Migraines and headaches caused by dental & orthodontics issues

What a Headache!

Dr. Daniel Noor, a pioneer in the field of Medical Orthodontics, has been conducting research for the past 15 years, both through treatment of his patients as well as through study of the literature.

According to studies and various resources, over 90% of young adults who suffer from headaches and migraines have a biting problem. In fact, many have beautiful smiles but their upper and lower teeth fit badly together and have alignment issues, causing not only headaches but several other dental and medical issues.

The great majority of headaches have an element relating to the patient’s biting issue. The importance of what dentists call functional occlusion is far beyond any physician or dentist is trained to understand.

Most dentists and physicians lack traning and understanding on the relationship between migraines and other medical issues to the patients’ biting or occlusal issues.

For this reason, great part of migraine patients are simply put on a long term drug therapy. This not only masks the real problem to some degree, but also leads to other long term medical issues. In fact, many patients with simple headaches and migraines keep using drugs to deal with the pain until they develop ulcers and problems in the jaw joint. Thus, for many reasons, including lack of specific training in medical and dental schools, health professionals often fail to diagnose and treat these conditions with a simple orthodontic fix.

According to research conducted by Dr. Black, the average force in the the back teeth (molar areas) is 171 pounds of pressure, as measured in 1000 randomly included adults. There is less pressure towards the front teeth.

This is an extraordinary amount of pressure and stress placed on our jaw muscles, ligaments and joint areas. When our posterior (back) teeth do not have the same inclination on the right and left side (they are not the perfect mirror image of each other), there will always be more forces on one side or in some teeth.

This will cause significant wear and tear of the teeth and more shifting on one side, placing more stress and strain on jaw muscles, which can lead to inflammation on one side or sometimes on both sides. This will turn into daily headaches and migraines, combined with head, neck and shoulder strain. As the situation gets worse, some patients develop back and lower back pain as well.

Patients often ask this question:

I have beautiful teeth or had orthodontics in the past and have a beautiful smile. So, I do not understand why I need orthodontic treatment or why no one else told me that my migraine, headache, etc is related to my teeth or biting issues.

For patients who generally have a nice smile but suffer from various dental, orthodontics or medical issues in the head and neck area, Dr. Noor does a full exam. This includes a typical dental exam, as well as special x-rays (such as panoramic and cephalometric) and orthodontic photos. While this should be a standard of care in all offices, the majority of dentists do not get to this level of diagnostics, hence missing key factors.

When photos are reviewed with patients, especially those with beautiful smiles and ideal front teeth, it is usually easy to notice the bite issues in the back teeth. Many times back teeth are tilted towards the inside of the mouth.

Dr. Noor explains that, when we are younger and our permanent teeth erupt, they do not erupt tilted. They are naturally upright in nearly all cases, however, over a lifetime, they tend to tilt inward towards the tongue or the palate.

This occurs for many reasons, including facial muscle pressure and environmental factors, such as eating or sleeping more on one side. It can also happen due to dental issues, such as loss of teeth, which allows for other teeth to shift, gum disease, problems in the jaw bone, fractured teeth or uneven dental restorations, such as fillings and crowns.

The typical bite-related headaches are felt in the suboccipitals and temporalis areas. When you start to open your mouth wide, the joint unseats and then comes back together when you close. Ideally, when the teeth are fully closed together, the mandibular condyles are fully seated.

In headache sufferers, those two things cannot occur together. Either the joint can fully seat, or the teeth can bite together. When they do not occur together, the four major muscle groups that control the jaw can NEVER relax.

The same is valid for patients whose condyles are never properly seated. Nearby muscle groups need to be continuously recruited for jaw function, causing stiff necks and headaches (see Figure 1.)