it, check back and we'll have a link to the show next week. Visit www.az-tmj.com or www.azsleep.net for more information.

2010-05-14T12:42:00.000-07:00

This past month at the American Academy of Orofacial Pain Annual Conference, Dr. Farrell received his certificate of Fellowship. We are honored by his accomplishment and dedication to the field of Orofacial Pain, treating TMJ, headache, and sleep apnea over the years. Congratulations, to Dr. Stan Farrell.

2009-09-08T14:35:00.000-07:00

TMD symptoms include pain or discomfort in or around the ear, jaw joint, and/or muscles of the jaw, face, temples and neck.

2009-08-27T10:24:00.000-07:00

Identification of the type of headache is crucial to treatment; many headaches are triggered and maintained by muscle, nerve, or joint problems. Decreasing and controlling these triggers can decrease the frequency and/or intensity of the headaches. Contact us at info@azheadache.com for more information.

2009-08-12T11:32:00.000-07:00

Do you have questions about Headaches, TMJ or Sleep Apnea? Visit our website at www.az-tmj.com or email us at info@azheadache.com.

2009-07-24T15:44:00.000-07:00

Dr. Farrell is a Diplomate with the American Board of Orofacial Pain making him the best choice for treating a wide variety of head pain.

2009-07-22T11:34:00.000-07:00

Dr. Farrell provides less invasive options for TMJ treatment. Call us today to schedule an appointment to see what your options are....

2009-07-17T08:36:00.000-07:00

We are excited about the launching of our new website! Check it out at www.aztmj.com