* Waking with a degree
of discomfort/headache is “not unusual” or daily.
Although they may not wake
up with a migraine, they rarely wake up "feeling fabulous". On a
0-10 scale (10 is worst head pain imaginable), walking around with "a number"
(anything other than a 0, that is, feeling fabulous) is rare *but unremarkable*
by the patient.
* Unsatisfied / unresponsive
to typical preventive meds.
They have a history of failed
preventive meds, or meds they could not tolerate due to side-effects.
* Unremarkable “typical”
TMD, or history of failed tx
May have used an occlusal
splint in the past (or currently), without significant relief.
* Toothaches &/or
sensitivity
They flinch at the air/water
syringe. Their teeth are sensitive to cold (they'll use a straw for
cold drinks). They get "phantom" toothaches (xray inconclusive)
* Resistant to mandibular
block
Their medial pteygoid has
developed a pH that the manufacturer of the anesthetic has not anticipated
it to be (due to the chronic fatigue of clenching against a clinically
hidden interference). After two or three block attempts, they'll
say their lip "feels fuzzy". Hours later, when they get home, they're
numb.
* Require/desire daily
meds.
Taking an OTC analgesic
several times a day practically goes un-noticed by the patient
* History of dental trauma
For example, 32 year old
female has two crowns and no other restorations. No history of decay.
They crowns were placed after a cusp fractured off, years ago. Anterior
incisal edges have wear patterns.
* Chronic sinus condition
and/or chronic stiff and sore neck/shoulders
Clenching in a protrusive
position obligates an isometric contraction of the lateral pterygoids.
Since there is no medial strain, the TMJs are asymptomatic. The coexisting
distal pull/strain on the pterygoid plates of the sphenoid bone by the
lateral and medial pterygoids causes a chronic irritation to the sinuses.
They may have been diagnosed as having "sinus disease" by an ENT.
The protrusive position of the mandible during the
event obligates the trapezius for balance, thereby allowing for chronic
neck/shoulder discomfort, or prolongs healing of neck/shoulder injuries.
* Unaware of / denies
activity
Whatever you do, don't suggest
that they are clenchers... you'll be accused of suggesting they're stressed-out
people. |