Caitlin Whyte (Host): Welcome to another enlightening episode of Wise and Well, presented by Community Memorial Healthcare. I'm your host, Caitlin Whyte. And we're excited to dive in to today's conversation. Joining us is Dr. Brigette Lovell, a distinguished physician specializing in orofacial pain and dental sleep medicine. Today, we'll explore her unique insights and the innovative treatments available at Community Memorial Healthcare.

 Dr. Lovell you help patients suffering from a wide variety of pain in the head, face, neck and jaw. So, to start off, can you elaborate on some of these lesser known headache disorders that you encounter and how you approach their diagnosis and treatment?

Brigitte Lovell, DMD: Sure, so I'm Dr. Lovell, and I'm in Ventura County. And, there are some very strange headache disorders out there. There are things that you would never think about that could be a headache. So sometimes, for instance, some patients will have pain in the sinus region and think they have a sinus infection, when in fact it could be a headache.

Sometimes headaches can even refer or radiate to the teeth. So sometimes they'll go see a dentist and they'll think that, you know, they need some kind of dental procedure, when in fact a migraine could actually be occurring in the tooth. Those are kind of strange. Now, some really strange headache disorders are what's called hypnic headache, and that's something that could wake you up around 2 or 3am.

That's not a common headache disorder, but you wouldn't think that someone would be awakened by 2 or 3am. And sometimes you have to rule out like is there some kind of brain tumor that's causing that at that hour. Is it potentially sleep apnea or is it just the hypnic headache, in which case you treat it?

So there are all kinds of weird headache disorders, including like cluster headache, trigeminal neuralgia, and of course more things that are, you've heard common that are migraines and whatnot, but migraines can occur in different parts of the face. Like I mentioned that you wouldn't think such as the teeth.

Host: Well, what are some of the common causes of that orofacial pain? Let's dive into that a bit more. And what non-invasive treatments can patients seek out?

Brigitte Lovell, DMD: So there are lots of orofacial pain symptoms that can occur. So you can have pain in your muscles in the jaw region. You can have pain in the neck that refers to the head. So, and then you have heard of, I'm sure of TMJ issues. And so there can be the temporomandibular joint, which is causing pain in the joint or surrounding areas.

So there's a lot of common causes of orofacial pain, but a lot of times it can just be musculoskeletal. So a certain muscle could be causing or triggering a pain or making it worse. And then also, you know, for headaches, it's just within the brain stem. So it's, it's coming from within the brain. But those are basically the main patterns or what common causes of orofacial pain.

And then as far as non-invasive treatments, it depends what you're treating. So if it's a nerve condition, then you probably need some kind of medication. If it's a musculoskeletal, then you need potentially like a night guard, or muscle relaxants or, diet modification or chewing less.

And then for headaches, there's all kinds of treatment options as far as, lifestyle patterns, headache, Botox and so forth.

Host: Well, you also treat patients suffering from sleep apnea. Can you describe this common condition and what causes it? And how does sleep apnea impact quality of life?

Brigitte Lovell, DMD: So sleep apnea is very common and prevalent. So the main way a person might know if they have sleep apnea is they might wake up with a headache in the morning. And if you don't have a headache, that individual might wake up feeling very tired and fatigued. So they may have had like a good night's sleep, yet they wake up very tired, so they'll drink some coffee. In the afternoon, they may feel like they want to take a nap. And all of those could be signs that you have sleep apnea. So, larger people can have sleep apnea, but also very slender people can have sleep apnea. It can be any age group. It could be female or male. But the main cause is when you're sleeping at night, the neck can somewhat smaller, the airway, and then you're not getting as oxygen at night.

So that's the main reason that that happens. So, patients can either be given a CPAP mask, which they wear at night, or you can wear a dental appliance.

Host: Well, in your practice, you also provide patients with those custom made oral appliances as an alternative to CPAP machines. So can you walk us through the process of getting fitted for one and the benefits it offers over a CPAP?

Brigitte Lovell, DMD: Sure. So, as I mentioned, you can use a CPAP or the dental appliance. So there are many benefits of wearing the dental appliance over a CPAP. First of all, people who like to travel, it's much easier to carry a night guard type of dental appliance in your handbag rather than a big CPAP machine. So or if you're going camping, like, you know, you don't have electricity, you know, putting something over your teeth is much better.

So the, the way the dental appliance works is it protrudes your mandible forward. So that means that your lower teeth are slightly in front of your upper teeth. So that brings your jaw forward, which opens your airway and that's how you treat the sleep apnea. So you don't need necessarily oxygen blowing down your throat. You just will be breathing in this natural position at night. And then when you take the device out in the morning, then you're able to go back to your normal bite and normal day. And it's not like your jaw stays in that protruded position.

So the benefits of this appliance is obviously when you travel, cleaning, all you have to do is use toothbrush and toothpaste versus like a CPAP, you have to take it apart. You have to clean the tubing. I hear it's very frustrating for a lot of patients because it takes a lot of time and it's like a side job for them. And then also it's just much easier to use, because when you put the appliance in, it fits on your teeth. So if you wake up, for instance, in the middle of the night and you need to go to the bathroom, you don't have to unhook yourself or worry that you're going to trip over some tubing.

You just go to the bathroom, use the bathroom and you go to bed because it stays on your teeth and you don't have to worry about setting it back in. Those are the main benefits of it. So it's easy to use and usually it's just as effective as long as you have moderate or mild sleep apnea.

Now if you have a very severe case of sleep apnea, then the CPAP would be your best bet. Now if you do not even use a CPAP even with severe sleep apnea, then you need to treat it with something and that's where the dental appliance comes in hand.

Host: So, Temporomandibular Joint Disorders, or TMJ, can be quite frustrating. Now what causes TMJ and what are some signs or symptoms that people should look out for? And what are the different treatment options you offer TMJ patients?

Brigitte Lovell, DMD: Yes, TMJ pain or temporomandibular joint pain, or you can also call it TMD, temporomandibular dysfunction, can be very painful for people. And there are a lot of individuals who do have this condition, and it can be provoked just by doing some kind of odd movement. Maybe the person opened too wide when eating a sandwich, maybe that person was chewing too much gum, maybe that person slept in a really bad position. But over time, sometimes if you do a lot of what are called parafunctional habits, such as over chewing gum, chewing too many hard foods, that can provoke the jaw into having a lot of pain. So you can either have muscle spasms, you can have joint pain where there's actually like a clicking going on in within the joint, and so you can have even locking of the joint where the jaw will get completely stuck.

So the way to treat it is a little bit different. You know, if you have a joint condition or if you have a popping condition or if the pain is coming solely from the muscles, then you can treat it different ways. But, great options are wearing a specific night guard. So there are different night guards based on your particular condition.

And then also injections can be done into the surrounding muscles. So say the masseter muscle can have either lidocaine injections if it's like a spasm in there and then sometimes patients will even benefit from Botox into the masseter muscles. So I do get a lot of patients who have TMD and we do Botox injections a few times a year and that helps to relax the muscle, so it's not as inflamed.

And this can, again, come from within the joint, and sometimes you have to image too because you could have arthritis when they're, within there. But a lot of times, with softening the diet, eliminating gum, having the night guard, having a few injections, the patient's on a good start and good path to continue.

Host: Well for listeners struggling with frequent headaches, can you explain those various treatment options offered at your program? I know you mentioned the preventative medication and Botox, just tell us a bit more about those.

Brigitte Lovell, DMD: Sure. So we want to make sure that there's not some kind of triggering factor that's going on with a patient to make sure that, you know, their lifestyle is in check, their diet is in check, and they're not having something that could be causing those headaches. And then once we discuss that, then we need to move on to some kind of medication because if a patient's having frequent headaches, whether that be eight days a month, 10 days a month, or even 30 days a month, that's not a good quality of life.

So for those patients, we would try potentially some kind of preventative medicine to try to lessen the frequency of the headaches. And once they've tried a few different kinds of preventatives, then you can actually qualify for Botox injections and Botox is indicated for a patient who has chronic migraine, which is more than 15 headache days per month.

And the Botox is great because a patient can come in every three months and the Botox will significantly lessen the frequency and the severity of the migraine. So say a patient started off with maybe 20 headache days a month, with the Botox injections, they can expect to have maybe five to 10 headache days a month, sometimes even less.

So that can be a huge improvement for someone who's suffering a lot. And the Botox is easy to do. The, patients just come into our office there is a chronic migraine protocol that we follow. There are certain specific injection sites. And we do those every three months and the patient is much better.

And then sometimes in addition to Botox, we add on different preventative medicine. So there's a lot of CGRP, calcitonin gene related peptide, mechanism, receptor or ligand antagonists that we use in addition to the Botox. So you can have someone who is on Botox injections plus CGRP medications.

And then also you sometimes need rescue medicine. Just because you prevent a headache doesn't mean that they're headache free all the time. So you need something that's effective when a patient gets an actual headache.

Host: That is great to hear. Well, to wrap us up today, Doctor, where is your practice located and how can patients get in touch with you?

Brigitte Lovell, DMD: We are in Ventura County. Our office is specifically in Oxnard and then it's through Community Memorial Health Centers. I believe if you visit mycmh.org, so that's my, and then c cap m mary h health.org, you can type in my name, Dr. Brigitte Lovell, and that's B R I G I T T E, and last name Lovell, L O V E L L, or look through or scroll for headache or orofacial pain, you should be able to find me.

And then the phone number to call if you want to schedule is 805- 948-6353.

Host: Thank you, Dr. Lovell for sharing your expertise on orofacial pain and dental sleep medicine with us today. For those interested in scheduling an appointment or learning more about the services offered, visit mycmh.org and search headache and orofacial pain. Or call  805- 948-6353. Remember, taking action on your health can lead to a better quality of life. I'm Caitlin Whyte and we'll see you next time on Wise and Well presented by Community Memorial Healthcare.