It’s a Small World

By Dr. Ronald Auvenshine

On May 1-4, I attended the Annual Scientific Meeting of the American Academy of Orofacial Pain. This year’s meeting was held in Las Vegas at the Red Rock Hotel Resort. It was a very successful meeting. We had more attendees at this meeting than we have had in our 40 years of existence. As I have written in previous newsletters, I was President of the AAOP in 1996 and 1997. I have been actively involved with this organization since 1985 and have served in many capacities of leadership since I became a member. This year, I gave a preconference course, along with my good friend and colleague, Dr. Henry Gremillion. The course was well-received and had approximately 25 members in attendance. This was a review course which Dr. Gremillion and I give every other year on head and neck anatomy, including a dissection of the head and neck.

I returned to Houston on Sunday, May 4. I left the hotel early in the morning and was driven to the airport by a pleasant man named Walter. Walter was very intelligent. The ride to the airport takes approximately 40 minutes. Our conversation began in the usual way, with Walter asking me what I had been doing in Las Vegas. I told him that I was attending a meeting of the American Academy of Orofacial Pain, which is an organization for dentists who treat complex pain, patients who suffer from headaches and shooting pain in the head and jaws. He told me that he was very pleased that he had this opportunity to drive me to the airport because he had some questions that he would like to ask. I was very receptive to him and told him that I would be more than happy to answer whatever questions he had. He then began to tell me about the pain that his wife suffered from. He said that she began having pain that was like an electrical shock on one side of her jaw.

It was a pain that would radiate from the jaw joint through the lower jaw and teeth, lasting for just a matter of seconds. Originally, about four years ago when it started, the pain would only come about once every three or four weeks. Recently, her pain has become more frequent, more intense and now has a longer duration – almost a minute to minute-and-a-half. The pain is so severe that it literally forces her to have to sit down or she feels that she will fall.

He told me that she had been to a neurologist and had a complete workup. The doctor diagnosed her with Trigeminal Neuralgia. He put her on a medication called “Tegretol,” which helped to control the pain but it did not make it go away. He has increased the dosage of the Tegretol several times and the pain now is manageable, but only if she takes the medication. They asked the doctor if there were any other alternative treatments, or if she would have to be on medication for the rest of her life. Walter told me that the doctor had mentioned a surgical procedure known as “decompression surgery.” He wanted to know what “decompression surgery” was all about.

I told Walter that this was an extremely opportune conversation because the day before I had listened to a lecture by an M.D. neurologist which dealt specifically with decompression surgery. One of the major causes of Trigeminal Neuralgia is the irritation of the Trigeminal ganglion in the midbrain by an artery that lies on top of the ganglion. The arteries of the head and neck are thin-walled, so the beating of the heart causes a pumping action in the artery which, when in proximity with the Trigeminal ganglion, causes an irritation to the ganglion. In a decompression surgery, the neurosurgeon will simply lift the artery off of the ganglion and insert a material between the artery and the ganglion, eliminating any irritation to the ganglion. The outcome of the decompression surgery is greater than 95% success. There are some risks associated with this procedure, but based on the success rate it is the treatment of choice.

I told Walter that there was another treatment modality called Gamma knife. The Gamma knife uses a directed beam of radiation which is guided into the midbrain and will cauterize the offending artery, eliminating the irritation to the Trigeminal ganglia. The Gamma knife procedure has shown great promise and is also successful. It carries some degree of risk, but it is a noninvasive type of procedure.

As we approached the airport, Walter asked more intelligent questions so that he could take the information home and share it with his wife. He was very appreciative of the openness of our conversation and was excited about the greater understanding that he now has as a result of our trip to the airport. I don’t know what Walter’s wife is going to do with this information or what decision she will make, but I do know that Trigeminal Neuralgia affects many people. I have just recently been dealing with an unusual neuralgia case of a woman who lives outside of the greater Houston area. This is a very common type of pain which must be taken seriously because of its intensity and its effect upon lifestyle. Trigeminal Neuralgia was originally called “tic douloureux.” It was a severe facial pain which was diagnosed and given that name many centuries ago.

It is exciting to live in a time where we now have techniques that have been developed to provide relief from severe pain disorders such as Trigeminal Neuralgia.

Here at MedCenter TMJ, one of our primary goals is to properly diagnose the type of pain our patients come in with. There are many other conditions which can cause orofacial pain that do not involve the TMJ. We don’t treat everybody exactly the same. Our prescription for care varies from individual to individual based upon their presenting symptoms. The most important thing in treating any medical problem is identifying what the problem is. With our technology here at MedCenter TMJ, we have a greater opportunity to identify the cause of the pain and prescribe the correct treatment for its resolution.

I was excited about my trip to the airport with Walter and the fact that on a Sunday morning I had an opportunity to share information with a gentleman that would help him and his wife deal with a very serious pain condition. All of this just goes to show me that, even though I’ve been doing this for 40 years, it is still new and people still need our care. At MedCenter TMJ we care for our patients. You are our greatest asset and we will continue to work diligently to earn your trust and respect.

Sincerely,
Ronald C. Auvenshine DDS, PhD, PC

This month, keep an eye out for some important topics we are addressing on our weekly blog!

Dental Care versus TMJ

Dental problems are not always visible to the naked eye. Cavities, damage to dental roots and cracked teeth are sometimes only detected with x-rays or a thorough exam by a trained professional. Don’t assume you’re in the clear just because you had a clean bill of health at your last dental appointment. Some dental problems can develop very quickly – almost overnight. That’s why it’s important to see your dentist regularly. If you suffer from TMJ pain, this blog is a reminder not to forget about your teeth!

Is TMJ a Woman’s Disease?

Did you know that women are more likely than men to receive a diagnosis of a TMJ disorder? This month, find out why! You may be surprised to learn how cultural factors, hormones and the role of stress affect the percentage of women versus men who seek treatment for this condition.

Happy Father’s Day!

This year, Father’s Day falls on June 15th. It was first celebrated on July 19, 1910 in the state of Washington. For decades afterward it played second fiddle to the more universally recognized commemoration of moms on Mother’s Day. Only in 1972 did dads finally catch up when Father’s Day was given its due and bestowed national recognition. On June 15th, take some time to celebrate the importance of fatherhood. Give dad the day off this year by throwing him a backyard barbeque. And we’ve got the perfect entrée.

Recipe of the Month

In honor of Father’s Day, serve your dad some Sloppy Joe Sliders. The ingredients call for leaner ground sirloin, and the smaller portion size is healthier – it won’t leave you overstuffed and unhappy. Sliders are also a perfect recipe for a backyard summer party! They are easy to serve and your guests will gobble them up. To avoid stretching your jaw muscles as you take a bite, use a knife and fork to cut the meal into smaller portions.

Ingredients
• 1 tablespoon(s) olive oil
• 1 large onion, finely chopped
• 2 clove(s) garlic, minced
• Coarse salt and ground pepper
• 3/4 pound(s) ground beef sirloin
• 1 can(s) (14.5-ounce) tomato puree
• 1/2 teaspoon(s) mustard powder
• 1 1/2 teaspoon(s) dark-brown sugar
• 1 tablespoon(s) cider vinegar
• 16 party-size potato rolls

Serves 8 people.
Total time 30 minutes. Prep time 15 minutes.

Directions
1. Heat oil over medium in a large saucepan. Add onion and garlic; season with salt and pepper. Cook until softened, stirring occasionally, 6 to 8 minutes.
2. Add beef and cook, breaking up meat with a wooden spoon, until no longer pink, 4 to 5 minutes. Add tomato puree, mustard powder, sugar, and vinegar. Cook, stirring occasionally, until slightly thickened, 8 to 10 minutes. (To store, refrigerate, up to 2 days.) Serve warm on rolls.