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Reference Bibliography




Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study.

Pain. 2008 Oct 15;139(2):260-6. Epub 2008 May 27.

Srbely JZ, Dickey JP, Lowerison M, Edwards AM, Nolet PS, Wong


Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy

Clin Rehabil. 2007 May;21(5):411-7.

Srbely JZ, Dickey JP.


Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study.

J Manipulative Physiol Ther. 2009 Sep;32(7):515-20.

Aguilera FJ, Martín DP, Masanet RA, Botella AC, Soler LB, Morell FB.


Acupuncture and ultrasound therapy for temporomandibular disorders

Zhou FH, Zhao HY.

Manual Trigger Point Therapy


Diagnosis and therapy of myofascial trigger points

Schmerz. 2003 Dec;17(6):419-24.

Simons DG, Mense S.


Myofascial trigger point syndromes: an approach to management.

Arch Phys Med Rehabil. 1981 Mar;62(3):107-10.

Rubin D.


Myofascial Pain and Dysfunction: The Trigger Point Manual

David G Simons, MD, Janet Travell, MD, Lois S. Simons, M.S., P.T.

Lippincott Williams and Wilkins, 1999




Evaluation of microcurrent electrical nerve stimulation (MENS) effectiveness on muscle pain in temporomandibular disorders patients.

J Appl Oral Sci. 2006 Jan;14(1):61-6.

Zuim PR, Garcia AR, Turcio KH, Hamata MM.


Trismus in head and neck oncology: a systematic review.

Oral Oncol. 2004 Oct;40(9):879-89.

Dijkstra PU, Kalk WW, Roodenburg JL.

Stress Control System (SCS)


Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury.

J Rehabil Res Dev. 2006 Jul-Aug;43(4):461-74.

Tan G, Rintala DH, Thornby JI, Yang J, Wade W, Vasilev C.

Low Level Laser Light Therapy


The first IRB FDA Approved, Clinical Study was conducted in 2000, to prove the effectiveness of Laser Energy for Pain Management.

Clinical trials lead by Dr. Richard Amy and Dr. Kevin Slattery made history, by being granted the first FDA market clearance of any low level lasers.




Treatment of Chronic Neck and Shoulder Pain with 635nm Low Level Laser Therapy. A randomized, multi-center, double blind, clinical study on 100 patients.

by Dr. Richard Amy, Dr. Kevin Slattery


Background and Objective

The purpose of this clinical study was to determine the effectiveness of the use of the LLLT in providing temporary relief of minor neck and/or shoulder pain of chronic origin by emitting 1 mw of near-infrared light to the affected area(s) for short durations, under randomized, double blind, placebo controlled conditions. This study was approved by an IRB (Institutional Review Board) and was conducted at three clinics.



The primary outcome measure was the change in a subject’s self reported Degree of Pain rating using the Visual Analog Scale (VAS) from immediately prior to the treatment administration to immediately after the treatment administration. The individual subject success criterion was defined as a 30# improvement in Degree of Pain rating on the VAS across the two measurement periods. The overall study success criteria was defined as at least a 30% difference between groups, comparing the proportion of individual success in each group, anticipating that about 50% of subjects in the test group and about 20% of subjects in the placebo group would meet the individual success criteria.

A total of 86 subjects complete the study, 43 in each in the test and placebo groups. Subjects were randomly assigned to either the test or placebo group. Subjects in the test group received the actual laser procedure using the specified treatment protocol and subjects in the placebo group received a “fake” laser treatment. “Pre and Post” procedure linear range of motion (ROM) in the right and left sides of the neck/shoulder regions were recorded in degrees on case report forms. A “Chronic condition” was defined as longer than 30 days.



65% (28 of 43) of the tested group met the individual subject success criterion which was significantly greater than the 11.6% (5 of 43) recorded for the placebo group. The overall study success criteria of 30% was exceeded with the actual difference in the proportion of the individual subject successes between treated and placebo group subjects being 53.5%.



Low level laser therapy is an effective single treatment option for the treatment of chronic neck and shoulder pain resulting from osteoarthritis,

muscle spasms or cervical /thoracic strain conditions.


Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active treatment controlled trials.

Lancet. 2009;374(9705):1897.

Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM


Management of myofascial pain: low-level laser therapy versus occlusal splints.

J Craniofac Surg. 2010 Nov;21(6):1722-8.

Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Source Department of Maxillofacial Prosthodontics, University of Istanbul Faculty of

Dentistry, Istanbul, Turkey.


Arthralgia of the temporomandibular joint and low-level laser therapy.

Photomed Laser Surg. 2006 Aug;24(4):522-7.

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.


Effectiveness of low-level laser therapy in temporomandibular disorder

Scand J Rheumatol 2003;32:114-8

Sevinc Kulekcioglu , Koncuv Sivrioglu” Orhan Ozean’. and Mufit Parlak


Low-level Laser Therapy in the Management of Temporomandibular Joint Disorder

Summer 2008 Volume 8 , Issue 2

Lassemi, Esshagh / Jafari, Seyed Mehdi / Motamedi, Mahammad Hosein Kalantar / Navi, Fina / Lasemi, Reza


Effects of Superpulsed Low Level Laser Therapy on Temporomandibular Joint Pain

Clinical Journal of Pain: September 2010 -Volume

26 -Issue

7 -pp


doi: 10.1097/AJP.0b013e3181e0190d

Marini, Ida MD, DDS*; Gatto, Maria Rosaria PhD†; Bonetti, Giulio Alessandri MD, DDS*


Management of mouth opening in patients with temporomandibular disorders through low-level laser therapy and transcutaneous electrical neural stimulation.

Photomed Laser Surg. 2006 Feb;24(1):45-9.

Núñez SC, Garcez AS, Suzuki SS, Ribeiro MS. Source Centro de Lasers e Aplicações, IPEN-CNEN/SP, Av. Lineu Prestes 2242, CEP: 05508-

900 São Paulo, SP, Brazil.


Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome.

Photomed Laser Surg. 2004 Aug;22(4):306-11.

Ilbuldu E, Cakmak A, Disci R, Aydin R.

Faculty, Istanbul University, 34390 Sehremini, Istanbul, Turkey.


Low level laser therapy with trigger points technique: a clinical study on 243 patients.

J Clin Laser Med Surg. 1996 Aug;14(4):163-7.

Simunovic Z.

Source: Laser Center, Locarno, Switzerland.


Low-level laser therapy is an important tool to treat disorders of the maxillofacial region.

J Clin Laser Med Surg. 1998 Aug;16(4):223-6.

Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Miranda ER, De Quevedo AS, Manzi CT, Vieira AL, Rolim AB. Source Laser Center, School

of Dentistry, Universidade Federal de Pernambuco, Brazil.

Ga-As (808 nm) laser irradiation enhances ATP production in human neuronal cells in culture.

Photomed Laser Surg. 2007 Jun;25(3):180-2.

Oron U, Ilic S, De Taboada L, Streeter J.


Laser Photobiomodulation of Proliferation of Cells in Culture: A Review of Human and Animal Studies

Philip V. Peplow, Tzu-Yun Chung and G. David Baxter. Photomedicine and Laser Surgery. August 2010, 28(S1): S-3-S-40. doi:10.1089/pho.2010.2771.

Philip V. Peplow, Ph.D.,1 Tzu-Yun Chung, B.Med.Sc.,1 and G. David Baxter, D.Phil.2 Department of Anatomy & Structural Biology, University of Otago, New Zealand. Physiotherapy Research, School of Physiotherapy, University of Otago, New Zealand.


Review Article

Mechanisms of oral somatosensory and motor functions and their clinical correlates

Journal of Oral Rehabilitation 2006 33; 243–261

B. J. SESSLE Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada



This article provides a review of somatosensory and motor pathways and processes involved in oral sensorimotor function and dysfunction.

It reviews somatosensory processes in peripheral tis- sues, brainstem and higher brain centres such as thalamus and cerebral cortex, with a particular emphasis on nociceptive mechanisms. It also outlines some of the circuits and processes involved in reflexes and motor control.

In addition, it emphasizes the concept of neuroplasticity and its applicability to oro-facial pain, to motor control and motor learning, and to adaptation to changes in the oral sensory environment such as may occur with the placement of dental implants.



Neural, neuroplasticity, osseoperception, pain, sensitization, touch

This article reviews somatosensory and motor pathways and processes involved in oral sensorimotor function and dysfunction, including the concept of neuroplasticity and its applicability to oro-facial pain, to motor control and motor learning, and to adaptation to changes in the oral sensory environment.


Anatomy and Physiology of Headache

Biomedicine and Pharmacotherapy

1995, Vol. 49, No. 10, 435-445

N. Bogduk


From Abstract

All headaches have a common anatomy and physiology.

All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.

The brainstem contains a region of grey matter called the trigeminocervical nucleus. This nucleus is caudally continuous with the grey matter of the dorsal horn of the spinal cord.


The trigeminocervical nucleus is “defined by its afferent (incoming nerve signals) fibers.” The trigeminocervical nucleus receives afferents from the following sources:

1. Trigeminal Nerve (Cranial Nerve V)

2. Cranial Nerve VII (Facial Nerve)

3. Cranial Nerve IX (Glossopharyngeal Nerve)

4. Cranial Nerve X (Vagus Nerve)

5. Cranial Nerve XI (Spinal Accessory)

6. Upper three cervical nerves


All of these sources of afferents terminate on common second-order neurons in the trigeminocervical nucleus.


The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. “All nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.”


Key Points

All headaches have a common anatomy and physiology.

All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.

Central pain involves no tissue damage but results from dysfunction of the descending pain inhibitory pathways.

The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which included cranial nerves V, VII, IX, X, and C1-C3. “Any structure innervated by these nerves is capable of causing headache.”


Structures innervated by trigeminal nerve CN V:

• Skin of forehead

• Orbit

• Eye

• Frontal sinus

• Dura mater of the anterior cranial fossa

• Anterior and posterior ends of the falx cerebri

• Superior sagittal sinus

• Proximal ends of the anterior and middle cerebral arteries

• Superior surface of the tentorium cerebelli

• Cavernous sinus

• Venous sinuses

• Temporal artery

• Nose

• Paranasal sinuses

• Oral mucosa

• Upper teeth

• Upper jaw

• Dura mater of the middle cranial fossa

• Dura mater of the middle cranial fossa

• Lower teeth

• Lower jaw

• Temporomandibular joint

• External auditory meatus (ear)

• Anterior aspect of the tympanic membrane


Nociception pain can be initiated by the accumulation of inflammatory chemicals or can be caused by mechanical stimulation following a “distortion of a network of collagen” such as ligament or dura mater. Pain in the occiput (primarily innervated by C2) may arise from trigeminal nerve stimulation.


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Assessment & Treatment
  • Assessment Process
  • Treatment Process
  • Only Dental Professionals
  • Assessing DMSD
  • Bite Force Analysis
  • Mandibular Range of Motion
  • Cervical Range of Motion

Only Dental Professionals

In many cases, only dental professionals can help the estimated 80 million Americans suffering from the painful symptoms caused by improper dental forces, called dentomandibular sensorimotor dysfunction (DMSD).

READ MORE "...it is imperative to include the training for orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues.” JADA Cover Story, 10/2015, Vol. 146, Issue 10, Pg. 721-728

Assessing DMSD

20% of your existing patients suffer from DMSD, as do 20% of all Americans. Your team members quickly assess patients for "red flags" (which indicate DMSD), utilizing TruDenta's patented technologies.

The National Institutes of Health estimate that over 80 million Americans suffer from one or more of the symptoms of DMSD, including:
• Chronic Headache
• Migraine
• Tinnitus
• Vertigo

Bite Force Analysis

TruDenta uses digital force measurement technology, powered by Tekscan®, for evaluating the amount of bite force that is present during closure, at closure, and while chewing. The technology is so advanced that it actually calculates the bite force and motion on a tooth-by-tooth basis. This digital exam literally shows a movie of the bite force in action revealing abnormal forces in the nerves, muscles and ligaments that are often the cause of symptoms.

Bite balance is also calculated to identify potential issues within the overall chewing system. READ MORE

Mandibular Range of Motion

A normal opening for an adult is 53 mm to 57 mm. Limited or restricted range of motion (less than 40 mm) is a reduction in an individual’s ability for normal range of movement. Along with opening movement, an individual should be able to slide their jaw to the left and to the right at least 25 percent of their total mouth opening in a symmetrical fashion.

When restricted movement exists, an imbalance in the system is present, and breakdown of the system is likely to occur. READ MORE

Cervical Range of Motion

The TruDentaROM is a system of hardware and software that digitally measures cervical range of motion (ROM) impairment based upon AMA guidelines. This directly affects the proprioceptive feedback system of the dental occlusion, TMJ, and the muscles of mastication.

ROM impairment is another “red flag” which assists doctors in accurately diagnosing symptoms that are often dental force related. This data enhances medical insurance collections and the collaboration with referring medical doctors. READ MORE

  • Doctor Chair Time
  • Therapeutic Ultrasound
  • Microcurrent Stimulation
  • Low-Level Cold Laser

Less Than One Hour Doctor Chair Time

A typical case requires less than one hour of doctor time in the diagnosis and minor occlusal adjustments during the rehabilitation period.

Treatments are performed by a trained team member once per week, in less than one hour. The most severe cases require 12 treatments. Therapies are spa-like, non-invasive and require no drugs or needles. Most patients report dramatic results after the very fist treatment. Note: The majority of patients utilize an orthotic only during the treatment period, up to a maximum of 12 weeks. READ MORE

Therapeutic Ultrasound

The goal of therapeutic ultrasound treatment is to return circulation to sore, strained muscles through increased blood flow and heat. Another goal is to break up scar tissue and deep adhesions through sound waves.

Therapeutic exposure to ultrasound reduces trigger point sensitivity and has been indicated as a useful clinical tool for managing myofacial pain. Additionally, ultrasound also has been shown to evoke antinociceptive effects on trigger points. READ MORE

Microcurrent Stimulation

Sub-threshold microcurrent stimula¬tion reduces muscle spasm and referral pain through low electrical signal. It also decreases lactic acid build-up and encourages healthy nerve stimulation. In particular, microcurrent electrotherapy has been shown to help increase mouth opening significantly.

• Reduces muscle spasm and referral pain through low electrical signal
• Decreases lactic acid build-up
• Encourages healthy nerve stimulation
• Increases mouth opening significantly

Low-Level Cold Laser

Low level laser/light therapy is one of the most widely used treatments in sports medicine to provide pain relief and rehabilitation of injuries. Over 200 randomized clinical trials have been published on low level laser therapy, half of which are on pain.

Low level laser/light therapy decreases pain and inflammation, accelerates healing of muscle and joint tissue 25 to 35 percent faster than without treatment, and reconnects neurological pathways of nerves to the brain stem, thereby inhibiting pain. READ MORE

Additional Content & Resources
Download this eBook on The Hidden Causes of Head Pain
DRSdoctor training
Download this eBook on The Hidden Causes of Head Pain
Download this eBook on The Hidden Causes of Head Pain
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