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Anti-tension device for teeth eases headaches

Tuesday, July 17, 2001

By Virginia Linn, Post-Gazette Staff Writer

Can an inch-wide device you wear on your two front teeth while sleeping prevent or reduce the number of headaches you're experiencing?

Dr. Joyce Warwick shows how the NTI Tension Suppression System fits into a patient's mouth. (Steve Mellon, Post-Gazette)

A few local dentists who use the device are hailing its effectiveness in reducing the grinding and clenching of the jaw that millions of people do as they sleep. This activity can contribute to the onset of tension headaches and even migraines, according to Dr. James Boyd, the California dentist who developed the device.

The NTI Tension Suppression System on June 20 received clearance from the Food and Drug Administration to be marketed for prevention of tension-related headaches and migraines. "Clinical studies showed it did reduce symptoms to some degree in some patients," according to an FDA spokeswoman.

"There are a lot of people who are really dedicated clenchers," said Dr. Elaine Giarrusso, a Scott dentist who has fitted the device on about two dozen patients. "They go to town all night on their teeth while they sleep."

Despite FDA approval of the device for headache treatment, a national headache and migraine expert last week called such claims "ridiculous" and said he's never read any studies that show dental devices can control migraine pain.

"Bruxism [the grinding and clenching] isn't even a trigger for migraine," said Dr. Seymour Diamond in Chicago, executive chairman of the National Headache Foundation, which he co-founded in 1970.

Boyd, 42, who lives near San Diego, isn't surprised by Diamond's reaction and said the theory behind his device even runs against conventional thinking in the dental community.

Helping himself

Boyd designed the device to ease his own severe headaches. The NTI has the same effect as placing a pencil between your front teeth.

It differs from other night guards because it fits over just the two top front teeth -- instead of the full mouth -- reducing clenching because the back molar and canine teeth can't touch.

"If people have plastic covering their back teeth, they're going to clench with the same intensity as if they had nothing at all on their teeth," said Dr. Joyce Warwick, who shares a Downtown dental practice with her husband, John, and is enthusiastic about the NTI's effectiveness.

Boyd originally marketed the device to address temporomandibular joint, or TMJ, disorders which involve muscle tension and anatomic problems at the points on each side of the face where the temporal bone of the skull connects to the lower jaw -- essentially the area that serves as the hinge to the jaw bone.

These disorders, most common in women between the ages of 20 and 50, include headaches, tenderness of the chewing muscles and clicking or locking of the joints.

Along the way, patients using the device said they were getting fewer headaches, including migraines. Boyd has worn the NTI for 12 years and said most of his headaches have disappeared.

The Warwicks have used the device on patients for 18 months and Joyce Warwick, 40, wears the device herself.

"I was getting migraines twice a month," she said. "Now it's down to zero or one a month."

A migraine sufferer for 15 years, she takes the drug Imitrex when a migraine hits. "But it makes you feel washed out and drained."

Getting relief

Tension headaches are typically caused by muscle tension in the neck, shoulders and head triggered by social or psychological stress or fatigue. Migraine, a recurring, throbbing intense pain that may be accompanied by visual problems or nausea, occurs when arteries to the brain become narrow and then widen, which activates pain receptors. It is not known what causes the vascular changes.

Dr. Michael Buckley, associate professor at the University of Pittsburgh School of Dental Medicine, said the use of conventional night guards is known to reduce the recurrence of tension headaches, but he's never heard of a connection to migraine control.


For more information

For more information, including a list of local dentists who use the device, visit

Boyd agreed there is no proof that jaw clenching or muscle contractions cause migraines. But he said they're a big contributor. "It's a gigantic ingredient."

Boyd conducted a clinical trial at four sites involving patients who averaged migraines twice a month, comparing the results on a control device. Within eight weeks of using the NTI, 82 percent of those patients reported a 77 percent average reduction in the number of migraines they experienced.

Patients typically get relief from tension headaches within the first week of using the NTI. With migraines it may take a few weeks.

One of Warwick's patients, Amanda Eakin, 29, of Cranberry, has used the NTI since March. Earlier use of night guards to address her TMJ pain had been unsuccessful.

"The headaches have decreased dramatically [with the NTI]," said Eakin, an administrative assistant. "I used to have pain to the touch on the side of my face, right above the joint. That pain is completely gone."

She takes yoga and exercises to help ease her stress. "But I think I will always vent some of my stress in clenching and grinding."

200,000 use it

Giarrusso and the Warwicks learned about the device through an Internet dental news group.

Giarrusso said the traditional thinking among dentists has been that if they can reconstruct a person's bite and align the teeth in the right position, "the joint will be happy. But there are plenty of people with perfect bites who clench and grind like crazy," she said.

That behavior is more tied to a person's personality, particularly distressed or driven individuals, the type As.

Giarrusso has yet to try the device to address migraines, but plans to pursue that.

Bob Weber, who handles regulatory affairs for NTI, said the device is being used by about 200,000 patients.

The national average cost of the device is $325, although prices can range from $175 to $1,200 depending on a patient's needs. Pittsburgh's rates are on the lower end of the scale. Local dental insurance companies generally don't cover the cost at this time.

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