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Question:
About 1/2 hour after a walk or run outside in only moderately cool to cold weather (+15 - -20 degrees Celsius) pain begins in my teeth and escalates to the point of migraine headache complete with naseau, although I have never actually vomitted. Sometimes all teeth (except the upper two, front ones, which are "dead" due to previous injury and subsequent root canal) throb with pain, sometimes only the bottom, and sometimes one side more than the other, on either side. The pain is unbearable and even with Fiorinal (prescribed for migraine) does not ever completely subside for several hours. Intensity of pain seems to be related to degree of cold and degree of exertion (I run and cross-country ski). Continuing to be physically active after coming in from the cold seems to alleviate the pain and often seems to prevent it. During this year's annual cross-country ski vacation, (five days of skiing most of the day, when normally, work prevents this level of activity) there was only sensitivity the first day. Of course, it is not possible to keep up this kind of activity for hours after being out in the cold when not on vacation. Pain lasts for hours and is often still present the next day after a 3 pm outing with the dog for a run, or even just a walk. Toothpaste for sensitive teeth doesn't make one bit of difference. I wear an upper mouthguard at night because of grinding my teeth. Help is needed. My dentist has been informed but has not suggested
any treatment other than the mouthguard and toothpaste. ...Nancy in Ontario
Answer:
Nancy, what you need to do is start by taking TMJ x-rays to determine the position of your condyles. It sounds like you have a stress induced wear of your teeth which probably has compressed your joints. Unnecessary stress
(pressure) to the teeth causes the enamel to wear off on the top surfaces
and break along the gumline.
This leads to your described sensitivity, which can only be controlled with .62% Stannous Fluoride (Gel-kam or Perio+). The joints, themselves have probably compressed to the degree that your circulation has been cut off and you are having migraines.
Please visit my website at michigan-cosmetic-tmj-dentist.com for more details. You need to find a dentist who understands orthodontics and condylar repositioning. You may have to extrude (grow) your back teeth either with orthodontics or crowns. Subsequently you may also have to decompress your anterior teeth if they are "trapping" your bite. The treatment and understanding is complex.
There are only a handful of dentists who understand this treatment. You may have an easier time searching out for a "new-age" orthodontist who believes in decompression of the joints and tries to perform orthodontics without extractions.
For now, your bite appliance is helpful but it is like a band-aid for a deep wound. Make sure it is adjusted properly, it is at least 3 mm. thick and it prevents you from shifting your jaws from side to side. The appliance should lock your jaws into a relaxed position for optimal healing. A Gelb appliance is your optimal choice for now.
If your dentist does not know what a Gelb repositioning appliance is, he/she is probably not an expert in TMJ. Find someone who knows what a Gelb appliance can do for your situation.
Editorial Staff
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