Toothache – Part 2

Volume: 4
Issue: 11
November 15, 2009
Toothache – Part 2

Dear Colleagues: 

Last month I suggested some methods for diagnosing toothache, when the dentist has found no obvious cause for it.  These included interference fields in the tooth itself, or in nearby autonomic ganglia (usually sphenopalatine ganglia for upper teeth and submandibular for the lower teeth).  And I also suggested methods of treating them. (See Vol. 4, No 10).
There are yet other causes of dental pain that the dentist is unlikely to detect.  These occur when pain is referred from trigger points in certain muscles.   The tricky part about trigger points is that they may refer pain to locations quite distant from the trigger point, just as pain refers from visceral organs.  But in the case of dental pain, the muscle trigger points are all located in the head and neck. 
According to Simons and Travell’s classic textbook “Myofascial Pain and Dysfunction: The Trigger Point Manual” there are three muscles likely to refer pain to teeth:

  1. Temporalis – upper teeth
  2. Masseter – upper and lower premolars and molars
  3. Anterior digastric – lower incisors 

One tip-off that pain is being referred from a muscle trigger point is that pain is usually felt in other places than just the tooth.  For example, temporalis trigger points usually also provoke pain in the temple or in the low forehead. 
The diagnosis is confirmed by palpating the characteristically tender nodules in the muscle and then by a therapeutic trial – usually involving local anesthetic injections.  
No physician practicing clinical medicine should be without the Trigger Point Manual (2 volumes).  It is truly one of the great medical books of all time.  The text is rich with clinical pearls; the illustrations are outstanding and best of all, it is organized in such a way that looking up trigger points and their referral patterns is easy, even for the busiest practitioner. 
Now, where does neural therapy fit into all this?  The answer is – in a number of ways.  Janet Travell was familiar with the same body of science that the early neural therapists were.  She correctly deduced that dilute procaine would treat trigger points and the associated pain.  But she also discovered that a longer lasting effect could be obtained by (in addition) stretching the muscles.  And she realized that “perpetuating factors” such as mechanical disturbances, malnutrition and psychosomatic factors had to be addressed to prevent recurrence. 
The modern neural therapist has the same and additional options.  Trigger points can be detected not only by palpation but also by autonomic response testing, i.e. touching an active trigger point makes an indicator muscle go weak.  When deciding on treatment, segmental therapy, injections of “quaddles” of dilute procaine into the skin overlying the affected muscle. (see page — of can be as effective as trigger point injections.  Stretching of the muscles is not required. 
One might also search for interference fields that explain the genesis of the tight muscles. Somatic dysfunction of related vertebrae can be treated either by manipulation or by neural therapy (quaddles of dilute procaine into the skin over the vertebra).  
Tight muscles in the head and neck may be part of a whole-body pattern, in which whole-body assessment and treatment is necessary.   Cranial somatic dysfunction can also cause tight muscles.  For those who are not trained in cranial osteopathy (or craniosacral therapy), a history of head trauma, however remote, should be reason enough for referral for cranial assessment. 
Psychological factors may be important in tight muscles, especially masseters.  The patient who is enduring anger and frustration, perhaps “through clenched teeth” is prone to toothache not only through dental malocclusion, but also from referral from trigger points. 

A letter from a reader:

The tooth issue is of course a major health concern, and although you may manage dental pain with neural and homeopathic remedies, the offending tooth, once infected to the point that the blood flow through the apex is blocked, will invariably have to be removed as part of clearing the interference field.  
Many, in fact, most “biological dentists” are still trying to do a better root canal therapy, when the fact is that the tooth is dead and gangrenous and cannot be revived. The lack of a biological mechanism for re-establishing blood flow and nerve innervation to the interior tooth pulp tissue, makes it illogical to mechanically rebuild the tooth. Once the pathological degeneration cascade has reached a certain point , there is no reversal possible. There are exceptional cases though for maintaining function and position of the tooth by doing root canal, as long as we accept it only as a temporary measure for which there may be a biological price.

Hans Schwartz DDS
Markham, Ontario, Canada.

Editor’s comment:

I agree with Dr. Schwartz.  Once the tooth has become gangrenous, neural therapy is a temporary measure. However it can be “life-saving” for that tooth that is close to death and for which the dentist is sometimes recommending root canal treatment.

Neural therapy’s role is to optimize the body’s defense mechanisms.  However in the case of the dead tooth these defenses must be maintained throughout life.  If the body’s defenses falter, the root canal may come back to haunt the patient, often in subtle ways. 

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