Did you ever wonder what these symptoms have in common other than making your life miserable?
ØTMD (TemporoMandibular Joint Dysfunction)
ØChronic tension headaches
They all are controlled and/or moderated by the Trigeminal nerve system.
The Trigeminal Nerve has two divisions:
A) Motor Root, which sends nerve impulses to the jaw muscles to make them contract;
B) Sensory Division (far more massive) which is made up of the nerves that bring in information from the periphery.
The Sensory Division is divided into three distinct segments of sensory reception (thus the term Trigeminal):
1) First Division: Opthalmic: receives sensory input from arteries that surround the brain to around and behind the eyes
2) Second Division: Maxillary: receives sensory input from the area below the eyes and the upper jaw.
3) Third Division: Mandibular: receives sensory input for the entire lower jaw.
All three divisions feed into the Trigeminal Sensory Nucleus. The current understanding of the
nature of the migraine, is that it results from a disorder of "sensory modulation", meaning that information received by the Sensory Nucleus is misinterpreted, thereby resulting in
either a disproportionate response, or an inappropriate response altogether. For example, during a migraine
attack, the simple pressure changes of the fluid that surrounds the brain (resulting from the beating of the
heart), is perceived as "pounding".
The therapeutic goal in migraine prevention is to limit the amount of noxious sensory input (that is, to limit your migraine "triggers") to the Trigeminal Sensory Nucleus, so that it is not perceived as nociception (noxious sensory input). Essentially, the goal is to limit as much negative input to the Trigeminal Sensory Nucleus as possible.
When considering an abnormal Trigeminal system where the Sensory Nucleus is hypersensitive, it is not unusual for the Motor Division to be also hyperactive. A hyperactive Trigeminal Motor Root results in excessive jaw muscle contraction, during certain stages of sleep, resulting in intense jaw clenching and/or vigorous teeth grinding.
These two activities produce a significant bombardment of noxious input (nociception) to the Sensory Nucleus, while also being the known cause of "TMD" (temporomandibular disorders), thereby becoming a self-perpetuation of chronic headache and/or migraine.
"NTI" refers to the nocturnal inhibition of trigeminal nociception.
In order for jaw clenching and teeth grinding to achieve pathologic intensity, the molars and/or canine teeth must be touching each other, or another object (like a traditional mouthpiece). By keeping the molars and canines from touching anything during sleep, Nociception to the Trigeminal is Inhibited.
Minimizing jaw muscle intensity (that is, Trigeminal Motor Hyperactivity and the resultant nociception) therefore requires providing for incisor (front teeth) contact only during sleep.
The NTI device is a dental mouthpiece that a trained dentist provides for the patient. The NTI fits securely on either the patient's upper or lower front teeth while asleep. The unique presentation of the patient's bite dictates the design of the NTI device.
The most distinguishing characteristic of the NTI device is the discluding element, or "DE", which creates the exclusive contact between the incisors. In addition to preventing any molar or canine contract during sleep, the practitioner must also ensure that the device's design does not overly "open" the patient's mouth. Excessive opening while the patient is clenching on an object can create a strain of the TMJ (jaw joint), which would result in another noxious sensory input, thereby defeating the purpose of the NTI device.
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