As many of you know, dear readers, I cannot fix everyone who walks through my doors. So today I am going to make a confession about one of my personal failures. This should provide some really good fodder for my naysayers out there, especially when you read about the outcome. This patient’s story goes as follows: Motor Vehicle accident in 1999- he was rear ended at fairly high speed while stopped as a jaywalker was crossing the street. The next morning, he was unable to move his neck or back due to the injuries sustained. TMJ MRI showed displaced discs. The two neurosurgeons told him the same thing: he needed surgery- rods down the neck and back to get stability. This surgery had nothing to do with the TMJ problem so there would be more work to do is how I figured. Anyway – this patient then told me that one of his surgeons told him he looked like “one of those marines who have jumped out of a helicopter a thousand times over” when it came to how damaged his cervical and lumbar spines were. And just to make it better, one of the surgeons told this guy that even if he did the surgery, he would probably be in a wheelchair within five years.
I knew right then and there I was over my head, but I had to try and help this guy. I made the usual decompression appliance which helped a lot. Then the patient went back and forth to MANY different pain specialists –from acupuncture, to chiropractors, to nerve specialists, and more. This poor guy saw everybody you can imagine and yet never really got a lot better. Fast forward almost twenty years and this patient is still wearing a similar appliance as he had right after the accident. He ‘manages’ the pain. There are lots of heating pads, back massagers, advil, hot soaking tubs, and whatever else he can manage with.
It was quite recently that I coined the term ‘train wreck’ with patients like this. It was also at that time that I openly learned to admit that I most certainly DID NOT have all the answers! And that was when life got just a little bit easier perhaps. I knew I could not fix everybody that walked in our doors because you see, dear readers, that patient is ME! Because of an irresponsible driver nearly 20 years ago, I now suffer daily back and neck pain and have learned how to manage my case very carefully. As I sit here typing, there is a massage device wrapped around my neck and I am wearing my dental appliance to support the TM joints. I simply could not take that risk with the rods going through my back- I did not want to end up in a wheelchair. So I too am seeking answers as I go along the journey. Maybe that is what makes me so passionate about what I do. My own failure with my own case has shown me that sometimes a person has so much damage that all you can do is to manage the pain and learn to keep looking for better answers.
I must admit that one of the ‘better answers’ has been working with the osteopath doctors that I work with. They seem to have a handle on getting things lined up better, longer. It is quite interesting having this type of doctor put their hands on your head, feel the cranial pulses, and tell you that you experienced an accident years ago when you never told them anything about it. So as a patient myself, I will keep you all informed of my own personal progress. My goal is to learn as much as I possibly can about this disorder that affects millions of people and is so poorly understood. I am hoping to educate millions of people in the coming years and to give them hope!
Today is a bit different from my previous blogs. Today I am going to speak about the experiences of my oral surgeon who does the TMJ surgery for my patients when they need the disc repaired or removed in the jaw joint. His name is Dr. Eugene Gregory and he has allowed me to use his name and explain what he does in this blog. Dr. Gregory has been doing TMJ surgery for about 30 years now and he has done thousands of joints- that’s right folks, THOUSANDS. In the past month I have had 4 or 5 of my own patients who needed the surgery try to find a surgeon ‘in their plan’- well that was a disaster of epic proportions. One of them actually called 19 – NINETEEN- surgeons hoping to get a discount on the procedure. As it turns out, not one of the nineteen surgeons really did TMJ surgery, although the insurance carrier said they did. (The patient was terribly misdirected by the insurance reps…but that’s a whole other blog) Anyway, all of these people ended up working with Dr. Gregory because no one else seemed to have the experience that he has.
The problem these people had with the surgeon was that he does not participate with their insurance plan – his fee of $6500 simply is not covered. The patient has to pay him the $6500 for his services and the hospital fees are usually covered by the insurance company. I actually asked Dr. Gregory the other day how he set his fees and why insurance did not cover that fee. He explained to me that 30 years ago, Blue Cross paid him $6000 to do the surgery and they also covered the hospital fees as well. It turns out he set his fee according to what the insurance company would pay and figured that would be fine as the years go by. Well, dear readers, what actually happened was that as the years went by the insurance carriers paid less and less for the TMJ surgery and today they only pay around $1500 or so to the surgeon who participates with their so called ‘plan’. This whole thing smelled kind of fishy to me. Instead of keeping up with inflation, ever increasing fixed costs, and higher malpractice rates the insurance company has undercut the surgeon to the point where there is no logic in participating!
I can see how sensible Dr. Gregory has been about all this, but I am also a bit perplexed. He has barely raised his fee in the past 30 years! To me this is incomprehensible for such a sensible surgeon! And when I asked him why he has barely raised his fees, he responded that he was just trying to keep it as simple as possible and help the patients out. So here I am, a guy who has an MBA and lots of business background, absolutely floored that his fee is that low and yet the insurance company has cut their payment by more than 75% over these past years – and this is based on THEIR original reimbursement plan, not Dr. Gregory’s, he was just following their lead years ago and being cooperative.
The way I look at it, these insurance companies are very readily taking over how we look at health care in this country and quite honestly it makes me sad. Just the other day on Facebook I was lambasted by two people – one said their fees would be set based on insurance company current rate plans (good luck with that) and the other said we had a free market system (that comment made me laugh for a good while). What we really have is insurance companies indoctrinating our people into thinking that the insurance company is doing right by them and the doctor is the real enemy who is ripping them off. Every week I explain to the patient who needs surgery that Dr. Gregory charged $6000 thirty years ago and today insurance would only pay him around $1500 if he participated. They are first a bit shocked, then angry, then really not sure what to do. Just imagine that your salary was cut, year after year, instead of going up. If you are smart, you would go find another job. Well folks, that’s what the good surgeons have done it seems- they do not participate because there is really nothing to participate with. But then, you have to wonder, who is really making the money when insurance rates go up, up, and up every year and benefits go down?
Dear reader – did you know carriers like Delta Dental in the past paid about $1000 per year to each of their dental subscribers for their benefit plan? And today, they pay about $1500 per year on many plans. There’s something quite wrong and really rotten with this. If subscriber fees were let’s say ten dollars a month forty years ago, and today it’s more like fifty dollars per month, then the benefit should be something like five times what it was forty years ago, not just 50% more. Do the math- you are being ripped off people!
So to finish up, my conversation with Dr. Gregory was a real eye opener the other day. He has only raised his fee by less than 10% over the past thirty years. I think if I was a patient, I would be quite grateful for a surgeon like that. If the insurance companies were run by people who could actually appreciate this, they would realize that he is doing remarkable work at a fee that is fair and reasonable, but alas, that is not how they think. I guess the motto of the story is that it might be more sensible to trust your doctor more than you should trust the insurance company!
Last Thursday I spoke to three of the osteopath doctors that I share patients with. The patients had all either been through a year of treatment, had the surgery, or were pretty much done and feeling good overall – that is until I sent them to the osteopath for their final checkups. You see, dear readers, I work with cranial osteopaths every day of the week and we very carefully check to see if my patients are able to go into braces and handle the stress of the braces. Let me explain a bit more. When a patient has an archwire- i.e. the wire attached to the bracket- and it goes across the midline, across the upper front teeth, this will effectively slow down the motion of the skull and may even slow down CSF and lymphatic drainage. And this is not a good thing.
Too many of my new patients come in complaining that their pain started during the braces or shortly after braces were done. I learned a long time ago to pay attention to the patients who tell me these things. The way the skull works is that it really needs to ‘move’ at all times to keep the CSF moving, otherwise things ‘lock up’ and ‘back up’ at the same time. Think of it like this- if the drains in your house are not open and able to drain out all the crud that happens to them, they back up and you end with damage to the house. That’s what happens in your skull too- if the crud produced by the brain is not allowed to drain out, then it backs up and you end up with things like ADD/OCD/autoimmune disorders, and other not so fun things happen. Don’t take my word for it- look up the research done at University of Virginia hospital center regarding the brain and lymphatics. This is going to be huge!
And so I have digressed…apologies. Back to the story at hand. The three osteopath doctors told me that the five (that’s right, five) patients that were supposed to be ready for their braces were not quite there yet- in other words crossing the midline with an archwire would have been too stressful on their bodies. But fear not, dear reader, they would all be in good shape with another month or two of osteo treatment. At that point in time, their cranial bones will be moving quite well and they can handle the small bit of stress caused by doing the braces and we can finish up their cases.
Now is where the ominous music should be placed in the program- the dum dum dum dum with lots of drums and scary sounds because by now, some of you have just realized that maybe, just maybe, they should take a different path other than slapping on braces or those clear aligners you see on TV. Just maybe you should have someone who understands TMJ disorders take a good look at you and figure out if your body can handle doing those braces. Just maybe your body is not ready to have the cranial motion locked up for a while. Just maybe such a screening would help you avoid headaches, neck strains, cranial distortions, etc – all of which are caused by having braces put on too early. Just maybe!
When a patient goes to their TMJ doctor, it is vitally important to make sure that certain technologies are used in order to get a good diagnosis and even greater treatment! In this article we will be looking at the merits of the dedicated Tesla coil, the xrays to look at the jaw joints, the digital impression scanner, and the low level laser therapy.
When it comes to getting a really great MRI of your TM joints, it is really important to be sure that the imaging center has a Tesla coil dedicated for this kind of work because it is so sensitive and can allow us to see the articular discs much better than the old technology. In too many cases, the MRI is done with an inferior machine and the reading is simply not that precise. This will often lead to a misdiagnosis and a path of treatment that costs lots of money, time, and frustration.
Another piece of technology in getting proper TMJ treatment involves the right xray equipment. It is important first of all to go with ‘green’ technology- i.e. low dose radiation and three dimensional imaging. The 3-D imaging comes in really handy when the doctor wants to see what’s going on behind and around the corners of various bones, especially the condyle or jaw bone. This information helps when trying to correlate to the findings of the MRI: Do the slipped discs make sense and is that why the jaw bone has shifted in that direction?
A very fun and very special advancement when it comes to doing braces to finish up a TMJ patient is the digital impression system. What this system does is that it basically uses a camera to videotape the teeth and the computer effectively ‘stitches’ all the videos together to show the lab what the teeth look like, instead of the old fashioned putty and tray method. In addition, the digital impressions are so much more accurate than the putty even could be. Then, the braces manufacturer uses a device to ‘cut’ each bracket to the best fit possible for every individual tooth- this means that each bracket is custom made, by hand (the hand of a computer guided laser that is) to the proper tip and torque needed to achieve the best result in the shortest time possible. Think of it like GPS for your trip up to Canada- the computer will design the least difficult, quickest, and most efficient path to get you there.
Let’s not forget to give mention to our old friend, the computer, which has advanced so much in recent years that we have become used to it running on terabytes, not kilobytes, of storage and how fast the processors have become. Without the computer, we could not show the patient the wonderful world of digital xrays and show them how their progress has changed. The computer and all these other technologies have surely changed our world!
In recent months I have met way too many new patients who were scheduled to have jaw joint or other more extreme types of surgery to handle their pain. This is about as smart as jumping into the path of a moving bus- in other words, it’s NOT smart! I am not sure why the increase in recommended surgeries is happening, but I think it’s important to put a stop to it now. The reason for this is that doing any kind of surgery will leave scar tissue and adhesions that will restrict the motion of the body. In my own practice, doing TMJ surgery is always done as a last resort after a course of careful and thorough appliance therapy. In addition, it is very critical that if the cranial bones are uneven, then there must be a concerted effort to level them out in order that if the surgery is done, it will be so much more successful.
The idea behind waiting on TMJ surgery is actually twofold: 1) The first phase oftentimes involves taking the pressure off the jaw joint discs so that inflammation will reduce, and many times those discs will actually go back into proper place so we can actually avoid the surgery and 2) Leveling the cranial bones, lining up the cervical, lumbar, and thoracic spine are all critical to good health and longevity when it comes to doing the actual surgery.
In other cases that I am currently working on, patients were told they would need one side of their jaw ‘cut and shortened’ to make it even with the other side. Well, that’s another ridiculous approach to a fairly simple problem. You see folks, in most of these cases the jaws are just twisted to the side because the discs are pushing the jaw bones out of the sockets and all we need to do is work on relieving the pressure on those discs and the jaw will actually realign correctly.
The only time that I have ever seen the need to ‘go in’ right away and do surgery is if the patient simply waited way too long to be treated and their jaws are locked shut. This is always a difficult situation. The patient tells me that it all started ‘a long time ago’ when the jaw just started to tighten up, things started to close down, they could no longer eat a hotdog or sandwich and eventually the jaw just locked. Sometimes I can use our low level laser to loosen up the muscles to take an impression and make our appliance but sometimes it’s too little, too late, and surgery is the only way to fix it.
So folks, if you are having head/neck pain, jaw popping/clicking, or even a movement disorder, get it checked out carefully before you become a surgical case!
Let’s start 2017 in a healthy fashion and see if we can all improve ourselves just a little bit more. Did you know that the latest research in sleep medicine is indicating that we are supposed to sleep around nine hours each night?
Yes, that’s correct – nine hours. There are so many reasons for this, but in this short article we can only cover a handful.
A few decades ago researchers did not understand why human beings needed sleep – it seemed to be a leftover from our hunting and fighting period. But now it is quite clear what is going on. The human body needs to “re-charge” at nighttime in order to prepare for the day ahead.
At nighttime, our brains drain out what are called beta amyloid particles in order to stay healthy and this requires us to shut down completely. Researchers at the University of Virginia have confirmed how critical it is that these particles drain out at night, otherwise the ramifications are that we are more likely to experience such maladies as Alzheimer’s, ADD, OCD, and autoimmune problems.
This is pretty scary stuff when you realize that there are millions of Americans who simply do not get anywhere near the amount of sleep they require to stay healthy.
Another massive problem in this country is sleep apnea. Apnea occurs when the body stops breathing a certain number of times per hour and oxygen levels in the blood drop substantially. Sleep apnea is directly correlated to heart disease, diabetes, gastrological problems, and a whole host of other issues.
Just imagine, if you are not getting anywhere near those nine hours of sleep – and let’s face it – most of us do not get anywhere near the sleep their bodies need – this means you are more likely to experience these problems as the years go by.
So what is the solution? Well, first you go see your regular doctor and have the normal blood work and yearly checkup that is needed to monitor any changes that might be happening.
In some cases it is necessary to wear a CPAP device to push air into your lungs. In other cases, simply wearing an intraoral device will prop open your airway enough that you can breathe adequately without the need for the CPAP device.
Either way, it is critical that you breathe properly or else you will one day have problems.
All of this information may sound a bit scary, but it is all true. You must see your doctor on a regular basis in order to monitor your stats – blood pressure, pulse, oxygen levels, bloodwork, etc. in order to keep healthy.
Otherwise you will end up on medications, which can reduce your quality of life. So get out there, call your doctor, and do those checkups!
A number of the parents of our Tourette’s diagnosed patients ask why the TV might be a factor in their child’s disorder. Well, let’s first be clear that I am ONLY treating TMJ disorders, I am NOT treating the actual tics, it just so happens that the tics of Tourette’s are likely a comorbidity of having slipped discs in the jaw joints. What I am seeing is that many of the patients who have these slipped discs- the younger patients- tend to be hunched over their TV or computer screens well into the night, my own kids do this too, and it’s hard to stop it.
When a person is hunched over a lot- leaning into the screen, it makes their jaws come forward and this alone can make the discs in the joints slip forward too. The other issue with lots of screen time is that your body does not produce the proper amounts of melatonin in order to get good sleep and this is highly contributory to not sleeping well, of course! And when the body does not get enough rest, it can go into hyperactivity mode and this is where a lot of the tourette’s kids tend to be- they are running all over the place and simply cannot settle down. This is called sleep deprivation by some doctors that I know.
So, dear readers, think of it like this. Your child is in front of a screen day and night on those long weekends- like mine were last weekend – and by Monday they are dead tired, cannot function, are really irritable and sleep deprived. No wonder they get hyper active, but even more so when they have tourette’s as their MD has diagnosed. As most of you already know, my position on movement disorders is that the discs in their jaw joints are displaced inward- medially- so if you add on the stress of extra screen time and not sleeping well, these kids are even more irritable and cranky than ever, which can exacerbate their tics! So if you have a family member with a movement disorder, think about what they are doing to themselves- is this child ‘on screen’ all day and all night? Are they gaming all night with their best buddies on the weekend? Are they up on Friday until 2:30am Saturday like my boys were last weekend? Hmmm….what a way to make a bad thing become a worse thing!
The area of TMJ (jaw joint) treatment is so little understood that maybe it would be good to explain why there are certain doctors out there who practice in this field. First of all, it would be helpful to understand what TMJ treatment is all about. Here are some of the symptoms that would prompt someone to seek help in this field. If you have chronic headaches, it is very possible, and often likely, that the discs of cartilage that cover the jaw bones are displaced, i.e. “slipped” like a disc in your back can be slipped. As you already likely know, a slipped disc in the lower back can hurt terribly. Well, a slipped disc in your jaw joint can do the same thing.
When the disc in the joint is out of place, this can prevent you from being able to open your mouth all the way. This is a very clear indicator that you might want to talk to someone who has an understanding of this problem. If your jaw joints pop, click, or crunch when you open and close, this is another clear sign that there might be a problem. This is something that should be looked at as well.
A small subset of TMJ disorders is when the discs are tipped “inward” from the jawbone and this can cause a patient to have tremors, tics, spasms, etc. Sometimes this is directly correlated to something called Tourette’s Syndrome – oftentimes something as simple as a specialized dental appliance will take the pressure off the joints and calm down a patient who has these “tics” as they are called. This is also the same concept with Parkinson’s – uncontrollable shaking is sometimes due to those slipped discs pinching the nerves around the joint.
Did you know that a TMJ doctor can help you reduce concussions and help with sports performance? It’s true. A well-constructed and well-fitted device will protect and support the jaw joints so that if you took a hit to the head, the risk of a concussion is greatly reduced. There are a number of mixed martial artists using this new technique very effectively already. They are much more able to handle a direct hit and the device gives them better neurological stability which means better strength all around. It’s a great device that can protect athletes and help them perform better, too.
The TMJ doctor can also help with sleep disorders, as well. The way this works is that a TMJ appliance will help the muscles of the head and neck to relax and this effectively helps the airway to open more. X-rays of the airway clearly show how before treatment the airway is nearly blocked, and how a year later the airway opens tremendously, which means better nighttime breathing.
Fixing TMJ problems is not a cure all for everything, but it is most certainly something that should be looked at when the head/neck/shoulders are involved.
As many of you already know, I see a lot of patients who are afflicted with Tourette’s Syndrome. This is truly an awful disorder- the patient can be blinking their eyes nonstop while their whole body twitches and shakes and the whole thing can be both embarrassing and painful at the same time. Tourette’s is difficult at best to deal with, but I think I have some ideas that might give a little insight into this terrible disorder. In the last two weeks, two of my patients, both adults, have had the micro surgery to put the TMJ discs back into proper position. The results were nothing less than miraculous according to the patients. The first one, we will call him Bill, did not even take the morphine drip that was offered post surgery because he felt no pain at all. But the good thing was that when he came back to my office to be checked, his tics were 60-70% gone (and now they are almost completely gone he told me!). And he then told this other guy (who also had Tourette’s) what he went through these past weeks so the second fellow did the surgery yesterday and came in to see me today. When I saw the young man, he only blinked heavily a couple times compared to constant eye wrenching and twisting- it was amazing to see. But more importantly, the spasms of his chest and stomach were over with.
As it turned out, the second patient had a totally perforated disc on one side! In other words, the surgery was beyond necessary and not just to attempt to repair the discs- there was serious damage in that joint and it needed immediate repair. Just imagine if your knee caps were way off to the side and you wondered why it hurt so bad every time you took a walk- well, this guy’s disc was literally blown apart on that side and it needed to be repaired. No wonder he was hurting so badly!
Now, dear readers, let’s get into something that is beyond coincidental, beyond what any of us has ever believed, understood, or even surmised over the years. In both these Tourette’s cases, the discs in the joints were tipped medially or inward. As a doctor, I am making a fairly bold statement here. I am stating that categorically when you have medially inclined discs, the likelihood of a movement disorder is likely higher…likely that is. (Sorry, like I could not resist that one) So what this means is that I am attracting movement disorder patients who ALL seem to have medially displaced discs! Or is it that patients with movement disorders actually, in reality, have articular discs that are medially displaced? That seems more likely, doesn’t it?
Anyway, I am so excited to bring this concept forward, and at the same time a bit sad too. You see, dear reader, I see so many patients with movement disorders and many of them have been misdiagnosed terribly. You need a great MRI and a great radiologist to see that the discs are tipped medially and I just don’t find too much of that happening in the real world. Because all I do is TMJ work, I am lucky enough to have the best radiologist working with me on reading the MRI’s so I admit that I might have the advantage here. This concept on the medial displacement is holding to be true in ALL cases that I see when there is a movement disorder here. Quite seriously, it is not at all likely that I attract patient with medially displaced discs. However, it is more likely that I attract patients who have movement disorders and I am lucky enough to have the tools in place to identify what is going on with them. As time goes by I hope to write a paper on this concept, but in the meantime I will just keep plugging along taking care of one patient at a time.
In the field of health and medicine, there is a lot of new research that health care practitioners need to pay attention to, especially the research that came out of UVA Hospital last year. This research, according to the reports, is about to change medical textbooks across the globe.
Basically, it confirms that the brain has a lymphatic drainage system. What this means is that for years it was believed that the brain did not have a system in place to drain out the debris, i.e. the ‘crud’, that builds up each and every day from normal use. Now researchers have proven that the brain does indeed have a lymphatic drainage system and that if it does not drain at night, then beta-amyloid particles can build up and lead to such debilitating problems as Alzheimer’s, autoimmune disorders, ADD, and OCD.
As an advanced lightwire functional device (ALF) dentist, the importance of this research is amazing. The ALF appliance is designed to open the airway, properly posture the tongue, and develop the face forward growth required to keep the cranial structures moving properly and in good health. This appliance is the only dental device that promotes good cranial motion, which is required to pump cerebrospinal fluid (CSF) and to keep the lymphatic system draining better at night. All of this is what helps keep the body as a system in good shape. Think of it like a well-tuned automobile – the oil flows well to keep the engine well lubricated and running at peak performance, just like all the fluids in the brain flow better when there are less restrictions.
The ALF appliance is made of a specialty wire from Elgiloy aerospace – the makers of some of the most high-tech wires in the world. The wire is actually activated by the patient’s own body heat and tongue pressure. It is adjusted on a monthly basis in order to be sure that it stays level in all dimensions, which promotes levelness of the cranial bones. In order to achieve the best result with the ALF appliance it is often necessary to work with an osteopath doctor to further assist in the leveling process. The results are often amazing when comparing x-rays only one year after treatment begins.
A good way to tell if you or a loved one is a candidate for the ALF is to simply look at the person. If the eyes/ears/eyebrows are not level, then likely the cranial bones are having some kind of distortion issue and could use the help. The ALF is also an amazing tool in reducing head and neck pain – think of it like this: it promotes better cranial motion, sort of like doing exercise, so it gets things moving and pumping and feeling better overall. It is great for both young and old because it gets things moving like Mother Nature intended all along.
Snoring is to obstructive sleep apnea (OSA) as thunder is to lightning. They may, but not always, appear together. One may be just an annoyance, but the other may be the precursor to serious trouble. The pathology of snoring is the same as for OSA, but not all people who snore have sleep apnea (although it is the most noticeable symptom).
Snoring is associated with an increased risk of hypertension as well as an increased risk of both cardiovascular and cerebrovascular disease. The percentage that a person snores has been directly related to the prevalence of coronary disease. In other words, the more one snores, the greater the risk for stroke.
With OSA, muscles of the soft palate at the base of the tongue and the uvula (the small, conical, fleshy tissue hanging from the soft palate) relax and sag, obstructing the airway, making breathing labored and noisy. Collapse of the airway walls can block breathing entirely.
When breathing periodically stops, a listener hears the snoring broken by pauses. As pressure to breathe builds, muscles of the diaphragm work harder. Sleep is then temporarily interrupted, sometimes only for seconds. This, in turn, activates throat muscles and “un-corks” the airway.
A listener hears deep gasping as breathing starts again. With each gasp, the sleeper awakens, but so briefly and incompletely that he does not remember doing so in the morning. Someone with obstructive sleep apnea may stop breathing for ten seconds or longer – dozens, even hundreds of times each night.
Each time breathing stops, oxygen in the blood stream falls and the heart must work harder to circulate blood. Blood pressure rises and over time may stay elevated after breathing restarts. The heart sometimes beats irregularly and may even pause for several seconds. This may account for some deaths during sleep of people who went to bed in apparent good health.
How Do You Treat Sleep Apnea?
The dental solution to treating obstructive sleep apnea is to utilize a comfortable, removable oral appliance. The oral appliance is an articulated elastomeric mandibular advancement appliance. This dental device is designed to allow the advancement of the mandible through a controlled range of forward movement, while at the same time allowing for a limited amount of vertical and lateral movement of the mandible. This type of appliance has proven extremely effective in treating snoring and sleep apnea.
There are three component materials in this type of sleep appliance. The body of the appliance is constructed of elastomer, a pliable material that offers the patients a much greater degree of comfort than harder acrylic materials. For additional support to the teeth as well as the temporomandibular joint, hard acrylic “bite pads” are placed in the molar regions. A commercially pure titanium articulating component grants the appliance the many adjustment characteristics that make this appliance unique – it is kind to the tissues, the teeth, and the temporomandibular joint.
These unique oral appliances are now a great choice for those who suffer from snoring and/or have mild to moderate OSAs. If you think you suffer from OSA, don’t hesitate to call a dentist specializing in sleep and TMJ therapy to schedule an evaluation. You’ll be glad you did.
Part I: TMJ refers to the temporomandibular joint, which is the joint that your jaw hinges and moves within. On top of the jaw bone is a little piece of cartilage-like tissue called a “disc”. When that disc is out of place, it is not unlike having a slipped disc in your lower back. If you had a slipped disc in your lower back, that would make it very clear as to why you might have back pain, sciatica, or even pain in the lower extremities. Well, a slipped/displaced disc in your jaw joint is exactly the same thing – it can cause headaches, neck/back pain, and even movement disorders like Tourette’s
Unfortunately, the TMJ (jaw joint) is perhaps one of the most misunderstood joints in the human body. In dental school, it is pretty much ignored except for teaching how to make a night guard. In medical school, they tell the students to leave it to the dentist – it’s their territory.
Dealing with the TMJ is quite often a cross disciplinary type of treatment. When the discs within the joints are displaced, patients oftentimes don’t really understand where the source of their pain is coming from. All they know is that their neck and back hurt and do not correlate that to the popping and clicking in their jaw joints. All that popping and clicking, however, is how Mother Nature gives out a warning sign of danger ahead to deal with it before it gets more serious. Once again, unfortunately for us as human beings, we go to the doctor and there is really no standard of care on how to treat this problem that can be very debilitating.
One of the best diagnostic tools to determine if the discs are indeed displaced in the joints is an MRI of the TMJ – a wonderful device that simply uses magnetic imaging to see the discs. The discs in the joints can be slipped in three different directions.
When the disc is slipped forward or anteriorly, it is kind of like if your knee cap was slipped forward of the knee – this can really hurt. With anterior displacement, the disc is actually stuck in that forward position, causing popping/crunching sounds.
When the disc is displaced laterally, or outward, this is more difficult to deal with than the anterior displacement. When the disc is not “reducing” (does not go back into place when you open your mouth), it is quite difficult to fix.
The other type of displacement is medial displacement. This occurs when the disc is squished inward toward the brain. This is the most difficult problem to fix. In many movement disorder patients, medial displacement seems to be the diagnosis.
Dealing with displaced discs requires wearing an oral device in order to decompress the jaw joints, which effectively gives the discs a chance to get back into proper position naturally. In fact, this technique is capable of reducing headaches, migraines, back/neck pain, and even movement disorders when done properly.
To be continued… next edition: Treatment Options.
So many people have TMJ disorders and they are suffering pain on a constant basis and this prevents them from leading a fulfilling and happy life. Let’s face it people, if you are hurting all the time, you are not going to be able to sleep as well as you should, and quite honestly you are not going to be all that pleasant to be around. Let’s get into why the jaw joint is so important to looking and feeling good!
Did you know that slipped discs in the jaw joints directly correlate to sleep apnea? That’s right, if your TMJ discs are out of place, you are more likely to clench and grind your teeth at night. All that clenching and grinding tightens up the muscles of the head and neck which means your airway becomes narrow and this is one of the causes of sleep apnea. With many of the patients who have an underlying slipped disc issue, when that problem is addressed, they feel better and sleep better. Sleeping better means your body can heal more effectively due to the production of more nitric oxide, so you can smile more the next day!
Another reason why the slipped discs can make you frown is that when those little discs are out of place, they cause imbalances in the cranial bone system. What this means is that if the discs are not in their proper place, the jaw bone works unevenly- kind of like if the front end alignment is not quite right in your car- the tires will wobble all over the place. Well, the jaw joints are the same; when the discs are out of place it will wobble around and this will affect how the bones in your skull react to the stress of that wobbling. In other words, the slipped discs cause an uneven pulling effect on your bones and can twist them out of shape. This will cause the bones to look uneven on an x-ray and this is a telltale sign something is amiss. When a person’s face is asymmetrical, this is perceived as being less beautiful compared to a person whose face is nice and even all around. We really do judge each other on appearance and this is something no one really talks about, but uneven faces are simply not as pretty as the face that is level.
Maybe it is a bit presumptuous to say we judge each other on our looks, but when you meet a person the first time, that is oftentimes all you have to work with. Research confirms that we are more attracted to a beautiful face, maybe it’s being prejudicial but after all – we are all human beings and we judge each other every day. So the bottom line is this: Get your TMJ happy and you will be happier too!
As most of you already know, I deal with many Tourette’s cases every day. These are such difficult cases that some of the other doctors I know have quit taking them on due to the simple fact that they are tough to ‘win’ the game when it comes to dealing with tics. I believe the reason for this is that the articular disc- the little bit of cartilage that covers the jaw bone- is displaced medially and this is really difficult to repair. What this means in English is that the little disc is jammed to the inside of the jaw bone- not forward or outside- but into all that muscle, blood vessels, and nerves that reside on the inner side of the jaw bone.
Just a moment ago, literally 60 seconds ago, I checked on a young fellow who had Tourette’s ALL HIS LIFE! Until now… of course. Today he came in to see me to check his appliance and there was no sign of any tics whatsoever. He had the surgery a year or so ago and Dr. Gregory found the discs were tipped in medially, as we have come to suspect in all movement disorder cases. Well, Dr. Gregory ended up having to remove the badly damaged discs, and here we are a year later and this young man now has a life. He is thrilled beyond what any of us could have imagined and at last visit, his mother was brought to tears when we told them the risk part was over with and he could eat normally and go back to a real and normal life. Just imagine being 27 years old and the pain, the humiliation, the shunning is now all gone and you can blend in with others whenever you want and no one feels sorry for you or treats you like you have something wrong with you.
As Ferris Bueller once said, and I’m sure I am paraphrasing here- sometimes you just have to step back a little and look around. Well folks… that is what I have done the last couple years because I see so many people with movement disorders. I can now state that approximately 99% of the patients that I have treated with movement disorders have medially displaced discs in their jaw joints. That is a really high percentage, wouldn’t you say?
Every day of the week I am critiqued for not writing papers and doing research on what I do. Just like my mentor, Dr. Stack, what I have learned is that there just is not enough time in the day to do it all. There just is not enough time to study and put it all together into a research article. Maybe one day. But until then I will keep observing and commenting. Besides, these blogs aren’t too bad a venue to tell you what is going on, are they?
Although I am not able to diagnose over the phone or over the Internet, I can get a good handle on a person’s situation just by talking to them. And even though I got the information third hand, I can still really get a decent idea of what is going on with someone’s case. Just recently my team was asked that I give an opinion over the phone and all I could say was “No, that will not happen” as it is inappropriate and unethical at best. This is why I am asking anyone who contacts my office not to pressure me into giving advice without seeing you first!
I can say, however, that if you are missing many teeth this will inherently ‘collapse’ your bite and may lead to some serious breathing issues. I see these kinds of cases too frequently these days. Let’s imagine that as a teenager, many years ago, you went to your dentist and he or she found a pile of cavities in the teeth and instead of filling them, just pulled them out. Well, dear readers, what will happen is that the teeth will collapse inwards and start to close the gaps between the teeth as things ‘dip’ inwards. This will cause the palate (roof of the mouth) to become smaller and on the lower jaw as things tip backwards, there is less room for the tongue. And guess what this contributes directly to? Sleep Apnea! You guessed it – if you yank out too many teeth, the upper and lower jaws (the arches) will inherently collapse and this closes down the throat, closes the airway, makes less room for the tongue and you can no longer breathe as well.
So please DO NOT have your dentist pull out teeth unless you absolutely have to! You will likely pay a price for those missing molars one day.
This is not exactly a Freddie Krueger story but it was similar, and it happened only a few months ago. I had a new patient here who simply could not cut his fingernails – it was simply too painful he said. He told me that every time he tried to cut his nails, the pain was terrible. The nails were not quite as long as the star’s nails from ‘Nightmare on Elm Street’, but they were pretty close.
So when I first met this young man I noticed he had some speech issues- his voice was just a bit slurred. He also reported not sleeping well. The MRI showed slipped discs – medial displacement in fact on both sides, and you all know how this correlates to movement disorders. The plan was simple: install upper and lower ALF appliances and see if we can get things to loosen up over time. Well, it seems to be working folks- when he came in the other day, he had already cut his nails down to what we would call an ‘almost’ normal length- sure, they were a bit longer than the average guy, but nothing like they were before. The funny thing is when his mother asked him why he cut his nails, he responded “I felt like doing it” and that’s when she winked at me because she knew the ALF appliances had done this.
What the ALF does is that it promotes better cranial motion- i.e. it gets the skull bones moving again. And when the bones move, the cerebrospinal fluid and lymphatic system all work better. There is now a lot of research going into the concept of ‘neurotensegrity’- the concept that by putting a slight stress onto the neurological system, the body can thrive so much better. It’s like with grapes on the vine- the best wine grapes are made from slightly stressed grapes- i.e. they have to grow on the side of a hill, not a lot of water- they have to work for their survival so they are more likely to thrive by being slightly stressed. It’s a very interesting idea, isn’t it? There is another term called ‘biotensegrity’ which is quite similar- the biologic system is slightly stressed due to the presence of the ALF’s so the whole body tends to work better because motion is stimulated. And let’s face it… we ALL need more motion in our lives!
And now since I am on a roll, might as well tell you about another story that might seem hard to believe, but it is so very true. About a year ago I met a nice young man who had severe pain all over his body. Well, the real interesting part of this is that he had terrible pain in his hair- YES, that’s right, his hair hurt all the time. So when I met this fellow, he had long hair because it simply hurt too much to brush it, wash it, or even cut it. Today, a year later, he now shows up very well groomed and told us he feels so good that he can actually cut his hair without worry. Go figure- that little ALF appliance gave him back his ability to groom!
Dear readers, as you can well imagine some of this may seem rather ridiculous to you, but I assure you all my words are true! I have seen many remarkable transitions occur because of the ALF appliance- from reducing brain fog to stopping fingers from trembling. All of this is likely due to simply getting things moving and working like they are supposed to- this is what the ALF is all about- getting nature working like she is supposed to. The body is actually quite remarkable- it will heal if you simply give it a chance, and that is what the ALF is all about- giving the body the opportunity to heal itself!
In our ongoing series of true stories and events, even this one surprised me recently. I met a young woman who goes to college nearby and she told me that a few years back she had her “jaw cracked” and “reset” more forward. What she had done was an advancement of the upper jaw and the lower jaw as well. When I met her, she was in terrible pain and her face was a bit distorted. So, of course I ordered my usual MRI of the TMJ’s. What I found was prominent displacement of the disc laterally on one side and just moderate displacement of the disc on the other side. This is a most serious matter when such displacement occurs. The interesting thing is that her teeth were pretty and straight- unfortunately!
As many of my readers already know, those slipped discs have caused a lot of problems for this young lady- mostly pain, but also the facial distortion as well. I truly wish that I had been on the team of doctors taking care of her a few years back because I think many of these issues could have been prevented. By first determining if the joints are healthy, only then would I recommend doing any type of jaw advancement surgery because the joints need to be healthy enough to handle the trauma of the surgery.
So, what happened here? Basically, imagine if you simply dragged your upper and lower jaws forward. Go ahead- pull your jaws forward and see how it feels. Not great, is it? Well, that will effectively ‘pinch’ the disc in the jaw joint and it might cause it to pop out of place which is possibly what happened in this case. Since I was not there to plan the case, I cannot be 100% sure of what happened. There is also the chance that this young person ‘messed up’ after her surgery and began doing activities way too soon which would have damaged the joints. So there is no way to really ‘pin this’ on someone as they say.
Now what do we do to fix the problem? In this case, the ALF on the upper jaw and Gelb on the lower. This will effectively give the discs a chance to go back into place while the cranial bones start to level. We also will do x-rays and if they show distortion of the cervical spine, which I already suspect will be seen, then we will use an osteopath doctor to work on these distortions as well. This work will take at least a few years and many appointments to get the job done, but all I can say is that I am so very glad that she came to see me since this is what I do all day long!
As we enter 2017, many of us are going to make their New Year’s resolutions- like going to the gym, losing weight, taking better care in general. Well, why not go a step further and help yourself reduce the chance of more serious conditions like heart disease and diabetes? What I am talking about is that if you snore, do not sleep well, wake up a lot at night, then you may have a dangerous condition called sleep apnea. As it turns out, many people these days suffer from this problem and don’t even know it!
One of the best ways to figure out if you have any sleep issues is to ask your spouse, your parents, or anyone in the house who might be able to hear you at night. Generally, when we ask a patient if they snore or wake up a lot, they really don’t know for sure. It is more often the husband, the wife, or the parent of the child who really knows what is going on. Another interesting way to follow your sleep patterns is to use a special ‘App’ on your phone that can record snoring and track restlessness. The fit bit can also track your sleep patterns as well- it tracks motion so if you are a restless sleeper, this may be an indicator that you might want to be checked more thoroughly.
If there are any signs that sleep is not going well, you should talking to your physician and maybe a sleep study would be indicated. This is a relatively simple procedure where you show up at a sleep center- the one that we use looks like the Ritz Carlton as you walk through the doors! Once there, you will get your pajamas on and the crew will put wires all over you to track the electric signals while you sleep. You will sleep in a king sized bed, have a private bathroom, and there is a big screen TV to watch your favorite shows while you relax- not bad!
In the event that your doctor discovers an apnea problem, you may need to wear a CPAP to help you get air in your lungs. But another issue with apnea may be that the jaw joints- the TMJ’s- are out of place. It is not a well understood field, and more research certainly needs to be done, but as it turns out, most sleep apnea sufferers have an underlying jaw joint problem- i.e. the discs are slipped out of place in the joints. The slipped discs cause an inherent irritation to the muscular system which in turn may cause tension in a person’s throat and this can close down the airway.
One of the best treatments to actually fix apnea has been through the amazing ALF appliance. It actually opens the airway and improves nasal breathing which is healthier than mouth breathing. So for better health this year, learn more about your sleep!
Last weekend I was in a most excellent advanced orthodontic program and had a great time learning, however, all the fun was dashed away when I started to talk to some of the dentists there and how they were faring. One of them was very happy to report that he was booked up for months on end and could not fit in another patient if he had to. My response to that was not the usual: Way to go! My response was: What insurance companies do you participate with? As it turns out, this guy participated with Delta dental, and so did a number of the other dentists at the conference. When I asked how much they have to discount, they all responded the same: around 40-60%. I was floored! I was shocked!
Dear readers, if someone told you that you would be paid 40-60% less than you were paid last year, how would you feel? Upset? Angry? Would you feel like one of the deplorables? I sure would! So when I got over the shock from these doctors telling me all this, I asked them if it was worth it and if there were any alternatives. One of them said retirement would be their only solution. Another said there was no way around it because they lived in a small town. Someone else said it’s time to find a new profession. In other words, the insurance companies have now clamped down so hard on these dentists that they see no way out- they have to discount their fees so very much just to stay in the game. And that’s a shame!
What this means is that these dentists will never be able provide Christmas bonuses for their staff members, or for themselves. This means these dentists will not be able to upgrade equipment and improve their training and services like they used to be able to do. What it means is a slow and steady decline in the quality of care they are providing to their patients. And that is the real shame of it all! Let me give you an analogy. These discount programs are kind of like eating at a fast food restaurant- sure, you save money, but your health is slowly being eroded over time because there really is no value to what you are eating- and we all know this to be true! So what happens in the future? Who is responsible for the erosion of the dental health care in our society? Is it the government, is it the insurance companies? Or are WE, the subscribers to the insurance, the ones who should be criticized for choosing the cheapest option?
In a strange new world where we are all required to pay more, get less, and are forced to cut corners, should we be forced to cut back on our oral health? That is a decision to be left for the politicians I would guess, but my feeling is that they are probably the worst ones to make that choice!
In an attempt to make my dear readers more aware of some great medical research, I dedicate this blog to crud: sludge if you will, or better yet let’s call them what they are: Beta Amyloid particles. You see, I’m not into technical stuff very often so I believe it makes more sense to refer to Beta Amyloid particles as what they really are: just plain crud. Crud is the stuff that accumulates as waste material during the course of the day from normal brain functioning. Just like most systems, waste builds up, and at night time that crud drains from your brain via the lymphatic system. Oh, some of you are going to say there is no such thing in the brain, but let me say ‘au contraire, mon ami’ – some incredibly brilliant researchers at the University of Virginia (much smarter guys than yours truly) last year confirmed it- the brain really does have a lymphatic system that drains crud out at nighttime.
And just to add a little to the mix, if that crud does not drain out at nighttime, this directly correlates to the incidence of ADD, OCD, autoimmune disorders, and Parkinson’s. That’s right, if you don’t drain out the crud, you can become quite damaged. Don’t take my word for it- the new research is quite available if you just look around a bit. Now it’s time for a very slight leap of faith. Last year several of the cranial osteopaths that I work with told me that the little ALF appliance that I use is the ONLY device out there that promotes good cranial motion. What they are saying is that the ALF gets things flowing and helps get the crud out of your skull. Maybe this is a really good thing? The answer is categorically YES!
So as a dentist who uses the ALF every day of the week, do I see this happening? Most definitely. Case in point: our friend from New Jersey who came to me a year or so ago had severe ‘brain fog’ as he called it, could not sleep, could not even go to school. A year or so into ALF therapy he has his life back, sleeps well, can drive a car again, and is back in college. And now my speculative and not-so-scientific conclusion: I helped this fellow by unclogging the drains so the crud could get out and things were able to flow normally again. And that is the concept behind what I do- I’m a plumber basically and darned proud of it!