Dental Tribune United Kingdom Edition

27May 21-27, 2012United Kingdom Edition Clinical should ensure that symptoms do not have another cause, such as perhaps a tumour or the after affects of a stroke. Interestingly, the classi- fication system used by the wider medical profession when talking about migraines is almost overcomplicated for the use that the dental profes- sion can put it to. While this is for a good reason, as part of the methodology doctors use to approach any problem, it can be simplified for dentistry, says Pav. Migraine sufferers don’t tend to put formal clas- sifications on their level of headache, but other people do. The sufferers are more in- terested in being pain free. “I don’t pretend to know as much as a neurosurgeon or doctor does about this type of issue but, from my under- standing, there are loads of different classifications. It is over-fragmented,” says Pav. “For example, if you have these symptoms you have a chronic headache; if you have these symptoms you have got a tension headache; if you have these symptoms you have a classical migraine; with oth- ers it’s a migraine with aura. However, to me, it’s actually all in the same rainbow, it’s just that the presentation of the symptoms is slightly dif- ferent. The vast majority of the patients respond in the same manner.” Studies sug- gest that of patients suffering from a single-sided, pulsing, moderate to severe headache, there is a 93% chance that they are suffering from a mi- graine. When migraine is con- firmed the patient is put through a full systems analy- sis, which can be far more thorough than most of them are expecting. “You can’t do it just on the back of a question- naire,” says Pav. “You have to know what is going on with the jaw joints, whether there is any history of trauma, and you look at the ligaments and see if there is any evidence of injury there. And it’s im- portant to identify and to deal with all of the issues. If the patient has three problems and you are dealing with one of them you are not going to be very successful. If there are three problems you need to deal with all three, in order to get pain relief.” A range of dental treat- ments is available for migraine sufferers, with the most prov- en results coming from the NTI-tss (Nocieceptive Trigem- inal Inhibition - Tension Sup- pression System), an occlusal splint system supplied by S4S. Pav has applied the NTI-tss to numerous patients with high rates of success. When fitted, this reduces the intensity with which patients can clench and grind their teeth by around 80%, allowing muscles in the jaw to relax. Migraines can be described as an abnormal response to sensory dysmodu- lation. As dentists, the nocio- ceptive feedback to the sphe- nopalatine ganglion from the trigeminal nerve plays a ma- jor role. When they are examined, patients are generally sur- prised to be given such a thor- ough check at a dental clinic, often mentioning that nobody has ever carried out such de- tailed tests before, says Pav. And this is the key to one of the most significant benefits to this approach to pain man- agement. “I really think people should be taking an interest in it. Even if they don’t want to do pain management work,” says Pav. “If you ask the right ques- tions and do a proper exami- nation you can avoid issues with big restorative cases. It’s directly related to restorative dentistry. If you are doing lots of crowns and veneers, you can avoid a lot of difficulties by understanding what is go- ing on with the pain. I have landed myself in trouble in the past while doing restorative work, and had I gone through the same diagnostic criteria I go through now, I would have avoided a lot of heartache.” With both migraines and dental problems often caused by the grinding and clench- ing behaviour associated with bruxism, simply restoring damaged teeth can be a short- term solution. “If you don’t manage the underlying causes of the problem you can end up in a situation where the same problem reoccurs,” says Pav. Careful examination can, in conjunction with the prop- er training, throw light on other issues too, says Pav: “It can help explain some of the more bizarre pains and sen- sitivities patients are hav- ing… when you understand this approach you can diag- nose a lot of them. And that includes sensitivity of teeth, facial pains and neuralgias. If you understand the anat- omy of what is going on you can really help. I’m not say- ing you can solve 100 per cent of cases, but you can offer pain relief to a lot of these pa- tients and they are very grate- ful for it.” Migraine sufferers often, due to the nature of the con- dition, suffer in silence. But being released from the de- bilitating pain of constant headaches can lead to enor- mous improvements in their quality of life. Migraines most commonly affect women, but sufferers can be from any walk of life. Pav has recently encoun- tered a patient in his teens, who was in such frequent pain that he was only attend- ing school on average twice a week. The problem had been ongoing for three years, with the obvious implications such pain has on education. “If we can get him out of pain he can go back to school and get on with his life,” says Pav. The second instalment of this article will look at how migraine and bruxism issues manifest themselves in the mouths of patients. DT About the author Dr Pav Kahira, the founder and direc- tor of the Migraine Care Institute, is a dentist with a special interest in migraine and pain management. Shortlisted twice for the accolade of Best Young Dentist, he trained at Kings College London and the University of London. He has exten- sive experience of treating migraine sufferers. For more information on further dates call 0114 250 0176 Or visit www.s4sdental.com Migraine sufferers don’t tend to put formal classifications on their level of headache ‘If you understand the anatomy of what is going on you can really help. I’m not say- ing you can solve 100 per cent of cases, but you can offer pain relief to a lot of these patients and they are very grateful for it’ Lower RV2