Photobiomodulation in Head and Neck Pain Gerry Ross, DDS Tottenham, Ontario Canada
Disclosure: Dr. Ross provides education and training for Zolar Surgical Diode lasers, for which he receives a fee. No company had any contribution to this presentation. No funding was received for this presentation.
KEY For successful treatment of craniofacial pain, a multi-disciplinary approach to treatment is necessary All the different practitioners must work as a team to get ideal treatment Each practitioners treatment magnifies the success when everyone works as a team
What are the tools used in diagnosing TMJ disorders?
History Clinical form for patient to complete www.queenstreetdental.ca Clinical Interview (let the patients tell you their story) A good clinical interview is key to a good diagnosis
History Janet Travel s Diagram
Clinical Exam Chart of Occlusal Function
Clinical Exam Muscle Palpation
Biomechanics of the TMJ Two joint systems Lower Compartment Upper Compartment
Lower Compartment Condyle with articular disc Disc bound to condyle by lateral and medial discal ligaments Only rotation possible Photo courtesy of Bite FX
Upper Compartment Condyle-disc complex with mandibular fossa Disc not attached to fossa Disc not attached to fossa so translation can occur Photo courtesy of Bite FX
To treat Craniofacial Pain properly you must first know what condition you are treating
TMJ Disorders Myofascial Pain Muscular Problems Intra-capsular problems Clicking and locking Arthritis Osteoarthritis, Rheumatoid, etc.
Other Craniofacial Pain Conditions Teeth - Referred Pain Cervical Pain - Referred in to face Fibromyalgia Tumors Psychological Problems
MYOFASCIAL PAIN
Key Manual for TMJ Treatment Myofascial Pain and Dysfunction: The Trigger Point Manual Written By: Janet C. Travell & David G. Simons Williams and Walkins Balitmore/London
What is a trigger point?
Diagram courtesy of Janet Travell
Key Always treat source of pain, not site of pain
Diagram courtesy of Janet Travell
ARTHRITIS
Using the Appropriate Dose Arndt-Schultz Curve Biostimulation For applications where you want to stimulate (e.g. soft tissue, bone, etc), use lower doses Bioinhibition - For applications where you want to inhibit (e.g. pain management), use higher doses
Excellent Article Biphasic Dose Response in Low Level Light Therapy Huang Y, Chen A, Carroll J, Hamblin M
Where to Apply Phototherapy
Li 4 Acupuncture Point Between thumb and first finger This is the main switching point for acupuncture system
SUBMANDIBULAR LYMPH NODES
Application for Lymphatic Drainage Submandibular Lymph Nodes
TMJ Open and Closed Open treats joint space and attachments Closed treats lateral pole
Styloid Process 3 places from top to bottom: treat styloid ligaments and muscle attachments, as well as joint capsule
Lateral Pterygoid Just anterior to angle of mandible
Use Clusters to Cover Large Muscles or Low Level Laser moving slowly around the muscle Masseter
Use Clusters to Cover Large Muscles or Low Level Laser moving slowly around the muscle Temporalis
Use Clusters to Cover Large Muscles or Low Level Laser moving slowly around the muscle SCM
Treatment Protocol Acute Condition Treat 3-4 times for 1 week Then do nothing for 2 weeks and reassess the patient and condition Chronic Condition Treat the patient 2-3 times weekly in office for 3 weeks Then do nothing for 2 weeks and reassess the patient Note: In chronic condition, patient may experience a slight malaise after the first appointment so it s recommended that you lower the dose to try to avoid this
Join us for Photobiomodulation: Mainstream Medicine and Beyond NAALT ANNUAL CONFERENCE WALT BIENNIAL CONGRESS Joint Session September 9-12, 2014 Arlington, VA Registration information and abstract submission www.naalt.org